Swansea in Wales is experiencing a serious measles outbreak, with 1,000 cases and one suspected death so far. The outbreak is the result of an unfounded fear that the combined measles, mumps and rubella (MMR) vaccine caused autism. This is just one among dozens of vaccine scares, and more will inevitably come if no action is taken.
Antivaccination campaigners have existed for as long as vaccination itself, using the same arguments over three centuries. If these scares were driven by evidence, we would expect them to appear everywhere at once. But vaccine panics respect local cultural boundaries, because they are cultural phenomena, driven by social and political factors.
In France, for example, there was a significant scare during the 1990s that a hepatitis B vaccine caused multiple sclerosis. And yet this was barely heard of outside France, even though the vaccine is offered universally in most developed nations. The UK’s MMR scare was most active between 1998 and 2003, creating 1,200 news articles in one year at its peak, and yet this was barely noticed outside the UK.
The US, meanwhile, had its own scare about vaccines and autism, centred on a preservative called thiomersal, which peaked half a decade after the UK MMR–autism scare. The US scare, in turn, received little coverage in mainstream European media.
Meanwhile in 2002, the World Health Organization was on target to eradicate polio from the face of the globe, when a vaccine scare arose across Kano province in northern Nigeria, with imams claiming that the vaccines were part of a plot by drug companies – and the US – to make Muslims sterile. Polio spread to neighbouring nations as well as Sudan, Yemen and Indonesia. But the scare also spread, often along religious channels, reaching Pakistan, where it contributed to the murder of seven vaccination workers last year in Karachi.
Local politics are a recurring theme in triggering these outbreaks. Suspicion around polio vaccinators in Pakistan was heightened by the US Central Intelligence Agency using the vaccination programme as a cover to find Osama bin Laden. The Kano scare emerged in the same area of Nigeria where Pfizer’s Trovan drug trial – associated by many with John le Carré’s novel The Constant Gardener – was blamed for eleven deaths just a few years earlier, and just as the case came to court in the US.
The peak of the UK MMR scare occurred in 2001, a full three years after the publication of the research – now forcibly retracted – on which it was based. It was driven by media speculation over the reluctance of Tony Blair, then prime minister, to disclose whether his eighteen-month-old son had had the vaccine.
But while the triggers may be political, scares land on fertile ground, and nothing has been done to address these background factors. In the UK, there is clear evidence to implicate irresponsible journalism. The South Wales Evening Post covers the area of the Swansea outbreak, and ran a notably aggressive anti-MMR campaign. Published academic research has shown that the MMR vaccine uptake in this one newspaper’s distribution area dropped 13 per cent, while coverage in the rest of Wales fell only 2 per cent. But many journalists remain reluctant to accept responsibility, while public health authorities are keener to promote positive messages than to confront misinformation.
Our systems in science to manage misleading content are also flawed, or even non-existent. Andrew Wakefield, author of the flawed MMR research, was only struck off the medical register after a decade’s delay. Retracting the paper took just as long. The research misconduct in his work was ultimately exposed by Brian Deer, an investigative journalist, while the institutions and academic journals involved were reluctant to accept responsibility for investigating at all. Again, little has changed here over the past decade.
It is right to deploy resources on catch-up programmes for MMR and other missed vaccines when outbreaks occur. But prevention is better than cure, and history teaches us that fresh vaccine scares will always emerge. Eradication is a distant dream, but better education, early media monitoring and improved accountability through scientific institutions may help.