Dr Andrew Wakefield has responded to the series of claims made in Brian Deer’s Sunday Times‘s articles: Andrew Wakefield’s Response To Brian Deer (pdf) (also now online in html). Wakefield continues to imply that any mistakes are the responsibility of his colleagues (see earlier indications of this) and his clearest message is that he regrets nothing:
There was and continues to be every reasonable basis for suspecting a possible link between MMR vaccination and autistic regression…
Measles outbreaks are preventable, immediately, by offering to parents with entirely valid concerns about the safety of MMR vaccine, a choice of single measles vaccine; not to do so is unethical and puts the vaccine policy, “our way or no way”, before the wellbeing of children.
The Sunday Times would help us all if they would respond, provide some documents etc. that would head off any speculation because, as is all too clear, for anti-vaccinationists and their heroes their maxim is:
Doubt is our product.
No and no, Dr Wakefield. There is a good reason why no set of reputable researchers has been able to replicate your original findings. There have been many detailed explanations as to why the findings you observed were within normal scope and not indicative of gross pathology, far less a new syndrome.
As for the issue of single jabs, major charities have reviewed this issue and they have come to a very different conclusion. I would urge interested readers to download and study the Sense Position Statement on the issue of MMR because it also responds to the calls for single jabs.
An immunisation strategy can only ever be effective if there is mass uptake, meaning that choice between single vaccines and MMR cannot be part of an effective vaccination programme. One of the difficulties with MMR uptake is that, while the prevalence of measles, mumps and rubella in the UK is low, the incentive to vaccinate can appear less. From the perspective of an individual parent, the risk of their child contracting an infectious disease can seem small compared with the risk of possible (or perceived) adverse reactions to immunisation. However, this is only true if vaccination levels remain high. It is actually the counter-argument to this view that is the rationale for vaccination programmes – that the risk of vaccine damage is extremely low compared with the risk of the ill-effects of contracting the disease.
At the same time, low uptake of rubella vaccination could actually have worse consequences than no uptake. If there were no vaccination against rubella, then most people would catch rubella in childhood and would subsequently be immune. A low uptake of vaccination would mean that the virus would still be able to circulate, but that fewer children would become immune in childhood. Outbreaks of rubella would be less common than the epidemics that would occur with no vaccination, and so a cohort of unvaccinated and un-immunised children would increase each year and get older, with the burden of the disease shifting to those who are most at risk. Thus the impact of an outbreak in terms of congenital rubella syndrome births could be greater.
For MMR vaccination to be effective, uptake needs to be above 95%: this is why boys as well as girls need to be vaccinated. From 1970 to 1988, schoolgirls were vaccinated against rubella, and this did have some success in reducing the number of rubella births. However, the real breakthrough came in 1988 when MMR was introduced for all children. This reduced rubella births by a further 90% – there were 447 congenital rubella births between 1971 and 1980 and 38 between 1991 and 2000…
Thanks to vaccination, rubella damage is now rare. However, this means that many people do not realise how dangerous rubella can be. In the United States, people from the Amish community have exercised their right for their children not to be immunised against rubella. As a result, in 1995, one baby in 50 born to Amish parents was born severely rubella damaged…
It has been be argued that even if the Government believes MMR to be safe, they should provide single vaccines as an alternative because then more children would be vaccinated. However, there is absolutely no evidence to support the suggestion that allowing single vaccines would lead to a greater uptake of MMR, and a significant amount of evidence to show that it would have the opposite effect. Single vaccines would be less effective than MMR and there is no evidence that they would be safer. Sense believes that it is unethical to promote six invasive procedures instead of two without sound scientific support, and when there is evidence that such a strategy would have negative effects. [They then give their reasons and some very good, supportive figures.]…
parents may opt not to vaccinate their children, particularly their sons, against rubella. This would lead to increased risk to pregnant women. Unvaccinated boys can catch rubella and go on to infect pregnant women, including their own mothers. This is exactly what happened before MMR was introduced….
[Reprise of what happened the last time single vaccines were offered because of a (groundless) vaccine scare.] In the 1970s, following a decrease in uptake of the diphtheria, tetanus and pertussis (DTP) vaccine, single vaccines for pertussis (whooping cough) were offered, with diphtheria and tetanus vaccines given separately. What happened was that over half of parents chose to vaccinate their children without the pertussis component. Coverage fell from 80% to 30%, there were three epidemics of pertussis, thousands of hospital admissions and around a hundred deaths. It took nearly fifteen years for vaccine uptake levels to recover…
[Sense list of recommendations] The Government should continue to offer MMR and should not make single vaccines available as an alternative.
This is an eminently sensible position. <a href=”AP Gaylard lists some additional literature on this topic that is worth reading.
For readers concerned about the safety of MMR, AP Gaylard has usefully produced a table of what Dr Paul Offit styles as “Studies exonerating MMR”, drawn from Offit’s book, Autism’s False Prophets (Gaylard has thoughtfully provided the full references and links to online content, where available.)
Touching on the myth of “measles is a trivial illness” – no, it isn’t. Once more and with feeling, it isn’t. Just to emphasise this point, look through Dr Aust’s post: Measles: Spot the Worrying Trend with its remarkable illustrations of the chilling billboard advertisements in Germany that advise the uptake of vaccinations and warn of the potential consequences of preventable childhood illnesses. Martin Robbins of The Lay Scientist also provides a comprehensive run through of why Measles is dangerous.
Just to emphasise the message that the word childhood is not a synonym for trivial, I would direct interested readers to The Expert on Measles, Dr Diane Griffin. Dr Griffin is the editor of the definitive Field’s Virology and her status is such that she has contributed the chapter on measles for the last 3 editions. She gave testimony at the Autism Omnibus Hearings in the US. She details the remarkable immunosuppressant effects of the measles virus (see pg. 2738 onwards, Day 11 Autism Omnibus Hearings pdf). It seems that measles not only challenges the immune system itself, it suppresses response to other challenges so most deaths from measles are related to secondary infections.
So there is a period of time which is initiated during this acute phase that children are more susceptible to other infectious diseases. So this is a very clinically important complication or outcome or by-product of measles and all of the data suggests that it’s clinically related, as I say paradoxically, to the fact that the immune system is so activated and so engaged in making a response to measles that it is not appropriately positioned to respond to some new challenge that comes along at this same time… [pg. 2768]…
So a number of viruses that are particularly pathogenic, actually, have figured out how to block the interferon response in order to have a better chance of really causing a more severe disease. And wild-type measles seems to be among those viruses that can do that…[pg 2772]
We forget in the US what a serious disease [measles] was and why it was such an early target for the development of a vaccine, because the [mortality] is substantial. And the mortality is substantial, even in developed countries. It’s less in developed countries but it’s substantial. And if everyone gets it, that’s a lot. [pg. 2797]
Even Andrew Wakefield is prepared to adopt a public stance of advocating vaccination against measles because of its acknowledged impacts and common sequelae.
Even Former Visiting Professor Patrick Holford is prepared to lend lip-service to the need for measles vaccination although strongly hinting that all any child needs is a strong immune system and vitamin A.
Updates and Related Reading
DeeTee has some useful comments about Wakefield’s Response to Brian Deer.
Dr Dave Gorski has written up a magisterial account both of the Deer revelations and the findings from the Autism Omnibus: 2009: Shaping up to be a really bad year for antivaccinationists.