According to the Minnesota Department of Health, a recent outbreak of measles in the Twin Cities area was caused in part by former doctor and medical researcher Andrew Wakefield’s influential but fraudulent study suggesting a connection between child vaccination and autism.
The outbreak, concentrated in a community of Somali immigrants, put four children in the hospital. Several of the parents informed the Health Department they had avoided the mumps, measles, and rubella (MMR) vaccine out of concerns their children would be at risk of autism.
Unfounded Vaccination Fears Persist
Wakefield’s 1998 paper has since been renounced by 10 of its 13 coauthors and was retracted earlier this year by the medical journal Lancet, where it had been published. British journalist Brian Deer found despite the claim in Wakefield’s paper that the 12 children studied were normal until they had the MMR shot, five had previously documented developmental problems. He also concluded all the cited cases had been altered when he compared data from medical records and the children’s parents.
In some communities, immunization rates for MMR have not recovered since Wakefield’s initial report, notes Steven L. Salzberg, director of the Center for Bioinformatics and Computational Biology at the University of Maryland.
“Even though Wakefield’s original study has been discredited, and dozens of much larger studies have disproven all supposed links between vaccines and autism, many members of the public still think there’s a link, and countless parents are refusing to have their children vaccinated,” Salzberg said.
“We need to continue to repeat the message until everyone gets it. Otherwise, we will see the return of preventable diseases. In fact we are already seeing it, as in the whooping cough epidemic this year in California,” he added.
Shoddy Peer Review Blamed
William Schaffner, chair of the Department of Preventive Medicine at Vanderbilt University, says the original Lancet paper did not receive appropriate peer review.
“If the paper had received rigorous peer review, it might never have been published. The original paper had numerous coauthors, almost all of whom have disowned it by now, but at the time they were not sufficiently critical or incisive [toward] their own work including the contribution from Wakefield,” Schaffner said. “Further, the Institutional Review Board of his institution seemed not completely aware of what Wakefield was doing. All of these factors contributed to this unfortunate circumstance.”
Children at Risk
Despite the paper’s retraction, continued advocacy from anti-vaccine groups needlessly puts children at risk, Schaffner notes.
“The situation is distressing. Whether inept science or, as alleged, deliberate fraud, the Wakefield paper and its subsequent publicity have set in motion a snowball of vaccine skepticism,” Schaffner said. “In Britain this has resulted in many parents withholding vaccines from their children, which has led to outbreaks of measles. Hospitalizations and deaths have occurred—all preventable, had the children been immunized. In the U.S., some parents withhold vaccines; others stretch out the vaccination schedule, leaving children susceptible to disease for longer than they should.”
Schaffner says he’s concerned parents who missed the press coverage of the study’s retraction will fail to vaccinate their children and continue listening to advocates whose concerns are not founded in science.
“With the exception of a relatively small group of Wakefield diehards, the issue of vaccines and autism has been decided scientifically with complete security. There is no connection. However, we have entered a new era of vaccine skepticism that will not quickly go away,” Schaffner said.
Attention to Accuracy Needed
According to Dr. Michael Smith, an assistant professor of pediatric infectious diseases at the University of Louisville, the knowledge gap on this subject between medical professionals and the average parent has increased and has to be closed.
“While it received major media attention, the latest revelations about Wakefield have little relevance to the medical world. There has never been any convincing data that vaccines cause autism, and there still is not,” said Smith. “While the allegation that Wakefield’s paper was fraudulent may change some parents’ opinions about the putative association between vaccines and autism, the medical community’s stance has been clear for some time now.
“Parents should know that we all vaccinate our own children because the benefits far outweigh any theoretical risks, and [we] encourage all parents to do so as well,” Smith added.
Outreach to Parents
Minnesota health department personnel say they intend to reach out to the Somali community through public forums and meetings to demonstrate vaccine safety. Schaffner says parents like those in the Twin Cities should have no doubt doctors are looking out for their children’s interests when they recommend vaccination.
“Parents, as in days of old, should and can have confidence in the pediatricians and family doctors who care for their children. Follow their guidance and be aware that the information on the Internet may be trash, not a treasure,” Schaffner said. “Vaccines have made growing up vastly safer than when I was a child. If we fail to vaccinate, the awful diseases that we have eliminated from the United States and Canada will return—and that would be very tragic.”
The best response, Schaffner maintains, is further education.
“The remedy is to provide clear, honest, straightforward information about vaccines to all who would request it. And to keep on doing it—it will be a long haul,” Schaffner said.
Tabassum Rahmani ([email protected]) writes from Dublin, California.