MMR Vaccine and Autism: Vaccine Nihilism and Postmodern Science

It is a truism that acting in one's perceived self-interest is not always in one's self-interest. Perhaps nowhere is this truer in contemporary public health than for the issue of the measles-mumps-rubella (MMR) immunization and persistent fears about a possible connection with autism. Although each of these 3 diseases had been controlled in the United States with the widespread use of the MMR vaccine, in the past decade those gains have been slipping. Even though the United States has had fewer than 50 measles cases per year during the past decade (mostly imported from other countries), 156 cases have already been identified in the first 6 months of 2011.' European countries such as England, Wales, Italy, France, Spain, and Germany are also experiencing substantial increases in measles outbreaks. Why should we be concerned? Measles is the most transmissible human disease known. Even with modem medical care, approximately 1 of every 3000 infected persons die, and many more are hospitalized or otherwise harmed as a result. Population coverage (herd immunity) needs to be in excess of 96% to prevent outbreaks. In addition, measles is a disease for which eradication is both possible and planned, a goal that obviously cannot be met given current vaccine coverage levels. This predictable sequence of falling coverage levels, followed by outbreaks of disease, has occurred because of decreased public confidence in the safety of the MMR vaccine. In large part, this has resulted from incorrect assertions that the vaccine plays a role in the development of autism, an idea promoted by Andrew Wakefield.^'^ No credible scientific evidence, however, supports the claim that the MMR vaccine causes autism, and indeed, national medical authorities and scientific professional societies have unanimously denounced that claim."' More than 20 studies have found no evidence of connection between receipt of the MMR vaccine and autism disorders.*'^ In fact, Britain's General Medical Council determined after its hearings that Wakefield was guilty of dishonesty and serious professional misconduct with regard to his MMR-autism research.* More recently, the editor of the British Medical Journal published a commentary stating that Wakefield's MMRautism research was clearly fraudulent.' Why in the face of nearly 2 dozen studies and every scientific committee rejecting such an MMR-autism connection does this myth persist? I and others have written extensively about the antivaccine movement and its negative effect on vaccine decision making, and on the role of the media in fostering fear.'"'" A recent example is worth examining. The Pace Environmental Law Review published an article concluding that a "preliminary evaluation" of cases compensated through the Vaccine Injury Compensation Program (VICP) "suggests that vaccine-induced encephalopathy and seizure disorder may be associated with autism."'^ Despite the fact that numerous studies have failed to find such a connection, substantial media attention was given to this article, undoubtedly causing further fear and confusion in the minds of the public. To the extent the authors intended to suggest that vaccines like MMR cause or contribute to autism, their conclusion is not only incorrect but also at odds with the work of the VICP itself. Such a conclusion cannot be reconciled with the overwhelming body of scientific research. The Centers for Disease Control and Prevention (CDC), for example, has concluded that "carefully performed scientific studies have found no relationship between MMR vaccine and autism"" and "no increased risk of [autism spectrum disorder] associated with receipt of thimerosal-containing vaccines."" (Note, thimerosal contains ethylmercury, another target of those who attack the safety of MMR vaccine.) Similarly, the Institute of Medicine concluded that the "body of epidemiologic al evidence favors rejection of a causal relationship between the MMR vaccine and autism,"'* and "between thimerosal-containing vaccines and autism."'* Other organizations, including the American Academy of Pediatrics, have reached similar conclusions."•^'' More importantly for current purposes, the VICP itself—after conducting the most extensive and elaborate fact-finding proceedings in its history—concluded there is no causal connection between childhood vaccines and autism. After considering the evidence, one special master stated that "numerous medical studies...performed by