Natasha Sarah Crowcroft is Chief of Applied Immunization Research at Public Health Ontario and a Professor at the University of Toronto in Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health. Her work aims to maximize the public health benefits of immunization.
It is good to celebrate anniversaries of major achievements in public health. The bicentenary anniversary of the publication of Dr. Edward Jenner’s paper on vaccination against smallpox, published in 1796, was celebrated on the cover of the 1996 edition of the United Kingdom’s (UK)’s immunization guide, marking one of the greatest achievements of humankind. Recently however we reached the anniversary of a publication that we might all rather forget. Twenty years ago in February 1998, two years after the celebration of Jenner’s legacy, The Lancet medical journal published a paper describing a small case series of “ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children”. The story has been described eloquently many times.
The 1998 publication may have passed without any attention but for a press briefing that took place at the Royal Free Hospital Medical School in London. At that briefing, the lead author, Andrew Wakefield informed the journalists present that his paper presented evidence that the MMR vaccine caused autism. He said children should not be getting measles, mumps and rubella vaccines all together at the same time. Not surprisingly, a media storm erupted. It heralded the start of a prolonged campaign against the MMR vaccine by some media outlets and a deafening absence of support from the UK’s Prime Minister at the time, Tony Blair, who refused to say whether his own son had been vaccinated. MMR vaccination coverage fell progressively, and eventually outbreaks of measles ensued.
A purported link between vaccines and autism came from unethical and scientifically indefensible work. No credible scientific work before or since supports any such link. While the UK media had a terrible part to play in fueling the storm, it later redeemed itself through the power of investigative journalism. Brian Deer’s work, published in the Sunday Times newspaper, led to Andrew Wakefield losing his medical license in 2010, and to The Lancet finally retracting the paper. The medical profession and the Lancet medical journal did not come off well in being too slow to regulate themselves. On 2nd February 2010, nearly 12 years after the original publication, The Lancet Editors announced that they had retracted the paper from the published record.
When the original story first broke in 1998, the damage was initially fairly well confined to the UK. The story has never had the same widespread impact in North America, remaining a more localized issue. Whilst measles was even declared eliminated in 2016 in the Americas, it continues to present a serious challenge in Europe, with more than 20,000 measles cases and 35 measles deaths in 2017. Investigative journalism is now in a parlous state, and Brian Deer doubts anyone now would get the support he received for his investigation.
Is there anything good to say about this anniversary? It started with a perfect storm of bad science, the advent of the internet and social media that simultaneously undermined the role of experts and amplified bad stories. Perhaps if it had not been this story, it would have been something else, and perhaps there were important lessons we needed to learn. So what have we learned?
Firstly, we have a clearer idea of what “balance” means in relation to reporting on science. In the early days of this issue, the typical scenario included a single vaccine expert facing someone who was blatantly anti-vaccine, or in extreme cases, a room full of angry parents. Balance does not mean that each side gets an equal voice, but that the issue should be represented in proportion to the evidence. How the media approaches topics such as vaccination has now changed. For example, the CBC Ombudsman in dealing with a complaint that a program “had stacked the deck in favor of vaccines” ruled as follows: “I found that there is no “stacking” because there is no equivalence when the overwhelming evidence points to the safety and efficacy of the MMR vaccine.”
We now appreciate the need for research on what people think about vaccines. We realize that people won’t just do as they are told by doctors and we are more creative in thinking about the issues for society. Ultimately, we all rely on each other to make the world a better place. Regardless of this anniversary, public health professionals everywhere share the common goal of wishing only the best for all children, which includes protecting children through the powerful force of immunization.