Andrew Wakefield: return of the wicked witch
Wakefield’s MMR-autism nonsense had a baleful influence on public health, but he doesn’t bear sole responsibility for recent measles outbreaks.
Dr Michael Fitzpatrick
An outbreak of measles in South Wales has led to the reappearance in the media of Andrew Wakefield, the discredited scientist who launched the scare linking the MMR vaccine with autism 15 years ago. Dr Wakefield is now cast as a pantomime villain, a role he appears to relish in his new career in reality TV.
It is true that Dr Wakefield’s claim of a link between MMR and autism triggered the panic which resulted in a 10 to 15 per cent fall in the uptake of the vaccine, with the result that localised outbreaks of measles are now occurring around Britain. Even though immunisation rates among toddlers have recovered to a level above 90 per cent, substantial numbers of older children and teenagers, who missed out on their jabs at the height of the scare, are now vulnerable to the highly contagious measles virus.
Though Dr Wakefield has been widely blamed for recent measles outbreaks, he does not bear exclusive responsibility. In line with national trends, a local newspaper in South Wales promoted ill-informed fears about MMR and a local solicitor encouraged parents of autistic children to pursue futile litigation claims. Doctors and scientists, who are now outspoken in their condemnations of Dr Wakefield, were largely silent when he enjoyed substantial media and celebrity sponsorship.
Some authorities – including the distinguished US childhood immunisation specialist Paul Offit – are proposing that the government should introduce measures of compulsion to raise MMR uptake and prevent further measles outbreaks. Some have even suggested that parents who opt out of immunisation should be referred to child-protection authorities. Quite apart from the principle of upholding individual liberty against state coercion, there are sound pragmatic grounds for resisting compulsion.
The historical experience of compulsory smallpox vaccination was that it was largely ineffective and counterproductive, provoking militant opposition campaigns. In the US, where immunisation is mandatory before school admission, parents often postpone vaccination until their children are three or four, whereas in the UK and elsewhere in Europe, the consensual system has been generally effective in ensuring a high level of uptake from the second year of life. The US system is now threatened by a rising rate of exemptions encouraged by anti-vaccination campaigns, with an associated growth of home-schooling.
Parents, who are generally committed to the welfare of their children, are more likely to make rational decisions about immunisation in a climate free from scaremongering (including exaggerating the risks of measles) and official bullying.
In response to critics of his role in the measles outbreaks, Dr Wakefield has blamed the government for ignoring his demand to introduce separate measles, mumps and rubella vaccines back in 1998. He has also recycled allegations about the safety of MMR and claims for the MMR-autism link, all long discredited. A novel feature of his recent statement was that it abandoned his familiar practice of citing a list of scientific papers which were claimed to provide independent confirmation of his theory. (On closer inspection, these were revealed to have been produced by past or present colleagues and could be found only in vanity-published journals, if at all.) Instead, Dr Wakefield now listed a number of US court cases in which parents had received compensation payments in relation to allegations of links between MMR and autism. But these judgments confirm only the preparedness of courts to make settlements in defiance of scientific evidence.
Another new departure is Dr Wakefield’s offer to debate the MMR controversy ‘live, in public, and televised’ with ‘any serious challenger’. No doubt this reflects his concern to attract publicity for his new venture into reality TV with his British business partners from his new base in Texas. In the past, he has been remarkably reluctant to engage in public discussion, particularly with his erstwhile scientific peers. In 2001, he refused to attend an inquiry established by the Medical Research Council into the epidemiology and causes of autism, in the aftermath of his MMR claims – even though this inquiry included parent representatives supportive of his case as well as scientific and medical experts. He has subsequently avoided any encounter with his critics, carefully selecting compliant journalists with no relevant scientific expertise for interviews. Any journalist who is suspected to be critical is either refused access by his PR representatives or referred to his lawyers.
The only occasion when Dr Wakefield has engaged in any debate on British TV came in the discussion following the broadcast of the hagiographical docudrama Hear the Silence in December 2003. Flanked by his US acolytes Jeffrey Bradstreet and Arthur Krigsman, and parent supporters, Dr Wakefield appeared assertive and defensive in response to challenges from Evan Harris (then a Liberal Democrat MP) and myself. Wakefield has subsequently restricted his public appearances to conferences of sympathetic parents, anti-vaccination activists and promoters of quack autism therapies. When I asked him a question from the floor at one such conference in Bournemouth in February 2007, he simply refused to answer, deferring to another platform speaker. When I offered to debate with him at a follow-up conference in March 2009, the organisers refused.
Yet Wakefield now welcomes a public debate. I hope that his removal from the medical register in 2010 following a protracted General Medical Council hearing, on grounds of ‘dishonesty’ and ‘irresponsibility’, will not mean he is just snubbed and ignored. The sorry truth is that Wakefield continues to enjoy some influence among parents of autistic children, particularly in the US. As both a GP and a parent of an autistic son who had followed the destructive consequences of Wakefield’s campaign over the past 15 years, I for one would welcome the opportunity to challenge his baleful influence. Are you ready for a debate now, Andrew Wakefield?
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