After having spent years promoting public anxieties around issues of health, the UK government's £3million campaign to reassure parents that the MMR immunisation is safe is likely to prove counterproductive.
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The medical top brass, who were assembled at the Department of Health on Monday 22 January 2001 in an attempt to reassure the public over the safety of the immunisation of children against measles, mumps and rubella, blame one man for the fall in the uptake of the vaccine. They believe that, by alleging that the MMR vaccine may cause inflammatory bowel disease and autism, gastroenterologist Andrew Wakefield has single-handedly reduced the rate of immunisation below that required to provide community protection against further epidemics.
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But Wakefield's work only had such an impact because it encountered a climate of opinion that was already highly sensitised to health scares. This climate was not created by Wakefield - though the government and its top medical advisers have certainly done much to encourage it over the past decade.
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As I wrote in response to the initial furore over Wakefield's paper, which appeared in the UK medical journal The Lancet in 1998, I think Wakefield is wrong about MMR (1). But the panic his paper launched has all the elements of a classic modern health scare (2).
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It raises the spectre of a devastating condition, confuses an association (autism appearing around the time of the immunisation) with causation ('MMR causes autism'), and taps into pre-existing suspicions about the dangers of immunisation (going back to smallpox, polio and whooping cough). Desperate parents have seized on the conviction that the MMR caused their child's illness, and have often been encouraged by lawyers on the scent of compensation.
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Over the past three years, the MMR panic has gathered such momentum that it now threatens to destroy the national immunisation programme. In response, the government and the medical establishment have adopted a two-pronged strategy: to rubbish Wakefield, and to try to make parents fear that their unimmunised children might die from measles.
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As this week's conference showed, demolishing Wakefield's case is not so easy. It requires a detailed review of academic papers, appraisal of epidemiological, clinical and pathological data, discussion of methodological issues. The ultimate problem is that it is impossible to prove a negative - that MMR does not cause autism.
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Promoting fears about rampant measles (and mumps and rubella) is more familiar terrain for the public health authorities. At this week's conference they cited recent minor outbreaks in Ireland and in south London, which resulted in a small number of deaths. But this approach raises a wider problem.
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It is this sort of official scaremongering, the promotion of public fears about dread diseases in the cause of influencing public behaviour, that has fostered the climate of general anxiety about health which now nourishes the MMR panic. The fact that these same authorities are now trying to reassure parents that MMR is safe means that the future of the immunisation campaign is now in grave jeopardy.
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Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).
Read on:
MMR: immune system as metaphor, by Dr Michael Fitzpatrick
Immune to the evidence, by Dr Michael Fitzpatrick
MMR: injection of fear, by Dr Michael Fitzpatrick
spiked-issue: MMR vaccine
(1) See 'MMR madness', Dr Michael Fitzpatrick, LM magazine, September 1998
(2) See chapter 2 of The Tyranny of Health: Doctors and the Regulation of Lifestyle, Dr Michael Fitzpatrick, Routledge, 2000
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