Week 1: Andrew Wakefield

One of the largest and most prevalent controversies surrounding the medical industry is vaccine use and its consequences. This controversy, sparked by gastroenterologist Andrew Wakefield in his 1998 article published in Lancet, has caused some of the public to reconsider the routine vaccinations given to young children, such as the MMR vaccine. In his article, Andrew Wakefield describes a study he performed that seemingly showed a link between regressive developmental disorder, chronic enterocolitis, and environmental triggers, in which he was referring to the MMR vaccine. According to Lauren Kolodziejski in her article “Harms of Hedging in Scientific Discourse: Andrew Wakefield and the Origins of the Autism Vaccine Controversy,” Wakefield purposely uses this ambiguous tone to imply a certain meaning without explicitly stating this conclusion to avoid criticism. This strategy can be seen when Wakefield states that his research does not imply causation or even an association, yet he gives multiple other examples of research that also implies that MMR vaccines have negative consequences. He also goes on to explain that further research needs to be done on the MMR vaccine before an association can be made, inspiring the controversy that was soon to follow the publication of this article.

There are also numerous problems associated with Wakefield’s research. To start with, Wakefield’s cohort only included twelve participants, which is an incredibly small sample size for a cohort-study. While Wakefield does make sure to state that his research does not indicate an association between the MMR vaccine and regressive autism, to even imply that an association might exist using research conducted with only twelve participants is entirely ridiculous. The participants used in the study were also carefully picked to help influence the results of the study in the direction Wakefield wanted. Wakefield, of course, proposes that his sampling was consecutive, yet a panel found this to be untrue. This diminishes the credibility and reliability of his research. The research also does not feature a control group, which is integral in any type of study, as it establishes that a significant difference does exist. The study also heavily relied on parental observations, which often was not able to be supported through the child’s medical records. A majority of the parents were also not supporters of the MMR vaccine, which automatically renders their observations unreliable and biased. Another large controversy surrounding Andrew Wakefield and his research was the fact that Wakefield failed to discuss where he was receiving funding from. Wakefield was being funded by a group of lawyers representing parents that were engaged in a lawsuit with a manufacturer of the MMR vaccine, which is a clear conflict of interest. 

Immediately following the release of this article, rates of immunization started to significantly lower, as the article sparked a media frenzy. This frenzy most likely occurred as a result of rising rates of autism in children, as parents were curious about the cause of the disorder. While the study and article were incredibly flawed, Wakefield did made sure to state that his research did not imply association. However, when the media covered the article, they used more familiar jargon and provided a much too generalized discussion of the article. Thus, for many parents, it seemed as if the article was a credible source of information when deciding whether or not to vaccinate their children, resulting in an all-time low for MMR vaccinations. In fact, the percentage of children receiving the MMR vaccine in 2003 in the UK was only 80%. With 80% immunized astonishingly below the herd immunity threshold of 95%, measles and mumps outbreaks began to plague countries that had nearly eradicated the disease. However, as researchers began to notice this drop in vaccination rate, they decided to perform other experiments to either refute or back up Wakefield’s implied claims. These researchers, who used larger sample sizes than Wakefield and implemented a more rigorous and credible study, were not able to find any link between the MMR vaccine and regressive autism. As a result, the public started to become more informed on the actual mechanisms and effects of the vaccine, and immunization rates have slowly started to increase again. In fact, in 2016, the Americas considered endemic measles eliminated. However, there are still outbreaks that occur, even in areas that are considered above the threshold of herd immunity. Some propose that this is a result of a waning immunity that occurs as people age. A possible solution that has been suggested amongst the scientific community is a third dose of the MMR vaccine, which is said to decrease the attack rate from 14.5 to 6.7 cases per 1000 population. When considering that outbreaks can still happen in well-immunized areas of the world, it is important to understand that herd immunity alone will not protect unvaccinated children from getting the mumps or measles, meaning it’s entirely important to vaccinate your children even in a region where it is considered eliminated.