Introduction
There have been ongoing disputations as to whether there is a link between administered measles, mumps, and rubella (MMR) vaccine and autism. This disagreement has led some investigations to justify these claims. In February 1998, Wakefield, a British gastroenterologist and medical researcher, proposed that there might be a relationship between vaccinating children with MMR and increasing the possibilities of either turning those children autistic or causing bowel diseases or both. According to News.bbc.co.uk, 2017, in February 2008, a team led by London's Guy's and St Thomas' examined the cases of 240 children (ranging between the ages of 10 and 12) and checked the immune response from the MMR jab to find out if it could have contributed to autism. They ended up finding no difference between autistic and ordinary children, which means that there is no link. This report will critically review the pros and cons, and outline the consequences on public health.
This debatable concern has divided people, researchers and scholars into two groups: those who think and believe in a link between the vaccine and autism and those who oppose that idea as they presume it is just a coincidence that other health problems were discovered shortly after taking the jab. According to Live Science, 2017, in my point of view, as long as there is no scientific evidence of a link between them, then we have to accept the fact that there is no connection, and that the vaccine is safe and does not cause autism.
Summary
In this quantitative research, researchers conducted medical tests on 12 children; ages ranged from three to ten years old in 1998. The parents accompanied their children, and health checks were applied. The children had an ordinary health-development background until a regression in their obtained abilities and behaviours occurred. Wakefield and his peers reported intestinal oddities, including reactive lymphoid hyperplasia in the ileum in children with autism and other developmental disorders (Hornig et al., 2008) (Ashwood et al., 2003). These findings, coordinated with the parent-reported cooperation of timing about the onset of behavioural oddities with MMR administration, prompted the theory that MMR contributes to autism pathogenesis (Hornig et al., 2008). The following studies from this group observed MV RNA in bowel biopsies and peripheral blood mononuclear cells (PBMC) in children with autism spectrum disorder (ASD) (Kawashima et al., 1998) (O'Leary, Uhlmann and Wakefield, 2000).
Many believe that intestinal and behavioural pathologies may have coincided, by chance, in favour of a prejudice choosing in a self-referred group. However, the symmetry of pathological intestinal alterations and the fact that abdominal dysfunction was found in children with ASD (autistic spectrum disorders) proposes that the link is genuine and reflects a rare disease process. Several clues including anaemia and IgA deficiency in some children would back up the hypothesis that theorises that an inflamed or dysfunctional intestine may have a role in attitudinal changes in some children’s behaviour. That was one of the positive approaches toward an answer.
According to bbc.co.uk, 2017, when a child is vaccinated, a small amount of virus is injected into the body. Because the virus has been weakened, the body's immune system effortlessly defeats it leaving the child protected. Wakefield felt that by giving three different viruses, the immune system was being overwhelmed. Instead of being inactivated, the measles virus from the vaccine remains in the body. Wakefield's theory was that the measles virus causes a persistent infection of the gut. This bold hypothesis that was based on Wakefield’s thoughts without being supported with any fact was more likely to be considered as a pointless approach.
Good points
The study was well articulated and followed ethical procedures. This research was cautiously structured and well-written using academic language and sufficient numbers of references to support its originality and avoid plagiarism. Secondly, consent was acquired from the parents and the Ethical Practices Committee of the Royal Free Hospital NHS to conduct the study on the children. Finally, patients’ details and information were concealed to preserve their rights.
Bad points
It is evident that this research has some drawbacks, flaws and negative consequences that outweigh the constructive aspects. Wakefield's standards of choosing the children were not clear, raising suspicions that their sampling was more selective than consecutive.
Also, the linkage between MMR and autism was pointed out without any evidence by a mother of an autistic child; it was constructed only on her observation, which might be as a result of feeling worried about her child and trying to find someone to blame. Moreover, in general, some details, are vague and not fully explained, such as the age at which the onset of symptoms start to emerge in children.
Implication on public health
The above diagram illustrates MMR coverage and its impact on public health in the UK between 1992 and 2012.
In the first five years (from 1992 to 1997), measles vaccination proportions were over 90% in the United Kingdom. When Wakefield and his team published their study in 1998, rates started to drop and reached a nadir of only 80% in 2003-2004. Merely in latest years have MMR vaccination rates began to soar again in the U.K., reaching about 90% in 2013(Willingham, E. and Helft, L. 2014).
Despite the small sample size (n=12), the unclear outline, and the hypothetical nature of the findings, the paper received enhanced public attention, and MMR vaccination rates began to decline because parents were concerned about the danger of autism after vaccination (DeStefano and Chen, 1999). Wakefield's study and his claim that the MMR vaccine might contribute to autism led to a drop in vaccination rates in the United States, United Kingdom and Ireland. A corresponding incline in measles and mumps, resulting in severe infections and deaths, and his continued warnings against the vaccine have contributed to a climate of distrust of all vaccines and the re-appearance of other previously controlled diseases (Poland and Jacobson, 2011) (Deer, 2011) (Park and Park, 2017). According to BBC News 2017, it has taken the medical establishment years to reassure the public that the claims were without foundation and for vaccination rates to revive.
Conclusion
According to Theguardian.com 2010, Toward the end of the GMC's most extended case, lasting 217 days, a disciplinary board discovered Wakefield liable of genuine expert wrongdoing on various charges associated with a paper issued in the Lancet medical journal in February 1998. Some of these interconnected to morals and others to irreconcilable monetary circumstances and neglecting to put patients first. Wakefield and his team subjected children to invasive medicinal methods such as colonoscopies and lumbar punctures, which they did not need and which the board of trustees of the Royal Free Hospital in North London, had not approved
The GMC inferred that Wakefield had "failed his duties." In 2004, 10 of the 13 writers separated themselves from a paper that the editor of the Lancet, Richard Horton, depicted as "fatally flawed" (Jardine, C. 2010).
References
News.bbc.co.uk. (2017). BBC News – MMR research timeline. [Online] Available at: http://news.bbc.co.uk/1/hi/health/1808956.stm [Accessed 29 Nov. 2017].
Live science. (2017). Just how safe are vaccines? Here are the numbers. [online] Available at: https://www.livescience.com/57488-vaccine-safety-numbers.html [Accessed 5 Dec. 2017].
Hornig, M., Briese, T., Buie, T., Bauman, M., Lauwers, G., Siemetzki, U., Hummel, K., Rota, P., Bellini, W., O'Leary, J., Sheils, O., Alden, E., Pickering, L. and Lipkin, W. (2008). Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study. PLoS ONE, 3(9), p.e3140
Ashwood, P., Murch, S., Anthony, A., Pellicer, A., Torrente, F., Thomson, M., Walker-Smith, J. and Wakefield, A. (2003). Intestinal Lymphocyte Populations in Children with Regressive Autism: Evidence for Extensive Mucosal Immunopathology. Journal of Clinical Immunology, 23(6), pp.504-517.
Kawashima, H., Mori, T., Kashiwagi, Y., Takekuma, K., Hoshika, A., Schepelmann, S., Pounder, R., Walker-Smith, J. and Wakefield, A. (1998). Detection and sequencing of measles virus in peripheral blood mononuclear cells in patients with inflammation bowel disease. Gastroenterology, 114, p.A385.
O'Leary, J., Uhlmann, V. and Wakefield, A. (2000). Measles virus and autism. The Lancet, 356(9231), p.772.
Bbc.co.uk. (2017). BBC – Science & Nature – Horizon. [Online] Available at: http://www.bbc.co.uk/sn/tvradio/programmes/horizon/mmr_prog_summary.shtml [Accessed 29 Nov. 2017].
Willingham, E. and Helft, L. (2014). The Autism-Vaccine Myth. [Online] Available at: http://www.pbs.org/wgbh/nova/body/autism-vaccine-myth.html [Accessed 7 Dec. 2017].
DeStefano, F. and Chen, R. (1999). Negative association between MMR and autism. The Lancet, 353(9169), pp.1987-1988.
Poland, G. and Jacobson, R. (2011). The Age-Old Struggle against the Antivaccinationists. New England Journal of Medicine, 364(2), pp.97-99.
Deer, B. (2017). Hidden records show MMR truth. [Online] Thetimes.co.uk. Available at: https://www.thetimes.co.uk/article/hidden-records-show-mmr-truth-rm6lp72ljrg [Accessed 29 Nov. 2017].
Park, A. and Park, A. (2017). Study Linking Vaccines to Autism Is “Fraudulent” | TIME.com. [Online] TIME.com. Available at: http://healthland.time.com/2011/01/06/study-linking-vaccines-to-autism-is-fraudulent/ [Accessed 29 Nov. 2017].
Theguardian.com. (2010). Andrew Wakefield struck off register by General Medical Council. [online] Available at: https://www.theguardian.com/society/2010/may/24/andrew-wakefield-struck-off-gmc [Accessed 8 Dec. 2017]
Jardine, C. (2010). GMC brands Dr Andrew Wakefield 'dishonest, irresponsible and callous'. [Online] Telegraph.co.uk. Available at: http://www.telegraph.co.uk/news/health/7095145/GMC-brands-Dr-Andrew-Wakefield-dishonest-irresponsible-and-callous.html?fb [Accessed 7 Dec. 2017]