In 1998, the Lancet published controversial research by Andrew Wakefield that suggested a link between combined measles, mumps and rubella (MMR) vaccination and the subsequent development of autism. It took several years for Wakefield’s paper to be definitively rebutted, during which time my children were born. There is autistic spectrum disorder (ASD) within my wider family; I spent hours agonising over literature on MMR before satisfying myself that Wakefield’s purported connection was wrong. Faced with the same dilemma regarding their own children, one of my relatives, with an even more direct family history of ASD, paid privately for single dose vaccines.
Even though Wakefield was struck off in 2010 – the General Medical Council found that he had acted irresponsibly and dishonestly in the conduct of his research – the shock waves from his discredited claims continue to be felt worldwide and provide much fuel for the anti-vax movement. MMR immunisation rates in England have been falling for years, and now stand at around 91 per cent at 24 months – perilously close to the minimum required for “herd immunity”, the suppression of an infection within a population by virtue of the vast majority having been vaccinated. The incidence of measles in England quadrupled between 2017-18, many of the 966 cases being in unvaccinated teenagers born during the aftermath of Wakefield’s paper. Just last month, our practice saw an outbreak of mumps in a sixth form college – another instance of the Wakefield effect.
Rates of immunisations against tetanus, diphtheria and polio have also been affected, although this appears to be delay rather than absolute decline. Previously, around 95 per cent population coverage would have been achieved in England by the age of one; now it is taking until age two. Vaccine-scepticism is found in many countries and is provoking a range of responses. Germany, for instance, is considering fining parents who don’t comply. Here, the Health Secretary, Matt Hancock, has suggested social media companies be forced to take down false anti-vax material and recently indicated that compulsory immunisation might even be considered.
Measles in the UK is fatal in around 1 in 5,000 cases; Public Health England estimates that 4,500 deaths have been prevented since vaccination was introduced in 1968. Mumps, too, can cause neurological damage and death. And rubella – German measles – causes major foetal abnormalities if contracted by a mother during early pregnancy.
Yet the idea of fining or compelling parents in order to achieve better MMR coverage would be disastrous. I know how I and my relative would have felt had we been forced to vaccinate our children before we had made up our own minds. I am sceptical too about social media censorship. Most parents take decisions regarding their children’s wellbeing very seriously. Most, even if exposed to anti-vax propaganda, will seek multiple sources of information, including from health care professionals.
The way to neutralise false anti-vaxxer claims is to provide rational, evidence-based information that respects parents as responsible people capable of weighing competing perspectives, not by curtailing some groups’ freedom of expression.
Hancock frequently appears beguiled by simple fixes to complex problems. A&Es at breaking point? Here’s an app to identify the one with the shortest wait. A minority of parents wary of vaccination? Silence dissent and compel compliance.
And while vaccination is important, it would be refreshing to see the Health Secretary tackle the greatest threats to our children’s health: the obesity epidemic, declining physical activity, air pollution and burgeoning mental ill-health. There are no quick fixes to these, but Hancock leading a cross-government drive to create policy focused on children’s health would have a far greater impact than coercing a minority of parents to get their kids jabbed.
This article appears in the 15 May 2019 issue of the New Statesman, Return of the Irish question