In an era of profound medical advancements in drug therapies and technologies, the U.S. finds itself immersed in a controversy over the very basic issue of vaccines. An increasing number of parents have made a decision to not have their children vaccinated for measles, mumps, and rubella. Their rationale for this choice comes not from science but rather anecdotal narratives about what has reportedly happened to many children after receiving the MMR, trivalent vaccine. There is a belief, unproven and untested, that autism is a risk of the MMR vaccine.
And the consequence of this fear was predictable.
By January 30th of this year, the CDC had reported that there were 102 cases of measles confirmed in 14 states, and in Arizona health care officials said they were tracking up to 1000 people who may have been exposed. The outbreak appears to have originated at Disneyland in California during the Christmas holidays, an international gathering place for families. The subsequent outrage directed at parents who choose not to fully vaccinate their children has led to demands that they be jailed, sued, or have their children barred from public schools. Vaccination, once considered almost a miraculous disease preventive, is now having its efficacy discussed as an issue in the coming presidential campaign.
How in the hell did this happen? And what can we do to end it?
There are untold thousands of parents in the U.S. and elsewhere that are completely convinced that their child developed autism after a reaction to the MMR trivalent vaccine. In fact, there is a kind of unofficial pathology that has emerged from these narratives. A child of 12-24 months is developing normally and possesses a vocabulary of several words; they are hitting their developmental milestones, and showing nascent cognitive skills. Weeks after the administration of an MMR vaccine, however, parents report that the child can no longer talk, is impaired socially, and often suffers from severe gastrointestinal symptoms. Ultimately, there is a diagnosis of autism.
While parents of the children who had these reactions and diagnoses are convinced of the causation, medical science has been considerably more circumspect. In fact, parents feel there has been a shortage of research regarding possible complications of the MMR vaccine.
The idea of vaccines causing autism is not simply the provenance of parents looking for answers to what happened to their children. The late Dr. Bernadine Healy, the first women to head the National Institutes of Health (NIH), told CBS News in a 2011 interview that we were obligated to find out the facts about vaccines and potential groups of children that are sensitive to exposures.
“This is the time,” she said, “when we do have the opportunity to understand whether or not there are susceptible children, perhaps genetically, perhaps they have a metabolic issue, mitochondrial disorder, immunological issue, that makes them more susceptible to vaccines plural, or to one particular vaccine, or to a component of vaccine, like mercury. So we know, in these times, have to, I think, take another look at that hypothesis, not deny it. And I think we have the tools today that we didn’t have ten years ago, that we didn’t have twenty years ago, to try and tease that out and find out if indeed there is that susceptible group. Why is this important? A susceptible group does not mean that vaccines are not good. What a susceptible group will tell us is that maybe there is a group of individuals, or a group of children, that shouldn’t have a particular vaccine or shouldn’t have vaccine on the same schedule. I do not believe that if we identified a susceptibility group, if we identified a particular risk factor for vaccines, or if we found out that maybe they should be spread out a little longer, I do not believe the public would lose faith in vaccines.”
The research Healy suggested has never been conducted. The most infamous researcher to even broach the subject was the controversial Andrew Wakefield. He studied 12 cases of children whose parents claimed they had been developing normally but regressed to autism after the MMR vaccine, and he discovered the same inflamed and ulcerated bowel problems in most of those subjects. This prompted a theory that undigested proteins from food were leaking through the lining of the bowel, into the bloodstream, and harming the brain, maybe even causing autism. When Wakefield first reported his findings at the Royal Free Hospital of Medicine in London, he was very pointedly asked in an interview if he had found a link between autism and MMR.
“No,” Wakefield answered. “The work certainly raises a question mark over the MMR vaccine, but, it is, there is no proven link as such, and we are seeking to establish whether there is a genuine causal association between MMR and this syndrome or not. It is our suspicion that there may well be but that is far from being a causal association that is proven beyond a doubt.”
Dr. Healy and Wakefield suggested an interim approach to dealing with parental apprehensions about a trivalent vaccine like MMR would be to return to monovalent, or single, vaccines. Although the incidences of autism have continued to climb dramatically in the U.S., the monovalent vaccines are no longer available in this country. If a parent were worried about an association and wanted to avoid the MMR and get their child a single and separate vaccine for measles, mump, or rubella, they would be compelled to travel to Europe, Africa, or Asia, where these monovalent vaccines are still offered to the public, which is hardly a cultural solution for our entire country.
Healy, and the later discredited Wakefield, were not the only voices recommending a monovalent strategy for vaccines. In her 2001 book, What Your Doctor May Not Tell You About Children’s Vaccinations, Dr. Stephanie Cave offered an alternative vaccine schedule from the triple-jab MMR and advocated for the continued use of the “individual components of the MMR vaccine twelve months apart, starting with the measles shot first at fifteen months.” A similar approach was suggested in 2007 by Dr. Robert Sears, who said, “Splitting the MMR into separate components is thought by some researchers to decrease the risk of autism and other reactions, although medical science has not proven this is so.”
Unfortunately, not acknowledging these issues is also frightening families. Pediatricians report that families are seeking alternative vaccine schedules and want to use monovalent, single dosages of measles, mumps, and rubella. In spite of that trend, the MMR manufacturer in the United States, Merck, ceased producing the single vaccines for the U.S. in 2009 and recommended everyone receive the MMR combined dose. The monovalent measles vaccine, however, is still available overseas, manufactured by Sanofi Pasteur of France, Bio Farma in Indonesia, GPO-MBP, Thailand, and the Serum Institute of India, LTD.
Making the monovalent (single) vaccines available in the states again would likely greatly reduce or possibly even end the current anti-vaccine movement. Clinical data indicates that for a population to avoid epidemics and outbreaks of those diseases, about 95 percent of all individuals must be vaccinated. The CDC’s latest statistics show that just over 91 percent of children aged 19-35 months have been fully vaccinated in the U.S., though there are pockets across the county where that figure is dangerously low.
Arguing with the anti-vaccination movement, and waiting on research that will address these concerns, will do nothing to end the increasing risk of potential outbreaks. Providing parents with single dosages of measles, mumps, and rubella vaccines over an extended schedule is likely to reduce fears and increase protection from disease. Either Merck should be compelled to again produce monovalents or they should be imported. There is no rationale for waiting to take those steps.
There remain far too many parents convinced their children regressed to autism after the MMR shot, and the government continues to ignore their concerns, to the detriment of public health.
“I think the government,” Dr. Healy said in her CBS interview, “or certain health officials in the government, are, have been too quick to dismiss the concerns of these families without studying the population that got sick. I haven’t seen major studies that focus on, three hundred kids, who got autistic symptoms within a period of a few weeks of a vaccine. I think that the public health officials have been too quick to dismiss the hypothesis as irrational, without sufficient studies of causation. I think we are saying, that public health officials have ‘turned their backs on a viable area of research, largely because they’re afraid of what might be found!”
Science is supposed to be fearless. Parents cannot afford to be. And the single dose vaccinations may be the best solution to end the current scare and prevent disease outbreaks.