Measles is back: not in regiments, but in numbers sufficient to send a shiver down many parents’ spines. There have been more confirmed cases of the disease in the first three months of the year than in the whole of 2005. One boy has died, the first measles death since 1992. Nine have needed hospital treatment.
Outbreaks started in the travelling community, and spread. In Doncaster, where there had not been a case of measles in the past 12 years, 36 children are affected. Six children in Chatham, Kent, have measles, and two have needed hospital treatment. And six nurses at the Central Middlesex Hospital in northwest London have gone down with the infection after looking after an ill child.
These, of course, are nothing like the numbers who used to catch measles, once a childhood rite of passage along with mumps and chickenpox. But today there is no excuse for any case of measles in a child younger than 18 because there is a vaccine, offered routinely to all children since 1988, that protects against it: MMR.
Today’s measles cases, which have the potential to grow into something much worse, are appearing because parents were frightened by bad science, and worse journalism, into refusing to have their children vaccinated.
The scare that linked MMR to autism was a personal crusade by a single doctor, Dr Andrew Wakefield, based on inadequate evidence and backed by millions of pounds of public money, pumped in by the Legal Aid Board over nine years as it supported a case brought by parents against the vaccine manufacturers.
Almost everybody involved now admits they were wrong: The Lancet, which published Wakefield’s paper that triggered the panic; his colleagues at the Royal Free Hospital in London, who allowed him to turn it into a campaign; and the Legal Services Commission, which funded a “fishing expedition” for evidence. It admitted at the end of 2003 that “in retrospect, it was not effective or appropriate for the LSC to fund research”. Never mind the “in retrospect”: it was never appropriate.
Only Dr Wakefield, who now presents himself as a victim, seems unrepentant, together with the journalists who backed him. But the true victims are the children who find themselves suffering an avoidable disease as a result of their activities.
It cannot be said often enough that MMR is safe, and has always been safe. A large number of studies attest to that. Simon Murch, one of Wakefield’s co-authors, said: “No other vaccine has ever been studied in such depth and the evidence for its overall safety is comprehensive.”
No other country shared the panic over MMR. It was made in Britain, flourished here and, thank heavens, never spread. But it always had the potential to do enormous damage. The mystery is why so many parents were persuaded to believe that MMR caused autism or, more implausibly still, that single vaccines for measles, mumps and rubella would be safer for their children than the triple MMR vaccine. There was never even a shred of evidence for this contention.
The MMR scare is a classic example of how confidence in science is being lost in Britain. For lack of timely defenders, and because even rational people are deaf to reassurances in the wake of the BSE affair, MMR became a fearful symbol of overbearing medical authority.
Weeping parents with autistic children were paraded as if they constituted evidence. Middle-class columnists took up the theme with gusto, combining — as Dr Michael Fitzpatrick, a London GP, puts it — “a high level of emotional engagement but no specialist knowledge of the subject”. To watch this happening and be powerless to stop it made me angrier than anything else I can remember in 40 years of journalism.
Sometimes, journalists need to be reminded that what they write can have consequences. Those of us old enough to remember the whooping-cough affair of the 1970s should have been, in a sense, inoculated against the error. That time, a false link between whooping-cough vaccine and brain damage caused a flight from the vaccine, a whooping-cough epidemic, and around 100 deaths.
So far, the resurgence of measles is on nothing like so alarming a scale, but the cause is the same. Of the first 72 cases confirmed this year by the Health Protection Agency, the vast majority had no vaccinations at all — hardly surprising, as at the height of the scare MMR uptake fell in some areas to less than 80 per cent, leaving a vast number of unvaccinated children and teenagers to act as tinder for the outbreaks.
Two among the 72 cases had had a single MMR jab, but not the follow-up necessary for full protection; and three had had single jabs, two of them in South Africa. It is hardly surprising that they were not adequately protected.
The whole point of the triple vaccine is that it minimises the number of times mothers have to take their babies to be vaccinated, and increases the chances that they will be fully protected. Middle-class mums who recommended single vaccinations took no account of the fact that this would mean six visits to the clinic instead of two, multiplying the risk that many babies — especially those of hard-pressed working-class mothers — would never complete the course. Clinics offering single vaccinations did super business, though: it’s an ill wind that doesn’t blow somebody some good.
How much should we worry about the outbreaks? The issue is whether there are sufficient numbers of unvaccinated children to enable the disease to spread. For complete protection, the World Health Organisation recommends a vaccine uptake of 95 per cent. The UK is significantly below that, at around 83 per cent, but there are pockets — in London in particular — where it has fallen much lower. Dr Ann Marie Connolly, area health director for Haringey, where the nurses have fallen ill, gives a bleak warning: “We run the risk of high outbreaks of measles and its developments — pneumonia, long term brain-damage, and even death.”
Talking of the Chatham cases, Dr Mathi Chandrakumar, director of Kent Health Protection Agency, said: “I am concerned this is the beginning of a wider outbreak of measles in Kent.” The Health Protection Agency said: “The agency has warned over the last few years that outbreaks are likely in areas where uptake has been low and particularly when it has been low for longer periods of time.”
Fortunately, MMR uptake has shown signs of increasing, though a computer glitch in several London primary care trusts has prevented full figures being published for the past year. We may yet escape without cases rising into the thousands. If we do, it will be thanks to the public health profession, and not the one to which I belong and of which, every time I think of MMR, I feel ashamed.
