22/2/02 Private Eye
MMR: SCARE-MONGERING?

When, 16 months ago, an "incalculably small risk" was identified in a polio vaccine derived from potentially "mad" British cows, the government withdrew it from the market. At the time chief medical officer Sir Liam Donaldson said: "Public confidence in medicine safety is paramount. We have to approach this from a precautionary principle..."

With public confidence in the MMR triple vaccine now at a critical low and with new research showing there might be a risk, one might have expected similar caution to apply. Even if the government didn't bow to pressure to withdraw the triple jab, it might have been sympathetic to the overwhelming wish of parents to be offered the choice of single vaccines instead. But no. Donaldson, along with ministers and other government health advisers, went on a bullyboy offensive instead, accusing those who express doubt or concern of "scare-mongering" and "playing Russian roulette" with children's lives.

In fact it is the latest research in the MMR-autism controversy - a study that shows the unexplained presence of the measles virus in the guts of vaccinated children who have both serious gut and bowel disease and autism - which has alarmed parents.

The study comes from Dublin-based Prof John O'Leary, and a team including Andrew Wakefield, the gastro-enterologist at the centre of the MMR-autism furore. Again, it does not prove a link and the scientists behind the paper are not claiming that it does. But it does raise serious questions.

What is the virus doing in children who have received either the MMR vaccine or another vaccine containing measles? Everyone knows how potentially damaging measles can be, so is it responsible for the rare gut disease from which they all suffer? Could that in turn trigger autism? Or is it a case of children who are prone to develop autism and gut disease have immune systems which render their bodies unable to properly deal with the measles virus, either from the vaccine or the wild?

These questions need serious investigation. But Sir Liam's response was to say the paper is "riddled with flaws". Really? The paper has been fully peer-reviewed and the researchers offered their raw data for scrutiny.

One criticism has been that the team did not do DNA sequencing to find out if the measles virus came from vaccine or the wild. But it would be an amazing coincidence if all the children from different parts of the country had contracted wild measles, when we have relatively few outbreaks. That in any case would raise questions about the efficacy of the jab - something the government might also want to investigate.

Instead, Tony Blair and Co tell parents there is nothing to worry about and the vaccine is safe. But there are hundreds of intelligent and resourceful parents, many of whom have read far more scientific papers on vaccines than any politician, who are convinced their children have been horrifically damaged by the triple vaccine.

They have access to the web and circulate critiques of the latest research almost as soon as it is published. They are not scare-mongering zealots who want to "see a return to the dark ages", but their children do share a rare combination of conditions that they appeared to develop after receiving MMR.

That may eventually prove to be coincidental; but so far nothing the government has said - and none of the studies it has cited as proof that there is no link - has changed their minds. (Indeed, the Institute of Medicine in the US has already conceded that in rare cases there just might be a link.)

Nor did an epidemiological study released last week - the latest from Prof Brent Taylor, head of child health at the Royal Free Hospital in London, and described by Dr David Salisbury, government head of immunology, as a "clean and elegant piece of work" - reassure parents. This study looked at the case papers of 473 children with autism born between 1979 and 1998 and found that the percentage of children who developed regressional autism was no higher before the introduction of MMR in 1988 than it was afterwards. Nor was there any difference in the frequency of autistic or bowel problems in children who had MMR before their parents became concerned about their development and those who had MMR afterwards or did not have it.

This paper - unlike the O'Leary paper - shows little raw data. It does not show the distribution of the children by year of birth and deals only in percentages, which makes it difficult to interpret because no idea is given of how many children are being dealt with in each year. On the face of it the research shows a straight line for autism and bowel disease across the 20-year  period - but we know both have risen dramatically. It is most likely that Taylor has very few children in the early year groups and many more later. Neither does the paper reveal how many in each group had MMR or what criteria Taylor has used to decide "regressional" autism as against "classic" autism (when the oldest children in his group were diagnosed as autistic, it was a good 15 years before a new variant regressive type had even been identified). Prof Taylor claimed last week that this paper "should be close to the end game" for the MMR-autism hypothesis, and that MMR has the safest profile of any vaccine. Yet MMR accounts for the largest claims in the US for vaccine damage compensation. Interestingly, to fund this relatively generous scheme (compensation bill to date: US$1.3billion) the vaccine manufacturers pay a tax per vaccine into the communal pot on a sliding scale of risk. MMR was assessed in second place to DPT (diphtheria, whooping cough and tetanus), attracting a tax of US$4.44 per dose compared to just 29 cents for polio, for example. One recognised category for compensation is vaccine-induced measles.

It is no longer enough simply to say that millions of doses have been used in 90 countries as evidence of safety. As Eye readers will recall, early MMR had to be withdrawn after it caused mumps-related meningitis around the world. Other countries, including Finland, Sweden and in particular the US, have recorded unexplained hikes in autism rates. On the other side of the coin, Japan does not use MMR and does experience high rates of measles-related deaths. 17 last year. It, unfortunately, does not record autism rates.

No one in Britain wants to see a re-emergence of measles. But people do want to know why autism rates are growing; and for faith to be restored in our vaccination programme, MMR has to be ruled in or out - or at least an honest assessment has to be made of the relative risks. That requires open research and debate and the choice of single vaccines for parents.