We realise there is a lot of controversy around this topic so we’re going to frontload our views. We agree with the scientific community that the MMR vaccination is safe, that the research behind its supposed links have been disproven and were poor science, and that overwhelmingly vaccination is the correct strategy.
Measles, mumps, and rubella are three childhood illnesses that previously accounted for a large burden of global disease. Measles was in some a mild illness but its potential to cause encephalitis and its high R0 (the number of people it can spread to from an initial case) made it a disease to be reckoned with. As with Measles mumps was typically a mild illness but it brought with it a risk of meningitis. Finally, rubella (or German measles) would cause a mild viral illness with rash but had complications associated with bleeding and carried high risk of miscarriage or congenital rubella syndrome for foetuses if a mother was infected in pregnancy.
Vaccines for these three have all existed since the 1960s, initially as three seperate vaccines. These were combined into MMR-1 in 1971 for ease of administration. MMR-2 was then developed in 1978. The MMR vaccine was introduced into the UK vaccination schedule in 1988. The introduction of vaccination campaigns saw a massive decline in disease burden by the three which was hailed as a public health victory.
A big part of the success was the large uptake of vaccine allowed for the development of herd immunity. Herd immunity is a secondary form of protection from infection wherein if enough members of a population are resistant to infection they will indirectly confer “immunity” to non-resistant members. The basic principle is that having enough protected individuals breaks the chain of infection, preventing it from spreading, even if a case is introduced to the community.
As with all vaccines there was a group of people who pushed back and refused vaccination. As with other vaccines this tended to be a relatively small group who’s views weren’t based on science. However, this movement was given a strong push in 1998 when Andrew Wakefield published a paper in The Lancet describing a link between the MMR vaccine and autism. From that point on, the MMR-Autism link was set in stone in some people’s minds.
Since that paper many others tried to replicate Wakefield’s findings. They could not. Then in 2004 the Sunday Times wrote that there were a number of conflicts of interest stemming from the paper. Firstly, the children involved in the trial were recruited by a lawyer with the aim of suing the manufacturer’s of the MMR vaccine. Secondly, Wakefield had apparently applied for a patent for a new form a three seperate vaccines. Thirdly, former researchers called into question the scientific vigour from the study. Finally, the study itself subjected the patients to unnescessary investigations including colonoscopies and biopsies.
These four points along with other flaws led to the paper’s retraction in 2004. This was followed by GMC hearings between 2007 and 2010 which struck off Wakefield’s registration as a doctor. They cited major ethical concerns around his research, concerns around an attitude of disregard for the pain of children participating in the study, general dishonesty around the situation, and a lack of qualifications in ordering investigations in children as reasons. Alongside this, a number of large papers including a 2002 paper in Denmark looking at over 500,000 patient records found no link between MMR and autism.
While one would have hoped that this would be the end of the controversy it has grumbled on, in part due to the popularisation of it by unqualified celebrities, prominently including Jenny McCarthy. This attention has led to a fall in MMR vaccinations, particularly seen in continental Europe. Alongside this, cases of measles, mumps, and rubella have unsurprisingly increased, with the number of epidemics growing year on year. This comprimises the principles of herd immunity.
The risk of transmission to vulnerable children has led to a few governmental campaigns to improve vaccination rates. A lot of fears around the MMR vaccine can be tied to misinformation or lack of information so a comprehensive education campaign can target that. Secondly, tying vaccinations to financial rewards helps particularly in areas where healthcare access may be difficult – for example low income areas. Thirdly, an exclusion rule where non-vaccinated children are excluded from areas or activities (including school). Finally, in the information age its important not to give a platform to people who are preaching unsafe pseudoscience. Some of these options may seem harsh however when looking at the risk these diseases can pose it may be necessary for the final push.
Author Details: Dr. Eliot Hurn, Foundation Year 2 County Durham and Darlington Foundation Trust.