The hideous impacts of the vaccine-autism myth—and the reasons it has proven so difficult to debunk.
Deadly Choices: How the Anti-Vaccine Movement Threatens Us All By Paul A. Offit, M.D. • Basic Books • 2011 • 288 pages • $27.50
The Panic Virus: A True Story of Medicine, Science, and Fear By Seth Mnookin • University of California Press • 2011 • 429 pages • $26.99
In February 1998, British physician Andrew Wakefield and 12 colleagues published a study of 12 autistic children in the prestigious medical journal Lancet. At a dramatic press conference, Wakefield declared that the combined measles, mumps, and rubella (MMR) vaccine was the likely cause of autism in eight of the children. Noting intestinal abnormalities in the subjects, he suggested that the measles vaccine virus had traveled to the children’s intestines and brought on infection and inflammation, allowing harmful proteins to enter the bloodstream and cross the blood-brain barrier, causing autism. Based on all this, Wakefield recommended that the different components of the MMR vaccine be administered separately. In practice, this meant that children wouldn’t get vaccinated at all if their parents refused the combination dose.
His claims, linked to so prestigious a journal, caused an immediate sensation. The spirit of public reaction was captured by the 2003 British television drama Hear the Silence, which depicted Wakefield as a heroic figure helping a mother find the true cause of her son’s autism. Unethical drug company executives and public-health officials were the film’s villains. This fictive Wakefield faced harassment and intimidating phone calls. His files were stolen, but he persisted in his important work.
British parents paid attention. MMR immunization rates in England dropped from almost 90 percent to 70 percent following Wakefield’s presentation, with markedly lower rates in specific areas. Local measles outbreaks soon followed. Wakefield also attracted a large following among parents of autistic children in America and around the world. In the year 2000, he testified in an odd House committee hearing chaired by Indiana Republican Dan Burton, who was apparently convinced that vaccines had caused his grandson’s autism.
Today, no serious medical or scientific expert believes that vaccines cause autism. Yet many nervous parents continue to think otherwise. One of these is actress and model Jenny McCarthy. During a 2007 “Oprah” appearance, she said that not long after her son received his shot, “The soul was gone from his eyes.” When Oprah asked what McCarthy knew about vaccine science, McCarthy responded, “My science is Evan, and he’s at home. That’s my science.” Winfrey said, “Thank God for Google,” to which McCarthy responded, “The University of Google is where I got my degree from.”
As in England, increasing numbers of parents in the United States chose not to immunize their children—for measles, mumps, and rubella, and for other diseases, too. As in England, outbreaks of vaccinatable diseases have re-emerged as a public health problem. In 2005, an unvaccinated Indiana teen was exposed to measles on a church mission to Romania. She exposed 500 others at a church picnic, infecting 31 out of the 35 unvaccinated picnickers. Of the remaining 465 immunized people, only three were likewise infected. In California last year, the state recorded thousands of cases of pertussis (whooping cough) and nine related deaths, the most in decades. In 2009, Australia saw a record 13,000 cases. How is it that in 2011 we are faced with significant, sometimes lethal outbreaks of such readily prevented diseases?
That is the subject Paul Offit and Seth Mnookin investigate in their recent books. Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, chronicles several such outbreaks in Autism’s False Prophets and Deadly Choices. Science reporter Mnookin, a contributing editor at Vanity Fair, covers much of the same material in The Panic Virus.
These authors tell depressingly similar stories. Sloppy or fraudulent scientists combine with like-minded parent-activists to spread false rumors, leading hundreds of thousands of parents not to follow public-health recommendations. The combination of public complacency, general ignorance and gullibility, and widespread distrust of pharmaceutical companies and scientific medicine created massive opportunities for anti-vaccination activists to do great harm. How should the medical and public-health communities address this problem? How should progressives respond when their respect for parental autonomy collides with their pursuit of public health and respect for legitimate expertise?
Why do so many people buy into readily debunked vaccine-autism claims spread by people who regularly turn out to be charlatans or grossly wrong? In part, this troubling trend is an ironic consequence of vaccines’ very success in protecting public health. Millions of older people remember terrified parents refusing to let their kids use the local swimming pool. They remember polio patients in iron lungs. Today we don’t experience the palpable fear that polio and other diseases ostensibly vanquished by vaccines once evoked. Complacency is the predictable result.
Part of the answer has to do with the nature of autism. Autism spectrum disorders (ASDs) are a frightening, sometimes mysterious set of social, communication, and behavioral challenges. Signs of an ASD often emerge in toddlers who appear to have been developing appropriately, yet who for no apparent reason begin to seem more withdrawn, behave strangely, or become unresponsive to usual social cues. An ASD is sometimes first diagnosed or suspected around the time a child receives her first doses of the combined MMR or the diphtheria-pertussis-tetanus (DPT) vaccines, around one year of age. Many parents then draw the obvious, statistically erroneous conclusion. Given improved diagnostic methods, greater public awareness, and an expanding range of autism-labeled disorders, the annual rate of ASD diagnoses has also increased, reaching a level of as many as one in every 100 children. No reliable data exist to indicate whether this trend reflects a true increase in underlying disease prevalence or is entirely explained by increased detection and labeling. The fact that this trend coincides with a steadily expanding vaccination schedule reinforces public concerns.
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