Fake news becomes dead serious for human health when the English doctor Andrew Wakefield publishes his fake research results in 1998. But many others are to blame in a new era of science scepticism where real experts are questioned and anyone can rise to experts.
By Gorm Palmgren, freelance science journalist writing for EUSJA’s NUCLEUS project
Had measles virus had hands, they would have rub them together in anticipation on Saturday, February 28, 1998. After being held brutally down by the effective MMR vaccine for decades, the door to freedom is now starting to open so they can finally get loose. The door to freedom is a scientific article published by the English doctor Andrew Wakefield of the Royal Free Hospital in London in the acknowledged journal The Lancet. In a study of 12 children, the doctor points to a correlation between autism, bowel disease and the MMR vaccine against measles, mumps and rubella. Wakefield has a theory that the combined vaccine attacks the intestines and somehow affects the brain, so the children develop autism within a few days.
The article stirs attention far beyond the ordinary research community, and already a few years later the consequences can be read directly in disease statistics. In large numbers, frightened parents choose not to give their children the MMR vaccine, and the measles virus is quick to exploit the vulnerability of the unprotected children. In just five years, the number of measles cases in Britain are doubled and most unfortunately, the parents and their children have received nothing in return from this high price. It turns out that Wakefield’s research is a scam, but this is not fully revealed until several years later.
Lawyers get paid to miscredit the vaccine
Andrew Wakefield is the son of two British doctors, and at the age of 24, in 1981, he graduates in medicine at St Mary’s Hospital Medical School in London, which at the time is Britain’s most popular medical university. He trains himself to become a surgeon specializing in organ transplants, but gradually he changes interests, and in 1993 he receives attention with a scientific article. In the article, the young doctor presents a theory that measles virus can cause Crohn’s disease. Two years later, he suggests that it is the living, but attenuated virus in the MMR vaccine, which is the cause of the disease, and soon he broadens the accusation and suggests that the vaccine may also cause autism.
Wakefield has reached his theories through studies of children, and gradually it appears that he has recruited his subjects in a highly unconventional way. When his son celebrates his 10th birthday in 1998, the doctor offers all the young guests £5 to donate a blood test to his experiments. During a lecture, the doctor later tells that two of the children fainted when the blood samples were taken while a third threw up in his mother’s lab. Such an approach is violating the ethical rules for medical trials, but it soon appears that Wakefield has made far more serious mistakes in his selection of subjects for his studies. This is revealed by British journalist Brian Deer when he digs into the case and in 2004 begins to present his disclosures in a series of articles in the Sunday Times and the medical journal BMJ.
The journalist can document that the parents of most of the subjects of the trial was from the beginning convinced that the MMR vaccine was responsible for their children’s autism. The parents are in the process of preparing a lawsuit against the pharmaceutical company behind the vaccine and, in anticipation of a generous fee, their lawyers pay Wakefield £435,643 to document the children’s symptoms. The journalist also reveals that the research results and the connection between the vaccine and autism are largely fraudulent. Three of the children who allegedly developed autism have never been diagnosed with the disease, and five of them already had mental and physical developmental disorders before being vaccinated.
Measles virus exploit the parents’ concerns
Immediately after the fake and disturbing results were announced, the UK doctor gives a press conference calling on parents not to vaccinate their children before researchers have further investigated the case. The following day, the story is all over media: “MMR vaccine causes autism.” Newspapers, tv-stations, radio and the net went mad, and like a snowball, the story grows bigger and bigger. It doesn’t culminate before 2002 – four years later – where British newspapers print 1531 articles on the subject, two thirds of which are critical of the MMR vaccine or directly refer to it as uncertain.
The negative press sends shock waves among parents, and from fear that their children will get autism they turn their back to the vaccine in large numbers. Before Wakefield published his results in 1998, 90 per cent of British children received the vaccine, but in 2003 that number was reduced to 80 per cent, and a similar trend can be seen in most other countries. The drop may not sound critical, but it is. Vaccines are only effective if the pathogenic bacterium or virus doesn’t have a safe reservoir in the form of unvaccinated persons whom it may infect and propagate in.
WHO recommends that at least 95% of the population is vaccinated against measles. In that case, measles virus has so bad living conditions in the population as a whole that everyone – even those who are not vaccinated – receives protection. Accordingly, it is a collective responsibility to be vaccinated, and by opting out, you expose not only yourself or your children but also put all your other family members, friends, colleagues and fellow citizens at risk of serious illness. Finland long ago achieved the target of 95%, which has led to the eradication of measles which has not showed up in the country for the past twenty years. Britain was also well on its way reach the goal, but was set back by Wakefield’s scam, which instead launched a new unfortunate development.
Measles virus doesn’t hesitate to exploit the open door to freedom. After the number of measles cases in the UK has remained relatively constant at 100-200 per year through the 1990s, the number of disease cases now begins to rise. In 2003 it has more than doubled, and from then on it continues to escalate up and down with a steadily rising trend. In 2008, it reaches almost 1400, and in 2012, it sets a new record with over 2,000 Brits who get sick of measles. For the first time in 14 years, people start to die from acute measles infections and since 2006 the death toll amounts to four British children. It is not only in Britain that Wakefield’s trial horrifies parents in great numbers. Also in the rest of Europe, the proportion of vaccinated children drops and the number of measles are quadrupled from 2008-2011. The same is true in the United States, where less children receive the MMR vaccine than in countries such as Libya and Zimbabwe.
Hand-picked subjects give predictable results
The parents’ concerns, however, are grossly exaggerated. Right from the beginning, health authorities all over the world assure that the vaccine is both safe and useful, and they have historical evidence for that claim. In the United States, about 400,000 cases of measles were reported annually until 1963, when the measles vaccine was introduced to children around the age of one year (the combined MMR vaccine came in 1971). Just five years later, the number of cases fell to about 50,000 a year, and since 1990, when the vaccination program expanded to include an additional shot at the age of 4, there have been less than 200 cases of the dangerous disease annually.
No matter if Andrew Wakefield’s results had been fraudulent or not, the media should have been extremely wary of spreading the worrying message from the very beginning. It is fundamental in the scientific method that one should never feel too convinced of the results of a single experiment, even though it is published in a recognized journal such as The Lancet. Experiments should always be repeated several times in different ways in other laboratories, because biological systems are so complex that there can be many explanations for the apparent findings. Had the media been more critical in their review of Wakefield’s investigation, they should be able to notice that his conclusions were very weak. But the British doctor also violated several other basic principles in the scientific method, that a highly qualified science journalist should have noticed.
Firstly, his subjects were not randomly selected but carefully handpicked among a group of people who already suspect the MMR vaccine to be the cause of their children’s ailments. This makes the investigation self-confirming and thus very difficult to conclude anything from. Although one can easily find 100 healthy people who have smoked like chimneys throughout their lives, it’s obviously misleading to use it as an argument that smoking isn’t harmful to the health. Instead, you must randomly select 100 smokers and 100 non-smokers, after which you compare their health – and then you will undoubtedly come to a completely different conclusion. But Wakefield’s study was also weak because he used only 12 subjects and had no control in the experiment. In other words, he should have included children who had not been vaccinated or who did not develop autism.
After the Lancet paper was published in 1998, several other researchers start to search for a connection between the MMR vaccine and autism. Already in 2002, Kreesten Meldgaard Madsen of Aarhus University in Denmark publishes a comprehensive study covering all children born in Denmark from 1991-1998. Among the 537,303 children, 82 percent had received the MMR vaccine, while 738 had developed autism. Together with his colleagues, the researcher now uses statistical methods to see if there is a connection, and the short answer is: No. In fact, researchers find that the risk of autism is 8-17 per cent lower for the vaccinated children compared to those who have not been vaccinated. Intuitively, one would think that the MMR vaccine might then protect children against autism, but researchers estimate that the statistical uncertainty is too big to make such a conclusion.
Guy Eslick from the University of Sydney in Australia also acquits the vaccine on all charges in 2014. In a so-called meta-analysis, he has analysed five major studies, where other researchers have investigated the connection between autism and vaccines – including Kreesten Madsen’s study. Together, the studies include 1,256,407 children, and again the conclusion is clear: Children do not risk autism by being vaccinated. Against this conclusive result stands Andrew Wakefield’s study of 12 children – 100,000 times less than the Australian meta-analysis.
The test results are withdrawn
Andrew Wakefield does not have much confidence in the academic world, but what has been revealed of his scam so far is still only the top of the iceberg. The journalist Brian Deer reveals in 2004, that the doctor has previously applied for a patent for an alternative measles vaccine. The existing MMR vaccine is a mixture of three vaccines against measles, mumps and rubella, and according to Wakefield, the combined vaccine is harmful in this mixture. In his patent application, he explains that he will be able to avoid the risk of autism and bowel disease by giving the measles vaccine separately, and it is precisely such a vaccine he has applied for a patent. Wakefield, accordingly, has a clear financial interest in discrediting the existing MMR vaccine because that would pave the way for his own alternative and it provokes an unpleasant suspicion that the doctor deliberately cheated with the article in The Lancet for his own financial gain. The new accusations make ten of the twelve other researchers who co-authorised the contested article turn their back to it and regret the consequences of it.
Wakefield is now deeply discredited, and The Lancet is under pressure to retract the 1998 article. So far, it has only regretted certain irregularities in connection with the attorneys’ funding of the investigation, and the editors’ motive is likely that a withdrawal may put the highly acclaimed journal in a bad light. However, in January 2010, the UK General Medical Council (GMC) states that Wakefield has committed both scientific malpractice and unethical treatment of ill children by taking blood samples from them without prior approval. The same year, The Lancet finally retracts the fraudulent article and shortly after, the British health authorities withdraw Wakefield’s medical authorization. Slowly, worried parents around the world become more calm. More and more children get the MMR vaccine and in many countries, the target of 95% vaccinated children is within reach.
The HPV vaccine is the new bogeyman
Even though the worst storm is now cleared, several vaccine sceptics are working hard to cast doubts over vaccines. They are especially going after the HPV vaccine, introduced in several countries about 10 years ago.
This vaccine protects against the most common varieties of human papillomavirus (HPV) that mainly infect young women’s genitals and cause genital warts. But in addition, infection with HPV virus is responsible for virtually all cases of cervical and rectal cancer, as well as over half of all cases of head and neck cancer as well as cancers of the vagina, lips and penis. Worldwide, HPV virus is believed to be behind 300,000 cancer deaths every year, equivalent to 5 percent of all cancer victims.
The HPV vaccine has only been in use for about 10 years, and since it protects against cancer, which typically takes 10-30 years to develop after an HPV infection, it is still not known how effective it is. The most comprehensive study of effectiveness dates from 2017, where 2084 women from the Nordic countries were followed for 12 years after they had been vaccinated. None of the women developed neither cervical cancer nor the progenitor of the disease. Based on this study and more extensive clinical trials before the vaccine was approved and marketed, researchers estimate that it can prevent 70-90% of all HPV-related cancer cases. This means that the vaccine can save more than 200,000 lives a year.
Despite the promising prospects, the HPV vaccine – most commonly known under the Gardasil brand – has received many opponents who encourage parents not to vaccinate their children. In particular, they use blogs, social media and other online services to spread information that is at best misleading and, at worst, can be termed fake news. The Canadian anthropologist and neuropsychiatrist Anna Kata of McMaster University in Ontario, has studied these groups, which, in her opinion, have greater and greater influence on the parents’ decision to say yes or no to vaccines. There is a general tendency for people to listen less to doctors and other experts and instead to be guided by information that they find themselves on the internet.
The arguments of vaccine sceptics are weak and misleading
Anna Kata has found that anti-vaccine campaigns create widespread distrust of the experts. They use arguments like “scientists are bought by pharmaceutical companies” and “science has previously been wrong”. On the other hand, the simple gut feeling of common people are praised as credible with arguments like “I am the greatest expert in my own child” and “So many people [those who do not allow their children to be vaccinated] cannot be wrong”. Other arguments put the vaccine in a bad light by emphasizing that it is not 100% effective and therefore failing, or that one does not yet know exactly how effective it is, which makes it uncertain. And again, other arguments strongly condemn the vaccine to be unnatural as opposed to immunization after a natural infection, or potentially dangerous because it is impossible to prove the opposite.
In other words, the arguments of the vaccines sceptics are very emotional and somehow difficult to argue against because they are so vague and broadly formulated, often based on individual cases, and do not at all consider scientific documentation. Not even one of the most scientifically based arguments of the anti-vaccine movement can pass the test, namely that several young women have experienced chronic fatigue after being vaccinated. These unfortunate cases have, however, been thoroughly studied by researchers who, overall, have not been able to connect them with the HPV vaccine. A
study by the British health authorities from 2013 thus found that 29 vaccinated girls experienced chronic fatigue symptoms between 2008 and 2010, in which period more than 1.5 million girls received the vaccine. Even assuming that only 10% of all cases of chronic fatigue were reported and thus contributed to the researchers’ study, the number is still only within the limits of what would be expected because the symptoms can also arise from completely different and often unknown reasons. In addition, the researchers found that the number of cases of chronic fatigue in young girls did not increase after the vaccine was introduced in Britain in 2008, but actually decreased by about 10%.
Two other comprehensive studies from 2017 by Anders Hviid of the Danish research center Statens Serum Institute also show that the HPV vaccine also has no such long-term side effects. The two studies comprise over 5 million women who were either vaccinated or not and the researchers have followed them for several years. The results show that the vaccine does not increase the risk of serious autoimmune or neurological diseases, and that women do not have to fear for side effects on their children if they become pregnant at a later date.
Fraudulent doctor goes to the movie
Far away from the broken reputation in his native country, Andrew Wakefield has now settled on the other side of the Atlantic. In January 2013, he appeared in Washington DC for the Realscreen Summit, an annual recurring meeting where the television industry is trying to develop new concepts for reality shows. From his laptop, Wakefield showed a short trailer promoting his idea for a new television show called The Autism Team: Changing Lives. The trailer showed three children with autism who screamed wildly, bit their mother in her hand, and hit themselves in the head with a book. But to the relief of the unhappy parents, Wakefield and his autism team had developed an effective cure, and in the new reality show, one would follow the dramatic journey of the families from the suffering of the disease to the blessing of healing. So far, the TV show has not been aired, but the former doctor continues his efforts to blame vaccines for causing autism. In 2016, he celebrated the premiere of his documentary Vaxxed, claiming to reveal the authorities’ attempt to destroy data that allegedly showed a link between the MMR vaccine and autism.
Even though Andrew Wakefield is an expert in such scams himself, the movie received a cool reception and has not attracted nearly as much attention as his first attempt to spread fake news in 1998. And fortunately, the documentary has not triggered a new wave of mistrust among parents. Hopefully, they will let science rule and give their children the vaccines that can keep them safe from lethal infections with measles virus and HPV.