The One Horrible Event That Spawned Our Modern Fear of Vaccines
Our fear originated from bad “science” and unethical conduct.
“Should I get the corona vaccine?”
“Should I vaccinate my son for MMR?”
“Why are vaccines even necessary?”
This is what my week sounds like these days. While I would prefer to speak about other things — like how difficult it is to find a cure for cancer — I’m stuck with questions on vaccines.
It’s exhausting considering that two decades ago, measles was declared eradicated in the US, just 32 years after vaccine introduction. HPV vaccination programs have the possibility to eliminate cervical cancer saving hundreds of thousands of lives annually, and Australia may be the first country to do so. There are countries where liver cancer is the top cause of cancer-related death, largely due to a lack of a robust Hepatitis B vaccination program.
I could go on but you can read more here.
Vaccines are one of the greatest scientfic breakthroughs of our modern times.
My short answer is always yes you should get the vaccine. The probability of negative side effects is far lower than the probability of dying from the disease the vaccine is designed to protect you from.
However, this article isn’t about proving that vaccines work, or an argument as to why you should get them. This article is to shed light on the origins of vaccine hesitancy — the root cause of the collective fear. Once we understand the origin, maybe then some of this can be put to rest.
It started with bad science
In 1998, Andrew Wakefield and 11 colleagues published a paper in The Lancet — a very prestigious medical journal — called “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” The study investigated 12 children with a history of developmental disorders and intestinal symptoms such as diarrhea and abdominal pain. Eight of twelve of the children’s parents claimed an onset of behavioral symptoms after the MMR vaccine. The authors concluded the following:
“We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.”
Basically, the paper claimed a link between a new bowel disease Wakefield termed ‘autistic enterocolitis’, the MMR vaccine, and the onset of behavioral symptoms in autistic children. In other words, they asserted that the MMR vaccine triggered the development of autism and a related bowel disease in previously normal children.
Big assertion.
Wakefield stated his concerns for MMR vaccine safety and his assertion of a connection between MMR vaccine and autism at a press conference at the Royal Free hospital NHS. Then the public took notice. When asked by the interviewer if the MMR vaccination should continue while he was investigating the vaccine, Wakefield replied:
“I think if you asked members of the team that have investigated this they would give you different answers. And I have to say that there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines, that is continued use of the individual measles, mumps and rubella components.”
In the aftermath of this press conference, MMR vaccination rates began to decline in the UK. The figure below shows the percentage of children receiving the first dose of MMR before 24 months in London, rest of England, and Scotland, 1999–2000, 2015–16. Overall, in England, MMR vaccination rates dropped from 91% in 1996 to below 80% in 2004.
Why this study was a hoax
The study was fully retracted from The Lancet in February 2010 — over a decade after it was first published. Why it took so long is another question.
Here’s what was wrong with the study.
1. The results were falsified and could not be replicated
When you make a big assertion in science, you better be able to back it up. If the biological effect you believe is there is actually there, then if another scientist searches for it, they should find it. The purpose of replication in science is to confirm or refute the existing evidence. However, no one has been able to replicate the results of this study. A review of 138 randomized and non-randomized studies, confirmed that there is no evidence of any association between the MMR vaccines and autism. Recently, a large cohort study of 657,461 children born in Denmark affirmed that the MMR vaccination does not increase the risk for or trigger autism in susceptible children.
2. Undisclosed financial conflicts of interest introduced bias
Much later, it was discovered that Wakefield was hired to provide evidence to the court for a class-action lawsuit brought forward by attorney Richard Barr on alleged ‘vaccine damage’ in young children. Children were referred to Wakefield by Barr which heavily biased the recruitment strategy. An unbiased strategy would be to systematically recruit all children vaccinated with MMR over a specified time period, not a select few that seem to back up your hypothesis. It was reported that Wakefield and colleagues were paid a substantial amount of money by Barr’s Law Firm. Within 6 weeks Wakefield recruited 12 children for the study.
3. The sample size was too small
It’s a mystery to me how a study with a sample size of 12 ended up in The Lancet. Without getting into the statistics of what is an adequate sample size, I think you can conceptually understand why you cannot put faith in the results of studies with small sample sizes. The issue is generalizability. If I told you and I interviewed 10 people and they all said they don’t like pineapple ice-cream, therefore, I think the majority of people don’t like pineapple ice-cream would you agree? Probably not. A sample of 10 people cannot tell me much about a sample of 1000 people, much less of all people.
4. There was no control group
The purpose of a control group is to determine whether an intervention (in this case the MMR vaccine) increases the risk of disease above the baseline value that exists in the population (in this case autism). An appropriate control group would have been children who did not receive the MMR vaccine. By comparing the prevalence of autism onset in children who did and did not receive the vaccine you may be able to conclude an association. Wakefield did not do this. Other studies that included a control group found no increased risk of developing autism in children who received the MMR vaccine.
5. Mistreatment of developmentally delayed children
This is what hit me the hardest. Wakefield gave the children unnecessary and invasive procedures for a scientifically invalid study. Specifically, the interventions included a lumbar puncture and colonoscopy — both painful procedures. The children endured pain and exploitation for a study that was never designed to measure any phenomenon. Wakefield showed no concern for their wellbeing.
6. Conflated association with causation
Wakefield is not the only person who mixes up association with causation. I see this all the time, particularly in the sensational media. One of the first things you learn in any statistics or science course is the difference between association and causation. It is very difficult to prove causation because: 1) biological systems are complex and often times the disease is the effect of several biological and non-biological mechanisms and; 2) studies that look at causation require large sample sizes, appropriate controls, and randomization. Such studies are usually expensive and time-consuming. Without a control group, Wakefield could claim association at best — but that would also be undermined by his small sample size and biased recruitment strategy.
7. Unethical conduct
All of the above is considered unethical conduct in science and medicine. In addition, Wakefield did not obtain ethical approval for the study. This is a big no-no. All human subject research must be approved by an ethics committee, no matter where in the world you are. This is to ensure the participants are protected, agree to participate voluntarily, and the research is justified. The committee evaluates several things including the scientific validity, risks and benefits to participants, if their rights will be upheld, and measures to protect their privacy and confidentiality. Wakefield’s study included invasive procedures such as a lumbar puncture and colonoscopy in a vulnerable population. This was a more than minimal risk study that would prompt rigorous evaluation by the ethics committee. As a member of an ethics committee for the last 4 years, I can say that this study would have been rejected on several grounds.
The aftermath then and now
Wakefield continued his unethical behavior. In 2007 he was accused of paying children $10 each to give blood samples at his son’s birthday party. In 2010, Wakefield was stripped of his medical license by the UK General Medical Council who cited that he had been dishonest in his research, acted against his patients’ best interests, and failed in his duties as a responsible consultant.
Wakefield has since moved to America where he is an anti-vax campaigner. He is sticking with his story, even pointing to the rise in autism since vaccine introduction to further his causation theory. However, more rigorous minds attribute the rise to increased autism awareness, improved access to healthcare in minority groups, and changes to the criteria for an autism diagnosis.
Today, we still suffer from vaccine hesitancy not just for the MMR vaccine, but vaccination in general. Vaccine hesitancy originated from a lie, basically. A lie we continue to pay for today.
“Mistakes are, after all, the foundations of truth, and if a man does
not know what a thing is, it is at least an increase in knowledge if he
knows what it is not.” — Carl Jung
Thanks for reading!
Kim
