MMR Vaccine Debate

MMR Vaccine Debate: Another Dose

(Private Eye Jan 2001) www.private-eye.co.uk

IT IS to be hoped that the department of health’s emergency summit conference to try to restore public confidence in the MMR (measles, mumps rubella) vaccine this week takes on board the lessons of the BSE inquiry and the government drops its claims to have all the answers. It clearly does not.

It is also to be hoped that in its continuing efforts to overcome doubts about the safety of the triple vaccine it stops making claims — as it did last weekend — that do not stand up to proper scrutiny.

For example, parents were no doubt relieved by the department’s announcement that a huge study of l.8m children and adults over a 14-year period in Finland had found no links between the MMR vaccine and autism. It sounded pretty conclusive... except the claims being made about the study’s findings were complete nonsense.

Indeed, they add nothing to the current debate on MMR: whether it could be a factor in the massive increase in cases of autism recorded in the last decade— Wakefield, in West Yorkshire, for example, records a 22-fold increase from five to 111 children with autism in just seven years.

Firstly, the Finnish researchers did not in fact study all l.8m children. They relied on "passive reporting" by doctors of specific adverse reactions to the vaccination: a bit like our own unreliable yellow card system which relies on doctors to make the link. At best, experts largely agree, this picks up only 10 percent of incidents.

Then, the adverse reactions that were being looked for — sudden death, fits, allergic reactions, neurological disorders and the possibility of chronic disease such as rheumatoid arthritis and diabetes —did not actually include autism or any symptoms associated with it. Because the search for adverse reactions largely concentrated on a three-week period after vaccination, the slow deterioration and detection of autism would anyway have been missed by the study.

In fact long-term follow-up only involved the 173 potentially serious reactions identified by doctors and researchers, the most serious of which was encephalitis. Even then researchers did not look to see if all of these children went on to develop autism. As evidenced by another paper by the researchers, they looked for autism in only 31 cases. Those were children who had suffered severe gastro-enteritis within days of the vaccination. But since no one has ever suggested that immediate acute gastro-enteritis symptoms were an indication of anything to do with autism, it is perhaps not surprising that none of the 31 developed autism.

So though the Finnish paper reports that it found no link, as the authors now admit they were not specifically looking for one.

As a strike against the second study by Andrew Wakefield, of London’s Royal Free hospital, which cast doubts on the vaccine, it singularly fails.

Wakefield

In a review of all the research into the vaccine, Wakefield, supported by experts in medicine safety, questions the swift decision to license the product in 1988 because it was never subjected to adequate testing; because the follow-up data was collected over too short a period; and evidence suggesting that the vaccines can interact with each other and the child’s immune system was not properly investigated.

We also now know, thanks to the BSE inquiry, that at the time the authorities responsible for medicine licensing were over-stretched, understaffed and in chaos.

It was of course Dr Wakefield who first questioned whether there was a link between MMR and a particular form of regressive autism which he found associated with rare inflammation of the bowel. His highly controversial study was published in the Lancet in 1998. Although he stressed he was not anti-vaccine and was careful not to conclude that there was a link — only that the area needed exploration — both he and his work were rubbished by the government and the scientific establishment.

But two more pieces of research that the government always quotes to allay people’s fears and to prove that Wakefield is barking up the wrong tree, are —just like the Finnish study — inconclusive.

The main one is a study by London professor Brent Taylor, which detected a sharp rise in the number of children with autism in north London but suggested the upwards trend began before 1988, when MMR became a routine vaccine. That study has since been criticised for not making clear that it included older children in a "catch-up" campaign, which might explain the earlier start of the increase in autism.

The second is one that the committee on the Safety of Medicines carried out itself, involving families who believed their children had been damaged by the vaccine. The committee did not look at any medical records but relied on questionnaires from GPs, less than half of whom had bothered to reply. The committee concluded it was impossible to prove or refute suggested associations between MMR vaccine and autism or inflammatory bowel disease, because of the nature of the information. Nevertheless the department of health claimed the study showed there was no evidence to support causal association.

Since then, however, events have moved a little in favour of Dr Wakefield’s theories. Professor John O’Leary, a leading pathologist, has found the measles virus in 24 out of 25 of Dr Wakefield’s autistic or bowel-diseased patients — and in only one of his control group. A research group in Japan has also found the measles virus in the blood of three of Dr Wakefield’s patients, which they say is consistent with the genetic fingerprint of the strain used in the MMR vaccine.

This still does not prove the link but it underlines Wakefield’s demands for more research and for caution. We are also facing — what the government seems to be slow in recognising — a steep and so far unexplained rise in autism in the last few years; not only in the UK but in countries like the US and Finland. No comprehensive figures for the UK are available. But in some areas, like Cambridge, researchers have found one autistic child per 173. An even higher figure emerges from a local education authority report in East Surrey. Among boys, the figure rises to one in 69. Yet the Oxford Textbook of Psychiatry in 1988 suggested the incidence in 1985 was only one per 2,500.

Diagnosis

Some experts believe the increase may simply reflect better diagnosis. Others suggest the increase is too dramatic and too sudden and that there may be some external trigger. Research is already underway to see, for example, if there is a link between viral infections in pregnant women and autism in their children.

But the increase also happens to coincide with the introduction of mass MMR vaccination. That again does nothing to prove any link. But some experts clearly believe MMR may well be a factor. The parents of more than 2,000 children are also convinced their sudden decline so soon after vaccination is not a coincidence. People like David Thrower, who says: "I watched my son descend from a perfectly normal 14-month old to a mentally handicapped 16-month old. At 14 months he could post square bricks through square slots. Today at 13 years, he still cannot. Did I miss some other major but mysterious adverse event in his development? And why was such an adverse event at exactly the time of his vaccination?"

Many parents are now consulting their lawyers with a view to suing the manufacturers of the vaccine as a desperate attempt to get at the truth. But shouldn’t a government, burned by the BSE debacle, proceed with caution instead of berating conscientious parents and preventing them from giving their children separate doses of vaccine — if they believe it to be safer? After all, just in case Wakefield and co are on to something, the costs involved in administering separate doses are only a fraction of the costs of care for the alarming number of our children who now have autism and related conditions.