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Vaccine Disputes PUBLIC HEALTH VACCINE ES G A DISPUTES M I Y Y As the MMR health scare retreats in the UK, doctors ETT /G P F fear it will migrate to the USA. Rebecca Coombes A MM/ A K investigates the role played by the AS HOL anti-vaccination lobby NIC n 2008, paediatrician Paul Offit had a the vaccine was not dangerous. The study, MMR TIMELINE book published—not exactly uncommon which followed 1.8 million people, found that 1988: MMR introduced for a doctor near the top of his specialty. serious adverse events were rare and greatly into the UK But the situation was complicated for outweighed by the risks of disease. The author 1992: Brands of MMR Dr Offit. As chief of the division of of the Lancet study, Andrew Wakefield, is still containing the Urabe strain I infectious diseases at the Children’s Hospital embroiled in a General Medical Council case of the mumps vaccine of Philadelphia, he is the most prominent—and over research misconduct. virus were withdrawn some would say most fearless—spokesperson In the UK, experts are signalling what they after research found that for vaccine science and safety in the United call a “burning off” of the health scare, as the it was associated with an increased risk of aseptic meningitis States today. His book Autism’s False Prophets, protest base diminishes, press interest drops 1998: Publication of Lancet paper linking deals with the false alarm that vaccines cause back, and immunisation rates recover, albeit MMR with autism autism and how antivaccine activists, and an slowly. An unpublished Department of Health 2001: “Leogate”— easily duped media, are sowing the seeds of a survey of over 1000 parents in 2008 assess- Tony Blair, the UK’s health scare similar to, if not worse than, the ing the effect of the childhood immunisation then prime minister, one that the UK is just recovering from. So programme found that 73% had their child and his wife wouldn’t inflammatory is this issue that Dr Offit opted immunised without seeking advice. The sur- say if their youngest out of the big city publicity tour that is usual vey concluded: “It’s possible that, as fewer child Leo had been for most authors. scare stories appear in the press, the deci- vaccinated “I do radio and television but not appear- sion over whether to immunise has become 2004: Fathers won right to get MMR for ances in book stores. I’ve had a few incidences easier.” In the second half of 2008, the UK ES children (if mothers disagreed). A doctor was G where I get heckled by people who disagree provided 350 000 more doses of MMR than A sent to prison for administering faulty single M I Y Y vaccines and struck off with me strongly, almost religiously, and over the same period the year before. MMR ETT disrupt my capacity to express my point of coverage fell from 91% to 80.7% in 2003-4 /G 2005: Cochrane review published of evidence K A L view,” he explains. He also receives a lot of and is now creeping up to 85.5%, according U of MMR link to autism H E hate mail—after one credible death threat, he to the Department of Health. R 2006: 13 year old dies of measles, the first BE L death from the virus in the UK for 14 years was accompanied at official meetings by an At the end of June, the BMA will debate 2006: Andrew Wakefield armed guard. mandatory vaccination at its annual confer- first appears in front of the The health scare linking the combined ence. Former BMA chair Sandy Macara, who ESEN/DANIE R GMC accused of research measles, mumps, and rubella (MMR) vaccine has proposed the motion, said he didn’t mind misconduct to autism is more than a decade old. A large being called draconian “as long as this issue DD ANDE DD O 2008: Measles outbreaks in body of evidence has built up to discredit is taken seriously.” The Welsh health minister ; ; L US, including 11 children in the decade old Lancet paper that linked the Edwina Hart last week ruled out introducing E/SP G San Diego measles virus with irritable bowel syndrome compulsory MMR vaccinations. “It would, A M I 2008: The UK recorded the K and autism. This includes a 2005 Cochrane on the advice I have received, make matters same number of measles P: TE P: systematic review of 139 studies to assess the worse, not better,” she said. Measles cases in O T cases in one month effects of the MMR vaccine in children, and a Wales are at their highest for 20 years, with (November) as in the whole of 1996 ROM F 14 year long Finnish study that concluded that 302 current cases. 1528 BMJ | 27 JUNE 2009 | VOLUME 338 PUBLIC HEALTH answers as baby dies regularly appears on top rated US shows such from vaccine,” is as Oprah and Good Morning America to air her one recent headline views. Founder J B Handley has a blog on taken from a local CNN.com. paper in Trinidad In June last year, Ms McCarthy led a “green and Tobago. The our vaccines” rally of a reported 8500 fami- group has emailed lies in Washington, DC. The rally demanded several members that congress re-enact legislation eliminating of BMJ staff, all of mercury and other “toxins” from children’s whom found them- vaccines, study the incidence of autism in selves unable to vaccinated versus unvaccinated children, and unsubscribe from allow more families to file for compensation the unsolicited for “vaccine induced autism.” email. The group, Less new age is the long established run by a former pub- National Vaccine Information Center (NVIC), lic relations worker, set up in 1982, which has its roots in the Jane Bryant, is pertussis vaccination health scare of the 1970s. especially uncom- A key function of the NVIC, run by Barbara promising in its Loe Fisher, is its vaccine reaction registry: message. Ms Bryant “When parents report a death or regression first came to promi- into chronic poor health after vaccination to nence campaigning NVIC, we document the report and advise to get chronic fatigue parents to also make a report to the federal Demonstrators protest against the use of mercury syndrome treated as a medical condition. Vaccine Adverse Event Reporting System,” in vaccines at the US Capitol, July 2005 The US has also witnessed a growth in says Mrs Loe Fisher. antivaccination organisations since the late Dr Offit dislikes the NVIC (“the national But while data from the UK suggest a 1990s, including the high profile Generation vaccine mis-information centre more like,” he renewal of public confidence in the MMR Rescue, whose slogan is “Autism is revers- says) but says at least the website has links to vaccine, doctors in the US fear a slide in the ible.” The organisation is fronted by former federal agencies such as the Centers for Dis- opposite direction. Figures from the Centers Playboy model Jenny McCarthy, who has an ease Control (CDC) vaccine information site. for Disease Control and Prevention report autistic son and is the girlfriend of Hollywood But he’s very concerned about the vaccine that the number of measles cases in early actor Jim Carrey. Some of these groups have registry. 2008 was at a 10 year high. During 2000-7, noticeably deeper pockets than their British “Barbara is a very powerful parent advo- the mean number of measles cases each year counterparts. Generation Rescue, for exam- cate. But if a parent contacts her to say that in the US was 62. In 2008, 131 cases had been ple, was founded by a wealthy financier from their child has had an adverse reaction to vac- confirmed by 31 July, including outbreaks in northern California called J B Handley, whose cines, she simply believes them. If the data San Diego (11 children), New York (27 cases), son has autism. Mr Handley and his wife are show the problem was not vaccine related she and Illinois (32 cases). This spike was not convinced that mercury chelation therapy has tends to say the data were manufactured by the result of an increase in imported cases successfully treated their son. In February, those [who gain from vaccines].” but higher numbers of unvaccinated school Generation Rescue took out a one page adver- age children. Sixty one of the 83 US citizens tisement in USA Today costing a six figure sum. aged 1-19 years who caught measles during Activist and blogger Gary Kompothecras, a this period had not been vaccinated because millionaire and political donor, calls himself their parents claimed exemption for religious “warrior dad.” Doctors who disagree that vac- or personal reasons. cines led to his son’s autism are “dirtbags,” he says. The message is typically hard edged and Campaigners against vaccines uncompromising. One of the main drivers of the safety fears Generation Rescue’s position is that autism are antivaccine groups. Prominent among is caused by “environmental illnesses caused the UK groups is Warrington based JABS, by an overload of heavy metals, live viruses, ES G A M whose website still maintains that “some and bacteria.” Ms McCarthy also implicates I Y Y children have and will continue to be dam- “the tripling of vaccines given to children in ETT /G aged by combined and single dose vaccines.” the past 15 years (with unstudied ingredients E G A M I Founder Jackie Fletcher has a son with epi- like mercury, aluminium, and live viruses).” E R lepsy and brain damage, which she blames The website recommends “biomedical inter- I /W I G on the MMR vaccine.
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