MMR-autism Myth
   HOME

TheInfoList



OR:

Claims of a link between the
MMR vaccine The MMR vaccine is a vaccine against measles, mumps, and rubella (German measles), abbreviated as ''MMR''. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, w ...
and
autism Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing d ...
have been extensively investigated and found to be false. The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 ''Lancet'' MMR autism fraud, characterised as "perhaps the most damaging medical
hoax A hoax (plural: hoaxes) is a widely publicised falsehood created to deceive its audience with false and often astonishing information, with the either malicious or humorous intent of causing shock and interest in as many people as possible. S ...
of the last 100 years". The fraudulent research paper, authored by
Andrew Wakefield Andrew Jeremy Wakefield (born 3 September 1956) is a British fraudster, anti-vaccine activist, and disgraced former physician. He was struck off the medical register for "serious professional misconduct" due to his involvement in the fraudu ...
and published in ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...
,'' falsely claimed the vaccine was linked to
colitis Colitis is swelling or inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and ...
and
autism spectrum Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing d ...
disorders. The paper was retracted in 2010 but is still cited by anti-vaccine activists. The claims in the paper were widely reported,Alt URL
/ref> leading to a sharp drop in vaccination rates in the UK and Ireland. Promotion of the claimed link, which continues in anti-vaccination propaganda despite being refuted, has led to an increase in the incidence of
measles Measles (probably from Middle Dutch or Middle High German ''masel(e)'', meaning "blemish, blood blister") is a highly contagious, Vaccine-preventable diseases, vaccine-preventable infectious disease caused by Measles morbillivirus, measles v ...
and
mumps MUMPS ("Massachusetts General Hospital Utility Multi-Programming System"), or M, is an imperative, high-level programming language with an integrated transaction processing key–value database. It was originally developed at Massachusetts Gen ...
, resulting in deaths and serious permanent injuries. Following the initial claims in 1998, multiple large epidemiological studies were undertaken. Reviews of the evidence by the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
, the
American Academy of Pediatrics The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of poli ...
, the
Institute of Medicine The National Academy of Medicine (NAM), known as the Institute of Medicine (IoM) until 2015, is an American nonprofit, non-governmental organization. The National Academy of Medicine is a part of the National Academies of Sciences, Engineerin ...
of the US National Academy of Sciences, the UK
National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
, and the
Cochrane Library The Cochrane Library (named after Archie Cochrane) is a collection of databases in medicine and other healthcare specialties provided by Cochrane and other organizations. At its core is the collection of Cochrane Reviews, a database of systema ...
all found no link between the MMR vaccine and autism. Physicians, medical journals, and editors have described Wakefield's actions as fraudulent and tied them to epidemics and deaths. An investigation by journalist Brian Deer found that Wakefield, the author of the original research paper linking the vaccine to autism, had multiple undeclared
conflicts of interest A conflict of interest (COI) is a situation in which a person or organization is involved in multiple interests, financial or otherwise, and serving one interest could involve working against another. Typically, this relates to situations in whi ...
,''The Sunday Times'' 2004: * * 2004 BBC documentary: * * had manipulated evidence, and had broken other ethical codes. The ''Lancet'' paper was partially retracted in 2004 and fully retracted in 2010, when ''Lancet''s editor-in-chief Richard Horton described it as "utterly false" and said that the journal had been deceived. Wakefield was found guilty by the
General Medical Council The General Medical Council (GMC) is a public body that maintains the official register of physician, medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the pu ...
of serious professional misconduct in May 2010 and was struck off the
Medical Register The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by c ...
, meaning he could no longer practise as a physician in the UK. In January 2011, Deer published a series of reports in the ''
British Medical Journal ''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...
'', which in a signed editorial stated of the journalist, "It has taken the diligent scepticism of one man, standing outside medicine and science, to show that the paper was in fact an elaborate fraud." The
scientific consensus Scientific consensus is the generally held judgment, position, and opinion of the majority or the supermajority of scientists in a particular field of study at any particular time. Consensus is achieved through scholarly communication at confer ...
is that there is no link between the MMR vaccine and autism and that the vaccine's benefits greatly outweigh its potential risks.


Background


Revaccination campaign

In the wake of the measles outbreaks, which occurred in England in 1992, and on the basis of analyses of seroepidemiological data combined with mathematical modeling, British Health authorities predicted a major resurgence of measles in school-age children. Two strategies were then examined: either to target vaccination at all children without a history of prior measles vaccination or to immunize all children irrespective of vaccination history. In November 1994, the latter option was chosen and a national measles and rubella vaccination campaign, described as "one of the most ambitious vaccination initiatives that Britain has undertaken" was commenced: within one month, 92% of the 7.1 million schoolchildren in England aged 5–16 years received measles and rubella (MR) vaccine.


MMR litigation starts

In April 1994, Richard Barr, a solicitor, succeeded in winning legal aid for the pursuit of a class action lawsuit against the manufacturers of MMR vaccines under the UK Consumer Protection Act 1987. The class action case was aimed at Aventis Pasteur,
SmithKline Beecham GSK plc (an acronym from its former name GlaxoSmithKline plc) is a British multinational pharmaceutical and biotechnology company with headquarters in London. It was established in 2000 by a merger of Glaxo Wellcome and SmithKline Beecham, w ...
, and Merck, manufacturers respectively of Immravax, Pluserix-MMR and MMR II. This suit, based on a claim that MMR is a defective product and should not have been used, was the first big class action lawsuit funded by the Legal Aid Board (which became the
Legal Services Commission The Legal Services Commission (LSC) was an executive non-departmental public body of the Ministry of Justice (United Kingdom), Ministry of Justice which was responsible for the operational administration of legal aid in England and Wales between ...
, which in turn was replaced by the
Legal Aid Agency The Legal Aid Agency is an executive agency of the Ministry of Justice (MoJ) in the United Kingdom. It provides both civil and criminal legal aid and advice in England and Wales. The agency was formed on 1 April 2013 as a replacement for the L ...
) after its formation in 1988. Noticing two publications from Andrew Wakefield that explored the role of measles virus in
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...
and
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being the principal types. Crohn's disease affects the small intestine and large intestine ...
, Barr contacted Wakefield for his expertise. According to Wakefield supporters, the two men first met on 6 January 1996. The Legal Services Commission halted proceedings in September 2003, citing a high probability of failure based on the medical evidence, bringing an end to the first case of research funding by the LSC.


1998 ''The Lancet'' paper

Wakefield's paper "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children" was published in ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...
'' on 28 February 1998. An investigation by journalist Brian Deer found that Wakefield had multiple undeclared
conflicts of interest A conflict of interest (COI) is a situation in which a person or organization is involved in multiple interests, financial or otherwise, and serving one interest could involve working against another. Typically, this relates to situations in whi ...
, had manipulated evidence, and had broken other ethical codes. Based on Deer's findings, Peter N. Steinmetz summarizes six fabrications and falsifications in the paper itself and in Wakefield's response in the areas of findings of non-specific colitis; behavioral symptoms; findings of regressive autism; ethics consent statement; conflict of interest statement; and methods of patient referral. The ''Lancet'' paper was partially retracted in 2004 and fully retracted in 2010, when ''The Lancet''s editor-in-chief Richard Horton described it as "utterly false" and said that the journal had been deceived. Wakefield was found guilty of serious professional misconduct by the
General Medical Council The General Medical Council (GMC) is a public body that maintains the official register of physician, medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the pu ...
in May 2010 and was struck off the
Medical Register The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by c ...
, barring him from practicing medicine in the UK. In 2011, Deer provided further information on Wakefield's improper research practices to the ''
British Medical Journal ''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...
'', which in a signed editorial described the original paper as fraudulent. The
scientific consensus Scientific consensus is the generally held judgment, position, and opinion of the majority or the supermajority of scientists in a particular field of study at any particular time. Consensus is achieved through scholarly communication at confer ...
is that there is no link between the MMR vaccine and autism and that the vaccine's benefits greatly outweigh its risks. However, by the time that scientists had shown the narrative to be false, it had become part of the lay understanding of autism. The narrative was easy to understand and apparently consistent with anecdotal evidence of children receiving autism diagnoses shortly after having been vaccinated. By the time it was retracted, all authors other than Wakefield had requested their names be removed from the publication. Fiona Godlee, editor of ''The BMJ'', said in January 2011:


Media role

Observers have criticized the involvement of mass media in the controversy, what is known as '
science by press conference Science by press conference or science by press release is the practice by which scientists put an unusual focus on publicizing results of research in the news media via press conferences or press releases. The term is usually used disparagingly, ...
', alleging that the media provided Wakefield's study with more credibility than it deserved. A March 2007 paper in ''
BMC Public Health ''BMC Public Health'' is a peer-reviewed open-access scientific journal that covers epidemiology of disease and various aspects of public health. The journal was established in 2001 and is published by BioMed Central. Abstracting and indexing ...
'' by Shona Hilton, Mark Petticrew, and Kate Hunt postulated that media reports on Wakefield's study had "created the misleading impression that the evidence for the link with autism was as substantial as the evidence against" through an attempt to create "balanced reporting". Earlier papers in ''Communication in Medicine'' and ''
British Medical Journal ''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...
'' concluded that media reports provided a misleading picture of the level of support for Wakefield's hypothesis. A 2007 editorial in ''Australian Doctor'' complained that some journalists had continued to defend Wakefield's study even after ''The Lancet'' had published the retraction by 10 of the study's 12 original authors, but noted that it was an investigative journalist, Brian Deer, who had played a leading role in exposing weaknesses in the study. ''
PRWeek ''PRWeek'' is a trade magazine and news website for the public relations and wider communications industry. It is published by Haymarket Media Group. History ''PRWeek'' was originally launched as a private venture in 1984 and was acquired b ...
'' noted that after Wakefield was removed from the general medical register for misconduct in May 2010, 62% of respondents to a poll regarding the MMR controversy stated they did not feel that the media conducted responsible reporting on health issues."Reputation Survey: MMR panic subsides"
''
PR Week ''PRWeek'' is a trade magazine and news website for the public relations and wider communications industry. It is published by Haymarket Media Group. History ''PRWeek'' was originally launched as a private venture in 1984 and was acquired ...
'', 2 June 2010: 24.
A ''
New England Journal of Medicine ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. Founded in 1812, the journal is among the most prestigious peer-reviewed medical journals. Its 2023 impact factor was ...
'' article examining the history of anti-vaccine activists said that opposition to vaccines has existed since the 19th century, but "now the antivaccinationists' media of choice are typically television and the Internet, including its social media outlets, which are used to sway public opinion and distract attention from scientific evidence". The editorial characterized anti-vaccine activists as people who "tend toward complete mistrust of government and manufacturers, conspiratorial thinking, denialism, low cognitive complexity in thinking patterns, reasoning flaws, and a habit of substituting emotional anecdotes for data", including people who range from those "unable to understand and incorporate concepts of risk and probability into science-grounded decision making" and those "who use deliberate mistruths, intimidation, falsified data, and threats of violence". In a January 2011 editorial in '' The American Spectator'', Robert M. Goldberg contended that evidence from the scientific community of issues with Wakefield's research "were undermined because the media allowed Wakefield and his followers to discredit the findings just by saying so". Seth Mnookin, author of ''The Panic Virus'', also partly blames the media for presenting a
false balance False balance, known colloquially as bothsidesism, is a media bias in which journalists present an issue as being more balanced between opposing viewpoints than the evidence supports. Journalists may present evidence and arguments out of pr ...
between scientific evidence and people's personal experiences: "Reporting fell into this 'on the one hand, on the other hand' fallacy, this notion that if you have two sides that are disagreeing, that means that you should present both of them with equal weight." Concerns have also been raised over the journal
peer review Peer review is the evaluation of work by one or more people with similar competencies as the producers of the work (:wiktionary:peer#Etymology 2, peers). It functions as a form of self-regulation by qualified members of a profession within the ...
system, which largely relies on trust among researchers, and the role of journalists reporting on scientific theories that they "are hardly in a position to question and comprehend". Neil Cameron, a historian who specializes in the history of science, writing for the ''
Montreal Gazette ''The Gazette'', also known as the ''Montreal Gazette'', is a Canadian English-language broadsheet daily newspaper which is owned by Postmedia Network. It is published in Montreal, Quebec, Canada. It is the only English-language daily newspape ...
'', labeled the controversy a "failure of journalism" that resulted in unnecessary deaths, saying that: 1) ''The Lancet'' should not have published a study based on "statistically meaningless results" from only 12 cases; 2) the anti-vaccination crusade was continued by the satirical ''
Private Eye ''Private Eye'' is a British fortnightly satirical and current affairs (news format), current affairs news magazine, founded in 1961. It is published in London and has been edited by Ian Hislop since 1986. The publication is widely recognised ...
'' magazine; and 3) a grapevine of worried parents and "nincompoop" celebrities fueled the widespread fears. The ''Gazette'' also reported that:


Folk epidemiology

Folk epidemiology of autism refers to the popular beliefs about the origin of autism. Without direct informed knowledge of autism, a complex disorder, members of the public are easily influenced by rumors and misinformation presented in the
mass media Mass media include the diverse arrays of media that reach a large audience via mass communication. Broadcast media transmit information electronically via media such as films, radio, recorded music, or television. Digital media comprises b ...
and repeated on
social media Social media are interactive technologies that facilitate the Content creation, creation, information exchange, sharing and news aggregator, aggregation of Content (media), content (such as ideas, interests, and other forms of expression) amongs ...
and the
internet The Internet (or internet) is the Global network, global system of interconnected computer networks that uses the Internet protocol suite (TCP/IP) to communicate between networks and devices. It is a internetworking, network of networks ...
. These misinformed beliefs persist even when contradicted by
scientific evidence Scientific evidence is evidence that serves to either support or counter a scientific theory or hypothesis, although scientists also use evidence in other ways, such as when applying theories to practical problems. "Discussions about empirical ev ...
. Folk epidemiology persists because people seek, receive, and preferentially believe information that is consistent with their existing views; misjudge the reliability of their sources of information, and are misled by
anecdotal evidence Anecdotal evidence (or anecdata) is evidence based on descriptions and reports of individual, personal experiences, or observations, collected in a non- systematic manner. The term ''anecdotal'' encompasses a variety of forms of evidence. This ...
; and tend not to revise their opinions even when their original sources of information are shown to be wrong. A June 2024 report in
Ars Technica ''Ars Technica'' is a website covering news and opinions in technology, science, politics, and society, created by Ken Fisher and Jon Stokes in 1998. It publishes news, reviews, and guides on issues such as computer hardware and software, sci ...
discusses recent research into popular beliefs about vaccines and autism in the US, finding lack of awareness of the CDC's clear stance against vaccines as a cause of autism. The article cites an April 2024 survey in which, "24 percent of US adults denied or disputed that the CDC ever said that", a result little changed from 2018. It also reports that a small but non-trivial percentage of Americans believe the vaccine definitely or probably causes autism (rising from 9% in 2021 to 10% in 2023). The research mainly comes from surveys by the
Annenberg Public Policy Center The Annenberg Public Policy Center (APPC) is a center for the study of public policy at the Annenberg School for Communication at the University of Pennsylvania. It has offices in Washington, D.C., and Philadelphia, where the University of Pennsy ...
.


Litigation

During the 1980s and 1990s, a number of lawsuits were brought against manufacturers of vaccines, alleging the vaccines had caused physical and
mental disorders A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
in children. While these lawsuits were unsuccessful, they did lead to a large jump in the costs of the MMR vaccine, and pharmaceutical companies sought legislative protections. In 1993,
Merck KGaA The Merck Group, branded and commonly known as Merck, is a German Multinational corporation, multinational science and technology company headquartered in Darmstadt, with about 60,000 employees and a presence in 66 countries. The group include ...
became the only company willing to sell MMR vaccines in the United States and the United Kingdom.


Italy

In June 2012, a local court in
Rimini Rimini ( , ; or ; ) is a city in the Emilia-Romagna region of Northern Italy. Sprawling along the Adriatic Sea, Rimini is situated at a strategically-important north-south passage along the coast at the southern tip of the Po Valley. It is ...
, Italy, ruled that the MMR vaccination had caused autism in a 15-month-old boy. The court relied heavily on the discredited ''Lancet'' paper and largely ignored the scientific evidence presented to it. The decision was appealed. On 13 February 2015, the decision was overturned by a Court of Appeals in Bologna.


Japan

The MMR scare caused a low percentage of mumps vaccination (less than 30%), which resulted in outbreaks in Japan. There were up to 2002 measles-caused deaths in Japan while there were none in the UK, but the extra deaths were attributed to Japan's application of the vaccine at a later age. A spokesman for the Ministry of Health said that the discontinuation had no effect in measles, but also mentioning that there were more deaths by measles while MMR was being used. In 1994 the government dropped the vaccination requirement for measles and rubella due to the 1993 MMR scare. It has been called a "measles exporter" by the US Centers for Disease Control and Prevention. As another consequence of the scare, in 2003, 7 million schoolchildren had not been vaccinated against rubella. Autism rates continued to rise in Japan after the discontinuation of the MMR vaccine, which disproves any large-scale effect of vaccination, and means that the withdrawal of MMR in other countries is unlikely to cause a reduction in autism cases. The Japanese government does not recognize any link between MMR and autism. By 2003 it was still trying to find a combined vaccine to replace MMR. It was later discovered that some of the vaccines were administered after their expiry date and that the MMR compulsory vaccination was only retracted after the death of three children and more than 2000 reports of adverse effects. By 1993 the Japanese government had paid $160,000 in compensation to the families of each of the three dead children. Other parents received no compensation because the government said that it was unproven that the MMR vaccine had been the cause; they decided to sue the manufacturer instead of the government. The Osaka district court ruled on 13 March 2003 that the death of two children (among numerous other serious conditions) had been indeed caused by Japan's strain of Urabe MMR. In 2006, the Osaka High Court stated in another ruling that the state was responsible for failing to properly supervise a manufacturer of the measles-mumps-rubella vaccine, which caused severe side effects in children.


United Kingdom

Commenced before the Civil Procedure Rules were promulgated, the MMR Litigation had its status as group litigation achieved by the then Lord Chief Justice's practice direction of 8 July 1999. On 8 June 2007, the High Court judge, Justice Keith, put an end to the group litigation because the withdrawal of legal aid by the legal services commission had made the pursuit of most of the claimants impossible. He ruled that all but two claims against pharmaceutical companies must be discontinued. The judge stressed that his ruling did not amount to a rejection of any of the claims that MMR had seriously damaged the children concerned. A
pressure group Advocacy groups, also known as lobby groups, interest groups, special interest groups, pressure groups, or public associations, use various forms of advocacy or lobbying to influence public opinion and ultimately public policy. They play an impor ...
, JABS ( Justice, Awareness and Basic Support), was established to represent families with children who, their parents said, were "vaccine-damaged". £15 million in public legal aid funding was spent on the litigation, of which £9.7 million went to solicitors and
barrister A barrister is a type of lawyer in common law jurisdiction (area), jurisdictions. Barristers mostly specialise in courtroom advocacy and litigation. Their tasks include arguing cases in courts and tribunals, drafting legal pleadings, jurisprud ...
s, and £4.3 million to expert witnesses.


United States

The omnibus autism proceeding (OAP) is a coordinated proceeding before the Office of Special Masters of the U.S. Court of Federal Claims—commonly called the vaccine court. It is structured to facilitate the handling of nearly 5000 vaccine petitions involving claims that children who have received certain vaccinations have developed autism. The Petitioners' Steering Committee have claimed that MMR vaccines can cause autism, possibly in combination with thiomersal-containing vaccines. In 2007 three test cases were presented to test the claims about the combination; these cases failed. The vaccine court ruled against the plaintiffs in all three cases, stating that the evidence presented did not validate their claims that vaccinations caused autism in these specific patients or in general. In some cases, the plaintiffs' attorneys opted out of the Omnibus Autism Proceedings, which were concerned solely with autism, and issues concerned with bowel disorders; they argued their cases in the regular vaccine court. On 30 July 2007, the family of Bailey Banks, a child with pervasive developmental delay, won its case versus the Department of Health and Human Services. In a case listed as relating to "non-autistic developmental delay", Special Master Richard B. Abell ruled that the Banks had successfully demonstrated, "the MMR vaccine at issue actually caused the conditions from which Bailey suffered and continues to suffer." In his conclusion, he ruled that he was satisfied that MMR had caused a brain inflammation called acute disseminated encephalomyelitis (ADEM). He reached this conclusion because of two vaccine cases in 1994 and 2001, which had concluded, "ADEM can be caused by natural measles, mumps, and rubella infections, as well as by measles, mumps, and rubella vaccines." In other cases, attorneys did not claim that vaccines caused autism; they sought compensation for encephalopathy, encephalitis, or seizure disorders.


Research

The number of reported cases of autism increased dramatically in the 1990s and early 2000s. This increase is largely attributable to changes in diagnostic practices; it is not known how much, if any, growth came from real changes in autism's
prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
, and no causal connection to the MMR vaccine has been demonstrated. In 2004, a meta review financed by the
European Union The European Union (EU) is a supranational union, supranational political union, political and economic union of Member state of the European Union, member states that are Geography of the European Union, located primarily in Europe. The u ...
assessed the evidence given in 120 other studies and considered unintended effects of the MMR vaccine, concluding that although the vaccine is associated with positive and negative side effects, a connection between MMR and autism was "unlikely". Also in 2004, a review article was published that concluded, "The evidence now is convincing that the measles–mumps–rubella vaccine does not cause autism or any particular subtypes of autistic spectrum disorder." A 2006 review of the literature regarding vaccines and autism found " e bulk of the evidence suggests no causal relationship between the MMR vaccine and autism." A 2007 case study used the figure in Wakefield's 1999 letter to ''The Lancet'' alleging a temporal association between MMR vaccination and autism to illustrate how a graph can misrepresent its data, and gave advice to authors and publishers to avoid similar misrepresentations in the future. A 2007 review of independent studies performed after the publication of Wakefield ''et al.''s original report found that the studies provided compelling evidence against the hypothesis that MMR is associated with autism. A review of the work conducted in 2004 for UK court proceedings but not revealed until 2007 found that the
polymerase chain reaction The polymerase chain reaction (PCR) is a method widely used to make millions to billions of copies of a specific DNA sample rapidly, allowing scientists to amplify a very small sample of DNA (or a part of it) sufficiently to enable detailed st ...
analysis essential to the Wakefield ''et al.'' results was fatally flawed due to contamination, and that it could not have possibly detected the measles that it was supposed to have detected. A 2009 review of studies on links between vaccines and autism discussed the MMR
vaccine controversy Vaccine hesitancy is a delay in acceptance, or refusal of vaccines despite availability and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using ce ...
as one of three main hypotheses that epidemiological and biological studies failed to support. In 2012, the
Cochrane Library The Cochrane Library (named after Archie Cochrane) is a collection of databases in medicine and other healthcare specialties provided by Cochrane and other organizations. At its core is the collection of Cochrane Reviews, a database of systema ...
published a review of dozens of scientific studies involving about 14,700,000 children, which found no credible evidence of an involvement of MMR with either autism or
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...
. The article was updated in 2020 and again in 2021, with the authors stating, "We have observed an improvement in the quality of the design and reporting of safety outcomes in MMR and MMRV in recent years both pre- and post-marketing." A June 2014
meta-analysis Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...
involving more than 1.25 million children found "vaccinations are not associated with the development of autism or autism spectrum disorder. Furthermore, the components of the vaccines ( thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder." In July 2014, a
systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on ...
found "strong evidence that MMR vaccine is not associated with autism", and in March 2019, a large-scale study conducted by
Statens Serum Institut Statens Serum Institut (SSI, The State's Serum Institute), is a Danish sector research institute located on the island of Amager in Copenhagen. Its purpose is to combat and prevent infectious diseases, congenital disorders, and threats from w ...
following over 650,000 children for over 10 years found no link between the vaccine and autism, even among children with autistic siblings.


Disease outbreaks

After the controversy began, the MMR vaccination compliance dropped sharply in the United Kingdom, from 92% in 1996 to 84% in 2002. In some parts of London, it was as low as 61% in 2003, far below the rate needed to avoid an epidemic of measles. By 2006 coverage for MMR in the UK at 24 months was 85%, lower than the about 94% coverage for other vaccines. After vaccination rates dropped, the incidence of two of the three diseases increased greatly in the UK. In 1998 there were 56 confirmed cases of measles in the UK; in 2006 there were 449 in the first five months of the year, with the first death since 1992; cases occurred in inadequately vaccinated children. Mumps cases began rising in 1999 after years of very few cases, and by 2005 the United Kingdom was in a mumps epidemic with almost 5000 notifications in the first month of 2005 alone. The age group affected was too old to have received the routine MMR immunisations around the time the paper by Wakefield ''et al.'' was published, and too young to have contracted natural mumps as a child, and thus to achieve a
herd immunity Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become i ...
effect. With the decline in mumps that followed the introduction of the MMR vaccine, these individuals had not been exposed to the disease, but still had no immunity, either natural or vaccine induced. Therefore, as immunisation rates declined following the controversy and the disease re-emerged, they were susceptible to infection. Measles and mumps cases continued in 2006, at incidence rates 13 and 37 times greater than respective 1998 levels. Two children who underwent
kidney transplantation Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantat ...
in London were severely and permanently injured by measles encephalitis. Disease outbreaks also caused casualties in nearby countries. Three deaths and 1,500 cases were reported in the Irish outbreak of 2000, which occurred as a direct result of decreased vaccination rates following the MMR scare. In 2008, for the first time in 14 years, measles was declared
endemic Endemism is the state of a species being found only in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also foun ...
in the UK, meaning that the disease was sustained within the population; this was caused by the preceding decade's low MMR vaccination rates, which created a population of susceptible children who could spread the disease. MMR vaccination rates for English children were unchanged in 2007–08 from the year before, at too low a level to prevent serious measles outbreaks. In May 2008, a British 17-year-old with an underlying
immunodeficiency Immunodeficiency, also known as immunocompromise, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that aff ...
died of measles. In 2008 Europe also faced a measles epidemic, including large outbreaks in Austria, Italy, and Switzerland. Following the January 2011 ''BMJ'' statements about Wakefield's fraud, Paul Offit, a pediatrician at
Children's Hospital of Philadelphia The Children's Hospital of Philadelphia, also known by its acronym CHOP, is a children's hospital in Philadelphia, Pennsylvania. Its primary campus is located in the University City, Philadelphia, University City neighborhood of West Philadelph ...
and a "long-time critic of the dangers of the anti-vaccine movement", said, "that paper killed children", and Michael Smith of the
University of Louisville The University of Louisville (UofL) is a public university, public research university in Louisville, Kentucky, United States. It is part of the Kentucky state university system. Chartered in 1798 as the Jefferson Seminary, it became in the 19t ...
, an "infectious diseases expert who has studied the autism controversy's effect on immunization rates", said "clearly, the results of this (Wakefield) study have had repercussions." In 2014, Laurie Garrett, senior fellow at the
Council on Foreign Relations The Council on Foreign Relations (CFR) is an American think tank focused on Foreign policy of the United States, U.S. foreign policy and international relations. Founded in 1921, it is an independent and nonpartisan 501(c)(3) nonprofit organi ...
, blamed "Wakefieldism" for an increase in the number of unvaccinated children in countries such as Australia and New Zealand, saying, "Our data suggests that where Wakefield's message has caught on, measles follows."


Impact on society

The ''
New England Journal of Medicine ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. Founded in 1812, the journal is among the most prestigious peer-reviewed medical journals. Its 2023 impact factor was ...
'' said that antivaccinationist activities resulted in a high cost to society, "including damage to individual and community well-being from outbreaks of previously controlled diseases, withdrawal of vaccine manufacturers from the market, compromising of national security (in the case of anthrax and smallpox vaccines), and lost productivity". Costs to society from declining vaccination rates (in US dollars) were estimated by AOL's DailyFinance in 2011: * A 2002–2003 outbreak of measles in Italy, "which led to the hospitalizations of more than 5,000 people, had a combined estimated cost between 17.6 million euros and 22.0 million euros". * A 2004 outbreak of measles from "an unvaccinated student return ngfrom India in 2004 to Iowa was $142,452". * A 2006 outbreak of mumps in Chicago, "caused by poorly immunized employees, cost the institution $262,788, or $29,199 per mumps case". * A 2007 outbreak of mumps in Nova Scotia cost $3,511 per case. * A 2008 outbreak of measles in San Diego, California cost $177,000, or $10,376 per case. In the United States, Jenny McCarthy blamed vaccinations for her son Evan's disorders and leveraged her celebrity status to warn parents of a link between vaccines and autism. Evan's disorder began with seizures and his improvement occurred after the seizures were treated, symptoms experts have noted are more consistent with
Landau–Kleffner syndrome Landau–Kleffner syndrome (LKS), also called infantile acquired aphasia, acquired epileptic aphasia, or aphasia with convulsive disorder, is a rare neurological syndrome that develops during childhood. It is named after William Landau and F ...
, often misdiagnosed as autism. After the ''Lancet'' article was discredited, McCarthy continued to defend Wakefield. An article in Salon.com called McCarthy "a menace" for her continued position that vaccines are dangerous.
Bill Gates William Henry Gates III (born October 28, 1955) is an American businessman and philanthropist. A pioneer of the microcomputer revolution of the 1970s and 1980s, he co-founded the software company Microsoft in 1975 with his childhood friend ...
has reacted strongly to Wakefield and the work of anti-vaccination groups: The proportion of children in England receiving the vaccine by the age of two fell to 91.2% in 2017–18, from 91.6% the year before. Only 87.2% of five-year-olds had received both MMR vaccines. With the onset of a large number of measles outbreaks in the United States in 2019, there is fear that parents who have not had their children vaccinated will help to spread infectious diseases in schools and universities where there are already other outbreaks.


See also

* Autism rights movement * '' Autism's False Prophets'' *
Controversies in autism Diagnoses of autism have become more frequent since the 1980s, which has led to various controversies about both the cause of autism and the nature of the diagnoses themselves. Whether autism has mainly a genetic or developmental cause, and the ...
* Epidemiology of autism * Measles resurgence in the United States * Vaccine shedding


References


Further reading

* * * * * Deer, Brian (2020) '' The Doctor Who Fooled the World'', Johns Hopkins University Press, {{Autism resources Autism pseudoscience Ableism Causes of autism 1998 hoaxes 2011 scandals Academic scandals Conflict of interest Fraud in England Medical scandals in the United Kingdom Scientific misconduct incidents 1998 in the United Kingdom 2011 in the United Kingdom Urban legends Alternative medicine Scientific folklore