Once a month, a parent of a 12-month-old baby will come into the clinic and ask: “Do you think the MMR really is safe? Maybe I shouldn’t vaccinate my child, what do you think?”
Despite the years that have passed since the MMR debacle first broke, it still carries enough of the unknown for vulnerable parents (and all parents are vulnerable when it comes to information or misinformation about their children) to make some think twice.
MMR is a vaccine for the measles, mumps and rubella viruses. All three used to be common childhood illnesses in the west and remain common in Cambodia. Usually they are fairly mild infections but all can have serious complications. Measles can even be fatal, and can cause serious pneumonia or encephalitis (brain infection). Mumps in an older child or adult can cause male sterility or encephalitis, and rubella in a pregnant woman can cause significant abnormalities in her baby. The MMR vaccine was introduced in the United States in 1971 and in the United Kingdom in 1988.
Media publicity and misinterpretation of the science presented in a paper by Dr Andrew Wakefield and 12 other authors in the British medical journal the Lancet in 1998 led to a massive crisis of confidence in the vaccine in the general public and a huge decline in uptake of the vaccine. As vaccinations fell well below the 95 percent level needed to exclude measles from the general population, outbreaks erupted across Britain and other countries, notably Japan and Israel. The first child to die of measles in the UK for 14 years was a 13-year-old in 2006. Since then there have been thousands of cases worldwide. In the UK the disease is now endemic, with more than 1,200 cases in 2008. Of approximately 164,000 deaths globally, more than70 percent are in Southeast Asia.
Wakefield’s research paper claimed to find the measles virus in bowel biopsies from children with autism who had received MMR. The authors claimed that this proved a link between MMR and autism. Many other researchers failed to replicate his findings in much larger, more reliable studies, and a detailed investigation by Sunday Times journalist Brian Deer showed that Wakefield had falsified much of the information in the original paper. In 2004, 10 of the paper’s 13 authors retracted claims of a connection between MMR and autism and the Lancet journal itself fully retracted the paper in 2010. Wakefield was struck off the UK medical register in May 2010 after a long investigation by the General Medical Council, the UK’s medical licensing body.
This clear evidence of how science can discredit all Wakefield’s claims should be enough to convince the media and parents that there is no link between MMR and autism. It is perhaps possible to understand how a scientist could get carried away by his ideas and research and exaggerate or even falsify his results to prove a point, but Wakefield appears to have been motivated by far more than scientific drive to prove his research ideas, which ought to be enough to dispel any lingering doubts.
At the onset of his MMR research in 1996, Wakefield was paid a retainer fee of thousands of pounds by a legal firm that hoped to launch a class action against the MMR manufacturers. The money was for Wakefield to conduct research supporting the claims of litigants against the manufacturers of MMR. When eventually publicly disclosed in 2006, it was eventually revealed to be a cool £435,000.
Hundreds of thousands of pounds were also paid from these public legal aid funds to the hospital Wakefield worked at to support his research, another clear conflict of interest.
And it gets even worse – in 1997 Wakefield filed a patent on a single measles vaccine. After the Lancet published his research paper, he gave a large press conference at which he extrapolated his bogus results to suggest that MMR had a link to autism. He added that he recommended people to use the single measles vaccine (which he had patented the year before) in preference to MMR. I still get requests from parents for the single measles vaccine today.
So when I get asked this question at the clinic, I take a deep breath, check the time, and try my best to explain that yes, MMR is an important vaccine and why, and to give a brief summary of how bogus research combined with unethical financial incentives ignited a media firestorm that still creates doubt, fear, and wholly avoidable death and disability, even today.
Reference: British Medical Journal 15 January 2011, 342:115-178
Dr Laura Watson specialises in women’s medicine. She is the deputy CMO at the International SOS clinic in Phnom Penh.