- Margaret McCartney, general practitioner, Glasgow
The sorry tale of struck-off Andrew Wakefield, first author of the Lancet’s infamous and subsequently retracted 1998 paper, barely needs repeating.1 The measles, mumps, and rubella (MMR) vaccine is effective and safe,2 and the BMJ has discredited Wakefield’s original study as “deliberate fraud,”3 but over the past 15 years various newspapers have reported subsequently debunked “concerns.” Can we conclude that such misinformation had anything to do with the current outbreak of measles in Swansea?4 5
The question is particularly interesting given the distribution of the outbreak. From 1997 the South Wales Evening Post ran a campaign, “Parents’ fight for facts,” against the MMR vaccine. Over three months the paper published five front page headlines, three opinion articles, and 18 other articles on MMR, many of which questioned its safety. On 30 August 1997, for example, page 5 was headlined “Families tell of drastic changes in their children after vaccination. Tot’s smiles faded after jab,” above a story about a boy with a diagnosis of autism. The child’s mother was quoted: “I believe Liam’s immune system was not capable of handling the three live viruses at once . . . I am very angry and bitter.”
Nevertheless, the newspaper never said that parents should not have their children vaccinated. Indeed, accompanying the article was a shorter piece saying that the local health authority “emphasised that it was essential that parents continue to have their children immunised.”
Two local public health doctors, Brendan Mason and Peter Donnelly, investigated uptake of MMR in parts of two health authority areas, Morgannwg and Dyfed Powys, where the newspaper was sold. They wrote in the Journal of Epidemiology and Community Health that the overall uptake of the MMR jab in Wales before the campaign was 89.2%, falling to 86.8% a year later; however, in the parts of the two health authorities where the newspaper was available uptake over the same timescale fell from 91% to 77.4%, which was statistically significantly lower.6 They concluded, “This suggests that the SWEP [South Wales Evening Post] campaign has had a measurable and unhelpful impact over and above any adverse national publicity.” However, as an observational study, it was not capable of showing a causal relation.
Mason told the BMJ that the South Wales Evening Post’s coverage and uptake of the MMR jab were “very tightly linked.” He and his team spoke often to the newspaper, offering evidence based advice, but the newspaper also received communications from parents who believed that their children had been harmed by the vaccine, and the newspaper published stories about their fears.
Mason and a colleague examined the case notes of children in Morgannwg referred to community child health services and found 18 children with a diagnosis of autism born between 1990 and 1994. There was no difference between the rate of MMR vaccination in these children and that in children in the general population, indicating that children with autism were no more likely than children without autism to have had the MMR jab. This finding was published in the Lancet as a letter in March 1998.7 The letter was not reported by the South Wales Evening Post, said Mason, but it is unclear whether it ever came to the paper’s attention.
Was he surprised about the current outbreak? “No. Only that it’s taken so long to happen,” he told the BMJ. He and his colleagues looked at other ways to increase uptake. They trialled an intervention where parents of children under 21 months old who had not yet had their first MMR jab were randomised to being sent a reminder letter or not. There was no difference in uptake between the two groups,8 implying that a personalised intervention designed to allay fears had no effect on MMR uptake.
Reporting on the MMR vaccine in the South Wales Evening Post differed from that in other Welsh newspapers. The Cardiff based Western Mail, for example, did not run any campaign similar to that in the South Wales Evening Post.
A smaller outbreak in 2009 with 159 reports of measles centred on Swansea.9 During 2009 the Western Mail published 73 stories online about the MMR vaccine, of which 61 reported the rise of measles or the need for MMR, or both, or comment from the public health team. The South Wales Evening Post, based in Swansea, and also a daily newspaper, has online records of 30 stories mentioning MMR over the same year, with 20 reporting on the outbreak or offering evidence based medical advice. Yet it remains difficult to conclude what the difference in volume of reporting actually meant. It isn’t possible to know whether this reflected or affected readers’ behaviour regarding health.
Scare stories in the media have been shown to be associated with a change in health behaviour. In 1995 the UK Committee on Safety of Medicines wrote letters to doctors about the increased risk of thromboembolism with third generation oral contraceptives; however, media reporting began before doctors had the information, and the committee’s advice contained inaccuracies.10 Subsequently, many women attending for a termination cited the media coverage as leading to their decision to stop the pill.11 In New Zealand a change in the formulation of levothyroxine, together with media reports of a single pharmacist’s concerns about alleged adverse effects, resulted in widespread reporting of side effects, especially in areas with greater press coverage of the story.12
So, after another measles outbreak, what do the media have to say? The present editor of the South Wales Evening Post, who noted that a different editorial team was responsible for the campaign in 1997, issued a statement on 9 April headed, “We have taken the lead in highlighting all facts,” and saying, “It gave those with worries about MMR a voice and . . . that voice was balanced by the views of those who supported the vaccine.”13
Recently Peter Hitchens wrote in the Daily Mail about the “scare” and said that the authorities should have allowed single vaccines and that “some legitimate concerns had been raised, and that parents were entitled to be worried.”14 This dissolution of blame is intriguing, as was the Independent’s decision to publish in full a statement by Wakefield on 13 April.15 The next day the main headline on the front page of the Sunday Times was, “First death feared in MMR scare,” when the “fear” should be attributed to measles, not the MMR vaccine.16
The BMJ could not reach the former editor of the South Wales Evening Post responsible for the campaign, George Edward, but he recently told the BBC, “It’s impossible to have regrets. I’m certain if we wound the clock back and started again, I can’t imagine any reason why we wouldn’t do it [the campaign] in the same way.”17
It is unlikely that we will ever have high quality randomised controlled trials to assess the effects of media health scares on people’s health behaviour. However, this should not preclude raising rational concern about how apparent uncertainties in medicine are reported by the broader press. The 2012 Leveson report into the practices and ethics of the press cited witnesses describing the reporting on MMR as an example of “false balance”—“that is to say, where the scientific view of a very small minority is given prominence which suggests that there is a significant conflict of opinion within the scientific community.”18
If we want to do better in the future we have to recognise where reporting has gone wrong and why it is important to look out for and mitigate against such “false balance.” Surely it would be healthier for the media to simply say sorry and commit themselves to understanding how to avoid the next media health scare?
Cite this as: BMJ 2013;346:f2598
Competing interests: I am an NHS general practitioner.
Provenance and peer review: Commissioned; not externally peer reviewed.