Hello, and welcome back to The Autistic Writer. One of the most provocative questions about autism is: Do vaccines cause autism? The answer to that question involves one of the biggest scandals in the history of the autism field.
my story
During the Covid-19 pandemic, I worked in an NHS hospital. As a key worker, I could not just stay at home. I would travel to work on public transport, as parking on site was so restrictive.
At the height of the pandemic, bus services in my city were scaled back, but plenty of key workers like myself had to use the buses to get to the cluster of hospitals in Sheffield, which are within a stone’s throw of each other: The Royal Hallamshire Hospital, The Jessop Wing, Weston Park Hospital, Charles Clifford Dental Hospital, and the Sheffield Children’s Hospital.
The buses were always crammed full of passengers going to the hospitals in the mornings, even during the worst part of the pandemic. It was frustrating and worrying. And all through this period, I kept encountering people who said they would never accept a vaccine.
Brian Deer
“As I pressed on, asking questions, gathering documents, and resisting lawsuits that he brought to try to gag me, his report was retracted as utterly false, and his doctoring days were done.” ~Investigative journalist Brian Deer on Andrew Wakefield.
andrew wakefield
Andrew Wakefield, a former British doctor who was struck off the medical register, became the public face of claims that the MMR vaccine was linked to autism. Those claims were later contradicted by extensive scientific research, while investigations uncovered serious ethical breaches, undisclosed conflicts of interest, and evidence of fraud in Wakefield’s work.
the mmr vaccine
The MMR (measles, mumps and rubella) vaccine was first licensed for use back in 1971. Prior to that, measles caused more than two-and-a-half million deaths worldwide every year, according to the European Centre for Disease Prevention and Control.
These days, thanks to a massive vaccination program, worldwide deaths from measles are well under two hundred thousand, annually. This is a breathtaking achievement in healthcare.
the lancet: wakefield’s claims
In 1998, Andrew Wakefield and several co-authors published an article in the highly respected medical journal, The Lancet. The paper suggested a possible association between MMR vaccination, gastrointestinal symptoms and, importantly, developmental disorders. The evidential basis for this claim was a study comprising only twelve children, a sample size far too small to support broad conclusions.
Wakefield’s paper did not explicitly conclude that MMR causes autism. It described a group of twelve children with developmental disorders and gastrointestinal symptoms and suggested that the onset of behavioural symptoms had followed MMR vaccination in some cases. Wakefield and his co-authors called for further research rather than claiming proof of causation.
However, of the twelve children in the study, only eight had autism diagnoses, and the others had non-autism-related developmental delays (although the later investigation by the General Medical Council revealed some of the medical records of these children had been falsified). But a perceived link with autism was then focused on in the media.
in the media
The vaccine-autism link seemed superficially plausible to many parents because MMR is typically administered at around 12–15 months of age. This overlaps with the age at which autistic traits often become more noticeable.
The narrative in the media morphed from:
- Suggestion of a link between MMR vaccination, gastrointestinal symptoms and developmental disorders.
to
- The MMR vaccine might cause autism.
Autism became a hot subject in the media. Wakefield was its poster boy, and he pursued the publicity relentlessly.
Although the 1998 paper itself was cautious in its wording, Wakefield’s public statements at the time went further. At a press conference and in subsequent interviews, he suggested that the findings raised concerns about the safety of the MMR vaccine and recommended considering the use of separate vaccines rather than the combined MMR.
These comments drove media coverage and contributed to the public perception that a link between MMR and autism had been identified. In retrospect, it is alarming that more people were not asking, What’s in it for him?
It eventually became clear that substantial financial interests were involved with his claims.
investigation and retraction
As was later revealed, not only was the science methodology used by Wakefield suspect, but there was evidence of fraud. Brian Deer, in his investigation, uncovered evidence that Wakefield had been paid several hundred thousand pounds to develop his study, by a British solicitor who was building a lawsuit against the makers of the MMR vaccine.
In 2004, ten of Wakefield’s thirteen co-authors formally withdrew their support for the paper’s interpretation, six years before The Lancet fully retracted the paper in 2010.
The General Medical Council found Wakefield guilty of professional misconduct, and he was struck off the medical register in May 2010.
Despite all the evidence against Wakefield, the decision of the GMC, and the overwhelming scientific and medical evidence in favour of the MMR vaccine, some people still believe the vaccine causes autism.
the anti-vaccine movement
The legacy of Andrew Wakefield is not simply that he misinformed the world about both autism and the MMR vaccine. He became, and remains, a figurehead for the anti-vaccine movement.
Following Wakefield’s false claims, vaccination rates dropped as frightened, misinformed parents decided they didn’t want their kids to become autistic from the MMR vaccine. Vaccine uptake fell significantly in the UK, contributing to subsequent measles outbreaks that infected thousands of people and resulted in preventable deaths.
The mistrust of vaccines and medical institutions that Wakefield helped to amplify became a significant feature of vaccine hesitancy during the Covid-19 pandemic.
bad science
Wakefield’s 1998 paper examined just 12 children. It wasn’t a controlled trial, it wasn’t designed to establish causation, and it relied heavily on case histories. Even if conducted perfectly, a sample of 12 children could never scientifically establish that the MMR vaccine causes autism.
In contrast, subsequent researchers used national health databases containing records of hundreds of thousands of children, allowing them to compare autism rates in vaccinated and unvaccinated groups.
How science refuted Wakefield
The 2002 Danish study (537,303 children)
One of the most influential studies investigating possible links between the MMR vaccine and autism was conducted in Denmark, and published in 2002.
Researchers examined 537,303 children born between 1991 and 1998. Around 82% had received the MMR vaccine. The researchers then compared autism diagnoses in vaccinated and unvaccinated children.
They found no increased risk of autism among vaccinated children. The incidence of autism was essentially the same, regardless of MMR status.
The 2019 Danish study (657,461 children)
After increasingly large studies failed to find an association between MMR and autism, proponents of the vaccine-autism hypothesis narrowed their position, to claim that any effect might be limited to a small subgroup of children who were already predisposed to autism
To address that possibility, researchers conducted an even larger Danish study involving 657,461 children born between 1999 and 2010. They examined not only autism rates generally, but also whether the MMR vaccine might trigger autism in children already at elevated risk, such as those with autistic siblings.
The results were unambiguous:
- No increased risk of autism after MMR vaccination.
- No evidence that MMR triggered autism in susceptible children.
- No evidence of autism diagnoses clustering after vaccination.
Over a million children: Meta-analysis
Scientists don’t always rely on a single study. They often combine evidence from multiple studies in what are called meta-analyses.
Several large reviews have examined data from well over a million children, and consistently found no evidence that vaccines, including MMR, cause autism.
The World Health Organisation’s most recent review again concluded that the available evidence does not support a causal link between vaccines and autism.
follow the money
Regardless of whether financial gain was Andrew Wakefield’s primary motivation, he did stand to benefit financially from the acceptance of his claims about the MMR vaccine and autism.
There are many ways to profit from public fear of autism without making claims that are overtly fraudulent. Repeatedly portraying autism as a crisis in need of prevention, treatment, or cure, can create a market for products, therapies, interventions, and services, regardless of how well supported they are by evidence.
Every time you come across some claim about research into cures for autism, or treatments, or therapies, you should ask yourself, like we all should have asked about Andrew Wakefield, who is making money from this?
That’s all for this time. Take care.
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