Dispatches. MMR: What They Didn't Tell You
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7477.1293 (Published 25 November 2004) Cite this as: BMJ 2004;329:1293
All rapid responses
In her review “Dispatches. MMR: What They Didn't Tell You” and
referring to Andrew Wakefield, Dr. A. Berger, Associate Editor of the
BMJ, stated: “In one fell swoop he had undermined the MMR vaccination
programme in the United Kingdom, and subsequently around the world.”
For the record, here are the REAL facts about the subject:
1. Andrew Wakefield never said that children should not be vaccinated
and protected against measles, mumps and rubella.
2. Andrew Wakefield never said that the MMR vaccine should not be
used.
3. Andrew Wakefield only suggested that the monovalent vaccines
against measles, mumps and rubella be made available alongside the MMR.
4. Wakefield not only notified the Department of Health of the above
in writing but also repeated it at a private meeting that was held in
October 1997 with the then Health Minister, Tessa Jowell and in the
presence of the Chief Medical Officer, Sir Kenneth Calman, Dr. David
Salisbury and others.
5. The UK had a single dose measles vaccine program since 1967. The
single rubella and mumps vaccines became available in the early seventies.
The MMR vaccine was introduced in 1988. When parents started requesting
the monovalent vaccines in increasing numbers, the DOH decided in August
1998 to withdraw their license. Those who could afford it crossed the
Channel to get their children vaccinated or purchased the single vaccines
at private clinics.
6. The single vaccines have always been licensed and available in The
United States and most other countries.
7. If the DOH had agreed to make the MMR and the single vaccines
available in the UK, the vaccination rates and the immunity against all
three diseases would have been remarkably better than they are.
8. The DOH did not have to endorse Wakefield’s recommendation for a
one-year interval between single vaccines and could have opted for the 3
month interval-routine recommended in the US pre-MMR. The argument raised
by the UK Medical Authorities that they could not support such a schedule
“because it had not been offered that way before” is frivolous. In fact
the DOH had previously recommended the administration of an MMR booster
three months after a primary vaccination at 12 months of age.
9. Starting in 1998, if the monovalent measles, mumps and rubella
vaccines had been made available and had been administered a whole year
apart to those children who were not getting the MMR anyway, most if not
all the children in the UK would have been, by now, protected against all
three diseases.
10. In November 1994, because of dropping vaccination rates, the DOH
embarked on a mass vaccination campaign of school-age children and over
seven million doses of Measles-Rubella (MR) vaccine were administered in a
short period of time. Although the DOH had strongly reassured parents that
serious adverse events were unlikely because most children were already
immune by either natural disease or prior vaccination, 530 serious adverse
events were reported and documented.
11. The extensive media coverage that followed those unfortunate
reactions resulted in a significant drop in the measles, mumps and rubella
(MMR) vaccination rates well before the Wakefield Lancet article of
February 1998.
The following information is from “NHS Immunisation Statistics,
England: 1997-98” - http://www.publications.doh.gov.uk/public/imunstat.htm
-.
According to NHS “This is the first statistical bulletin to be
published on immunisation since 1987”.
Approximately 19,000 (3.3%) fewer children received 3 doses of
pertussis vaccine in 1997-1998 than in 1993-1994. In comparison, 87,000
(13.6%) fewer children received one dose of MMR vaccine.
Reporting on vaccination rates during the two years preceding
Wakefield’s paper in the Lancet, the DOH stated: “Between 1996-97 and 1997
-98: The highest ever levels of immunisation coverage for diphtheria,
tetanus, polio, pertussis and Haemophilus influenzae B., achieved for
children reaching their second birthday in 1996-97, continued in 1997-98;
coverage for measles, mumps and rubella vaccine in this same age fell by
about 1%.
“In the case of pertussis, coverage rates have regained the ground
lost in the mid-1970’s due to public anxiety about the safety and efficacy
of the vaccine. The recent fall in MMR coverage may be the result of
similar concern over the vaccine”. (End quote)
12. Spokespersons for the Health Department and the Press have stated
that the MMR Vaccine is “more effective” than the monovalent vaccines.
Looking specifically at the Merck products, this is not true.
MMR II contains Attenuevax, Mumpsvax and Meruvax, all registered
trade marks of Merck and Co.
In the 2003 Physician’s Desk Reference (PDR), the manufacturer states
that a single injection of MMR vaccine induced measles hemagglutination-
inhibition (HI) antibodies in 95 %, mumps neutralizing antibodies in 96%
and rubella HI antibodies in 99% of susceptible individuals (p. 2022).
Referring to the monovalent vaccines, the manufacturer states that a
single dose of Attenuevax has been shown to induce measles HI antibodies
in 97% or more of susceptible individuals (p. 1946). Similarly, one dose
of Mumpsvax resulted in 97% immunity in susceptible children (p.2046) and
one dose of Meruvax II resulted in immunity in 97% or more of susceptible
individuals (p. 2035).
Pre-MMR licensure, the manufacturers had to conduct safety and
efficacy studies. It is well known that the safety studies were few, small
and of short duration.
On the other hand, there were many efficacy studies performed because
of fear that combining the three live attenuated vaccines would result in
decreased effectiveness of one or more of the components. (End quote)
One must note that no synergistic effect was ever claimed or detected
by the manufacturer.
The problem of decreased efficacy when vaccines are combined was
demonstrated recently when the DOH ordered the revaccination of thousands
of UK children because of vaccine failure and a high incidence of invasive
Hemophylus Influenzae B illness in children who had received a combination
vaccine containing HIB, tetanus, diphtheria and whooping cough vaccines.
13. The DOH claims that a vaccination rate of over 90 % is needed to
provide “Herd Immunity” and effectively eliminate disease.
That is often true but not always so.
Toronto, Canada: “Eighty-seven laboratory-confirmed or clinically
confirmed cases of measles were identified (for an attack rate of 7.7%).
The measles vaccination rate was 94.2%” Sutcliffe PA, et al. CMAJ. 1996
Nov 15;155(10):1407-13. PMID: 8943928
Anchorage, Alaska: “The 33 case-patients ranged in age from 2 to 28
years (median: 16 years). Twenty-nine case-patients had received at least
one dose of measles-containing vaccine (MCV) at or after age 12 months;
one person with laboratory-confirmed measles had received two
appropriately spaced doses of measles-mumps-rubella vaccine (MMR). At the
high school where 17 cases occurred, based on school records, only one of
2186 students had not received at least one dose of MCV before the
outbreak. 49% of the students had received one dose of MCV, and 51% had
received two or more doses. CDC, MMWR: January 08, 1999 / 47(51); 1109-
1111
Cape Town, South Africa “Immunisation coverage (at least one dose of
any measles vaccine) was 91% and vaccine efficacy was estimated to be 79%
(95% CI 55-90); it was highest for monovalent measles (100%) and lowest
for measles-mumps-rubella (74%) Coetzee N, et al. S Afr Med J. 1994 Mar;
84(3):145-9. PMID: 7740350
West Switzerland: “Since 1991, 6 years after the recommendation of
universal childhood vaccination against measles, mumps, and rubella (MMR
triple vaccine), Switzerland is confronted with a large number of mumps
cases affecting both vaccinated and unvaccinated children. Up to 80% of
the children suffering from mumps between 1991 and 1995 had previously
been vaccinated …”Ströhle A, et al. Schweiz Med Wochenschr, 1997 Jun,
127:26, 1124-33
Switzeralnd: In evaluating the impact of the MMR mass vaccination
program begun in Switzerland in 1985: “We conclude that MMR mass
vaccination has not interrupted the circulation of rubella virus in
Switzerland, and that improvements in the implementation and surveillance
of the MMR vaccination campaign are necessary in order to avoid [the]
untoward effects of it.”European Journal of Epidemiology, vol. 11, no. 3,
June 1995, pp. 305-10)
14. To prevent a measles epidemic the Afghan Government embarked in a
massive campaign in 2002. Some twelve million children aged 6 months to 12
years were given the monovalent measles vaccine under the auspices of WHO
and UNICEF. The Minister of Health estimated that 35,000 lives may have
been saved by the campaign. (1)
15. It was estimated that there were 350,000 cases of measles in
Madagascar in 2002. Between September 13 and October 8, 2004 a massive
campaign was carried out with the help of the UNICEF. Over 7,000
vaccinators and 15,000 community workers administered the monovalent
measles vaccine to over 7 million children aged 9 months to 14 years in
the Country’s 111 districts. (2, 3)
16. Without a doubt, the WHO and UNESCO will be using the single
(monovalent) measles vaccine and NOT THE MMR, to vaccinate thousands and
prevent outbreaks of measles in the areas of the Far East that were
devastated by the Tsumanis of December 2004.
The above are the facts, the REAL facts.
They are well worth remembering.
References
1.http://www.unicef.org/publications/files/WHO_UNICEF_Measles_Emergencies.pdf
2. http://www.unicef.org/media/media_23437.html
3. http://www.medscape.com/viewarticle/490996
Competing interests:
Grandfather of a child with regressive autism
Competing interests: No competing interests
I am very grateful to Christina England but there is a further point
I would like to make. In my opinion Simon Baron-Cohen is not simply wrong
because he fails to show respect for an alternative belief system, he is
wrong because he arrogantly dismisses the testimony of people who
contradict his own theory based on their experience. He says he will
happily give up his theory if disproved on the one hand, but on the other
those that not only think differently but possess contradictory knowledge
are shown the door. The intolerance hides scientific weakness, and this is
the way public discussion of science is now conducted.
Competing interests:
Parent of an autistic child
Competing interests: No competing interests
What Simon Baron-Cohen reported to the Guardian was that he supports
the theory that there is a possible Genetic link that causes Autism.
No doubt to enable him to say this he has come into contact with many
Autistic children with Autistic Parents or Grandparents and many Autistic
experts support his belief. However surely this can only account for a
proportion of children with Autism.
I feel what experts are saying in the field is not that MMR is the
cause of Autism but that in certain children who are susceptible it can
cause Autism.
It is being proven in Scientific studies and through careful study of
case histories that some children have become Autistic after the MMR. This
has also been seen in video footage.
If Genetics were the only or main cause for Autism then surely the
children would be born Autistic and developmental patterns such as eye
contact and non appropriate speech patterns would emerge from birth.
However Experts have seen video evidence where a child has full eye
contact and good speech patterns which deteriorate or diminish very often
after the booster MMR at the age of four sometimes within 48hours.
Children do not simply loose established skills, some children have been
left severely brain damaged. If these cases were not fact why then are
parents winning compensation battles?
I agree with Mr Stone when he says 'What he dislikes is the
dismissive way and intolerant tone Mr Simon Baron-Cohen adopts with those
who disagree with him'.Simon Baron - Cohen says 'but I will not give up on
the idea simply because it will prove unpopular with certain groups'. If
he holds with this, then he must in turn respect others who have
alternative ideas and theories. Why should they give up what they believe
to be true?.
There is a rise in Autism some have said to epidemic proportions
since the MMR was introduced however any professional speaking out and
voicing their opinion is quietened or discredited.When parents speak out
they are often accused of MSBP, one has to wonder why this is and also why
certain professionals who go along with the traditional theories are
allowed to have their opinions where others are not even when backed up
with solid evidence.
Competing interests:
The Mother of Two Autistic Children
Competing interests: No competing interests
It is important to understand that the campaign against Andrew
Wakefield is not only a campaign against Andrew Wakefield, it is a
campaign against parents who have seen things they ought not to have done.
In the last year it has become very intolerant indeed in the British
media: not merely Brian Deer but Ben Goldacre in the Guardian
[1], Tim Hames in the Times [2] and dozens of other opinionated journalists who seem to
think they are being intellectually superior. I myself had a particularly
unpleasant outburst of sarcasm in a private communication from a high
profile BBC journalist when I tried to call for a fair hearing. And of
course when Dr Evan Harris MP announces that Andrew Wakefield and concern
about MMR safety have been discredited [3], no one raises a murmur of
protest for Wakefield, the parents - least of all for hundreds of deeply
compromised children.
But the reality is that people who were not there are brow-beating
and insulting the people who were.
I thought in context that some comments by Simon Baron-Cohen in the
Guardian two days ago [4] were deplorable:
"I believe the cause of autism will turn out to be the assortative
mating of two hyper-systemisers. I believe this because we already have
three pieces of the jigsaw: (1) that fathers of children with autism are
more likely to work in the field of engineering (compared to fathers of
children without autism); (2) that grandfathers of children with autism -
on both sides of the family - were also more likely to work in the field
of engineering (compared to grandfathers of children without autism); and
(3) that both mothers and fathers of children with autism are superfast at
the embedded figures test, a task requiring analysis of patterns and
rules. (Note that engineering is a chosen example because it involves
strong systemising. But other related scientific and technical fields
would have been equally good fields to study.) We have had these three
pieces of the jigsaw since 1997, published in the scientific literature.
They do not yet prove assortative mating theory. They simply point to it
being highly likely. I will be the first to give up this idea if it is
proven wrong, since I am not in the business of holding onto wrong ideas,
but I will not give up the idea simply because it will be unpopular with
certain groups (such as those that want to believe that the cause of
autism is purely environmental).
About this I would note:
(a) I have not observed the major claim despite wide acquaitance with
parents and granparents of autistic children.
(b) The general claim being made against parents who observe
environmental damage is that they are collectively fantasists, so they do
not fit into the Baron-Cohen stereo-type: a self-defeating paradox.
(c) The intolerant tone adopted against those who disagree with him
prejudices his evidence.
(d) He proposes a false alternative. In fact no one claims that the
causes of autism are purely environmental: even the mainstream view has
been that it results from a confluence of genetic and environmental
factors. If there was no genetic predisposition presumably all children
would be as badly affected by adverse environmental factors (subject
critically to other issues of health and nutrition).
(e) It would surely be an extreme - not to say eccentric - view that
all examples of the non-specific disorder of autism are determined by pure
genetics.
But what I like least is the dismissive and intolerant tone he adopts
towards those who disagree with him, and the context, the Guardian
newspaper which is not only in the habit of publishing such things, but
which in my experience excludes any contrary views, even in its
correspondence. Simon Baron-Cohen is wrong simply on the grounds of
manners. (I await his early renunciation of the theory.)
[1] Notably, 'Atomic tomatoes are not the only fruit', Guardian 16
December 2004:
http://education.guardian.co.uk/higher/sciences/story/0,12243,1374401,00...
[2]'Elvis lives, MI5 murdered Diana, MMR is dangerous' The Times 23
February 2004. One of many examples of science by sarcasm in the Times in
the weeks surrounding Deer's orginal article:
http://www.timesonline.co.uk/newspaper/0,,170-1011853,00.html
[3]'Plan for new vaccine for babies':
http://news.bbc.co.uk/1/hi/health/4147969.stm
[4] The Edge: Faith v.Fact , 7 January 2005:
http://www.guardian.co.uk/g2/story/0,,1385026,00.html
Competing interests:
Parent of an autistic child
Competing interests: No competing interests
It was also most interesting to see Dr Evan Harris at the meeting on
False Accusations of Abuse (1) in which, as one of the speakers, I
referred to vaccine and other experimental drug damage as some of the
omitted material in false abuse court cases.
His presence in various situations set out in John Stone's responses
and in this one surely waves the flag for a connection between drug
reactions and false accusations.
1. Blakemore-Brown LC 'MSBP - A Pseudo Scientific Trap.' APGAI -
'Abuse Allegations - Systemic Failure' - Portcullis House - UK Houses of
Parliament 2nd December 2004
Competing interests:
Expert on Autistic Spectrum Disorders
Competing interests: No competing interests
Extraordinary to note, following my documented observations above
'Kafka dreamt it II', that Dr Harris, Liberal-Democrat' MP was interviewed
on the radio the other day (5 January) flying the infant meningitis
vaccine kite on behalf of the Department of Health. Where were the
Government ministers?
http://news.bbc.co.uk/1/hi/health/4147969.stm . See also: "Where are
the named authors of the beleaguered Madsen and Smeeth papers?" (Stone, 7
January 2004)
http://bmj.bmjjournals.com/cgi/eletters/325/7373/1134/a#91543
Competing interests:
Parent of an autistic child
Competing interests: No competing interests
Many parents are speaking out, we are simply ignored, brushed aside
or accused of actually causing the problem.If facts are ignored what is
now emerging as an epidemdic will actually become the 'norm'.
More and more children are showing symptoms of ASD and related
gastrointrological problems, many of whom are unrecognised so do not show
up in the overall figures being presented to the government. My child was
born 1986 and I adopted him at four. He came to me with mild Cerebral
Palsy and learning difficulties. When he was placed I recieved Foster
Carers diaries outlining a reaction after MMR mostly severe stomach
problems. These had continued. He had many tests and was looked at for
Crohn's and eventually at 12 was put on a restricted diet of no
Wheat,Dairy,Eggs or Soya which improved his condition. However at 13 he
was being fed on nightly feds through a naselgastric tube as he was
severely underweight. Instead of receiving help and support I was accused
of Munchausen by Proxy. If Lisa Blakemore-Brown and not been the excellent
professional she is and intervened seeing the connections straight away I
may not have my children today.She found that my son had Aspergers
Syndrome which explained the behaviour issues and directed me to Paul
Shattock for testing and sure enough the gut link was found.
My son now is now 19 and he is not recognised as having either of
these problems by my local Authority, I have no help or support and am
finding it extrememly difficult to cope with his behaviour which includes
violence towards me.
Until these problems are looked at seriously by the medical
profession and the Government, more and more children will suffer neglect
and ridicule and parents like myself instead of getting help will be
targeted as abusers if we speak out. Andrew Wakefields work is valuable
scientific evidence and MUST NOT be ignored. The work of Lisa Blakemore-
Brown as an Autistic Expert and a Psychologist who sees proof of many
children with these problems during her assessments, her views, work and
opinions MUST NOT be ignored, Paul Shattock is finding Scientific links
between ASD and gut problems often related to adverse reactions to MMR
again his work MUST NOT be ignored. Until these professionals and many
more are taken seriously and not targeted as trouble makers the situation
in this country will gradually slide into 'Autistic Chaos'.
Please help our children and stop accusing the parents and the few
professionals who realise THERE IS A PROBLEM.Just look at the evidence the
facts are there.
Competing interests:
Mother of two Autistic Children
Competing interests: No competing interests
A suggested analogy: Autism epidemic? What autism epidemic?
Tsunami? What Tsunami?
Competing interests:
A child with autism
Competing interests: No competing interests
May I contribute to recent correspondence on the 'autism issue' by
providing some hard facts from a Scottish perspective?
THE Scottish Executive’s Social Work Statistics Branch recently produced
an Audit of Services for People with Autistic Spectrum Disorder, as part
of a wider Public Health Institute for Scotland (PHIS) exercise. The full
report is to be found in the deepest bowels of an impenetrable government
website. It contains the long awaited official confirmation that ‘autism’
is epidemic in Scotland. There are now more than 3,400 children ("an
underestimate") in school and pre-school with the diagnosis of autism, a
once very rare condition. I ask you to consider this appalling statistic
for a moment; 3,400 Scottish children have lost the gift of a full,
meaningful and intelligent life, and to a condition implausibly considered
solely genetic in origin.
To those of us within the community of autism and the many carers,
teachers and special needs operatives, verification of what we have been
witnessing with our own eyes will come as no surprise. In fact this tragic
phenomenon has been occurring throughout the UK, the USA and the rest of
the developed world for a number of years. It is evident that an
environmental factor, or factors, as yet unidentified, is implicated in
this catastrophe.
Exacerbating what is already a heart-breaking experience for parents
has been the denial by health officials worldwide that an epidemic even
exists, citing unsustainable spurious arguments, such as ‘better
recognition’ and ‘changing diagnostic criteria’ for the increase. This
knee-jerk denial culture has without doubt left tens of thousands of
seriously ill children in need of proper medical investigation and
treatment. Many of the children may be in constant pain and distress.
Public health officials rather than addressing this human tragedy have
become an impediment to progress. Astonishingly, had the affected children
contracted an infectious disease a pre-planned action programme would have
been implemented. For a chronic condition like autism no programme exists.
The role of medical politics in this episode must urgently be given
thorough investigation.
Autism is an epidemic. That is now proven. It is now time to
acknowledge the role of environmental factors. Investigative research into
the potential culprits must be instigated and the results published, no
matter the consequences to the medical and political establishments.
Examination of the seriously ill children should be an urgent priority;
only then can treatment protocols be properly established, founded on
robust evidence.
We are talking about an ‘epidemic’ sweeping the developed world, an
epidemic affecting our most precious asset, our children.
One Scottish example speaks volumes; in November 2003 it was
established that one child in 49 at primary school in Inverness either
had, or was awaiting the diagnosis of autism, a ‘rare’ condition. Why was
no emergency debate called in any UK Parliament? Why did the Health &
Community Care Committee of the Scottish Parliament not alter its agenda
to discuss the loss of so many children to a lifelong and incurable
illness - an agenda that included in December 2003 the Food (Brazil Nuts)
(Emergency Control) (Scotland) Amendment Regulations?
One assumes the advice being given to ministers and then driven down
to the parliamentary foot soldiers was that no problem existed. Media
scaremongering, a frequent loophole for beleaguered officials, was
probably advanced as a reason for inaction. Action was and is essential,
then and today. If they could all talk, 3,400 sick Scottish school
children would testify to that.
The lifetime cost to society for each autistic child has been
estimated at £2.94m, which indicates a £10bn problem nestling within the
Scottish school system, and growing daily. Extrapolate that figure for the
UK and one asks when this £100bn plus cost is going to cross the UK
chancellor’s radar screen?
The UK Medical Research Council meanwhile has trumpeted the
investment of £2.5m into autism research - less than the lifetime cost to
society of one child. This tawdry response epitomises the lack of
commitment the medical establishment has to identifying the causes of
autism and to the important and urgent introduction of interventions that
will aid the recovery of medically ill autistic children. Where is their
compassion?
The truth is inescapable; autism is a public health emergency.
Competing interests:
Chairman of an Autism Charity and grandfather to a child who withdrew into autism following MMR vaccination.
Competing interests: No competing interests
Re: Kafka dreamt it II & III - Evan Harris, a political question for the Liberal-Democrats
In order for Dr Evan Harris, Liberal-Democrat MP, to speak on behalf
of the proposed infant meningitis jab on the BBC Today programme he must
surely have been briefed by the Department of Health. Pushed foward ahead
of ministers to soften public opinion this could also surely have only
have happened with the agreement of the Secretary of State for Health,
John Reid. Did he also, I wonder, do it with permission of his party
spokesman on health Paul Burstow, and his leader Charles Kennedy?
This plainly circumvents all traditional political discussion and
public scrutiny. Frankly, it is a marketing strategy.
The real message to the public is no more vaccines until there is a
radical change of culture at the Department of Health.
Competing interests:
Parent of an autistic child
Competing interests: No competing interests