Measles and MMR - where did it all go wrong?
Where did it all go wrong? There is little doubt that apart from clean water supplies, effective nationwide immunisation programmes have done more to increase the likelihood of living to adulthood than any other health measure in the last 100 years. Before immunisation was introduced, the deadly diphtheria, with its death rate of up to one in 20, killed 2,500 children a year and infected over 45,000. With an effective immunisation programme, that figure fell to 20-25 cases a year and no deaths. Polio has pretty much been eradicated in the UK, but still paralyses and kills 25,000 children a year in countries without really effective immunisation programmes.
Before the measles vaccine was introduced in the UK in 1968, about half a million Britons caught measles every year. About 100 of them died, up to one in 20 developed pneumonia, one in 200 suffered seizures and up to one in 1,000 developed encephalitis (inflammation of the brain), with the risk of permanent brain damage. In 2010, there were just 380 confirmed cases in England and Wales (1). Yet one man - admittedly aided and abetted by a powerful national industry, the media - has brought the spectre back to haunt us. In the latest outbreak in Wales, 765 children have been diagnosed with measles, 77 have been admitted to hospital, and there will be many more to come.
Perhaps we have become blasé - we live in a country where almost nobody is personally touched by the consequences of these diseases. At the same time, some parts of the media bear a heavy responsibility for whipping up hysteria about the 'dangers' of immunisation in order to sell newspapers. In the year after Dr Andrew Wakefield first published his 'scientific findings' in 1998, claiming a link between the combined MMR vaccine and autism, one in 10 fewer children were immunised than the year before. I was already working in the media, and had good relationships with the news programmes I worked with. Yet when I asked them repeatedly to cover reassuring stories about MMR, and the very large and reliable studies which showed no evidence of a link, they refused. Apparently this good news 'wasn't a story'.
In the years that followed, every baby clinic I worked in included at least one long discussion with a caring parent, terrified that if they allowed their child to be injected they could be sentencing them to a diagnosis of autism. They found it hard to understand that not immunising their child carried a much greater risk. All too often, I would quote detailed statistics of studies involving millions of children, showing no evidence of a link with autism. This made not a jot of difference. But when I told them I had never had a moment's doubt about immunising my own children - that helped.
Andrew Wakefield couldn't have been more completely discredited. In 2010, the General Medical Council struck him off the Medical Register for Gross Professional Misconduct, saying that he had behaved "dishonestly and irresponsibly" and showed "callous disregard for children's suffering". Shortly afterwards, the Lancet finally retracted the paper they had published 12 years earlier (1) and the British Medical Journal said that: " Clear evidence of falsification of data should now close the door on this damaging vaccine scare"(2). Yet with the first whiff of an epidemic, a tragedy waiting to happen, the media trots him out again and gives his attempts to shift the blame on to the government the oxygen of publicity. How can parents really make an informed decision when the media allows him a voice?
The good news is that most children born in Wales today are immunised - uptake of the MMR vaccine last year was 94.3% among two-year-olds (3) and uptake of the second dose by age five was 89.9% (3). That's small consolation for the 10- to 18- year-olds who were called for immunisation at the height of the scare stories, and who make up the biggest group of children in the current outbreak. Being a parent is a terrifying thing. As doctors, we have to keep working to help our patients understand the whole picture. But the media too, while it may never admit to being wrong, must learn from its mistakes.