We’ve reached a very ignominious anniversary. Today, the infamous study that claimed to link the MMR vaccine to autism, published in the prestigious medical journal The Lancet in 1998, is exactly twenty-five years old.

The study, led by the British doctor Andrew Wakefield, was a report of twelve children aged 3-10 years who’d shown regressions in their social and language skills – characteristics of autism. Eight of them had apparently displayed these symptoms just after being given the MMR – the vaccine against Measles, Mumps, and Rubella. The children also had a variety of gut-related complaints. Wakefield’s theory was that there was a new condition, called “autistic enterocolitis”: the MMR vaccine caused intestinal disturbances that were toxic to the developing brain.

But the study was fraudulent. An investigation by the journalist Brian Deer showed that Wakefield had misstated the medical history of several of the children, who had begun to show symptoms before their MMR vaccine, or a long time afterwards (“no case was free of misreporting or alteration”, stated Deer). Not only that, but Wakefield had subjected the children to invasive medical procedures for no good reason, and had a serious conflict of interest since he was being paid by lawyers preparing a case against the vaccine-makers.

In between the publication of the study and its eventual demise—it was only retracted from the scientific literature in 2010—enormous damage was done to the public’s trust in vaccination. The Wakefield affair stands as one of the worst and most damaging incidents of scientific fraud in recent history, as well as a harsh indictment of our scientific, medical, and media establishments.

After twenty-five years, what have we learned?

The Wakefield Fraud

It’s not true to say that Wakefield’s study was the start of worries about vaccines, or even the start of worries about vaccines and autism. Anti-vaxxers have been around for as long as vaccination itself, and concerns about a preservative used in vaccines, the mercury-containing thimerosal, had been buzzing around all through the 1990s.

But the 1998 study—accompanied by a febrile press conference at the Royal Free Hospital a few days prior to publication—kicked off a media storm. Reports of side-effects, a useful indicator of how much public concern there is about a vaccine, began pouring in. MMR rates in the UK collapsed immediately after the study was published, to nearly as low as 80% – a far cry from the 95% required for “herd immunity”, where vaccination rates are high enough that even those who don’t or can’t take the vaccine are still protected.

Years later, we saw the inevitable measles outbreaks – thankfully these have resulted in only a few deaths in the UK, but other countries haven’t been so lucky (and even outside of deaths, measles can have severe complications, including causing deafness and intellectual disability). 2019 also saw an unusually-high level of mumps infections, often in students and other young adults – potentially because they were the right age to have skipped the MMR during the scare.

And for what? Was there anything behind the fears? Is there actually any evidence—beyond Wakefield’s fraudulent study—that the MMR vaccine causes autism?

FILE - This Feb. 6, 2015, file photo shows a Measles, Mumps and Rubella, M-M-R vaccine on a countertop at a pediatrics clinic in Greenbrae, Calif. State health officials say the number of measles cases is up in California this year and much of the increase is linked to overseas travel. Dr. Karen Smith, director of the California Department of Public Health, says the state recorded 38 measles cases as of Thursday, April 25, 2019, versus 11 around the same time last year. She says the state typically sees fewer than two dozen cases a year.(AP Photo/Eric Risberg, File)
The MMR vaccine has been shown to have no links to autism, despite Andrew Wakefield’s study (Eric Risberg/AP)

The MMR vaccine and autism

The computer programmer Alberto Brandolini came up with “Brandolini’s Law”: The amount of energy needed to refute nonsense [he used a harsher term] is an order of magnitude bigger than that needed to produce it. It’s very easy to make people panic on the basis of false information; it’s much harder to calm that panic with sober, high-quality research.

There was never any good evidence for Wakefield’s MMR-autism link. But now, a quarter-century later, we can be as certain as we are about any medical question that there’s no relation. When the panic first hit, researchers began running a variety of different kinds of study to check the link between symptoms of autism and the vaccine. A Danish study in 2002 looked at vaccinated and unvaccinated children, testing whether autism rates were higher in either group. They were just about the same. A 2004 study from the UK looked at things the other way around: they took children with and without autism, and checked whether one group were more likely to have been vaccinated with MMR. Again, there were no differences to speak of.

Perhaps you might think it’s something to do with predisposition. Perhaps it’s not that giving the MMR vaccine to anyone will cause autism, but that it might for those with a higher familial risk. Not so: a study in 2015 compared children who had older siblings with and without autism – the MMR wasn’t linked to autism in either group. And an even larger 2019 study, including more than 650,000 children in total, confirmed this result.

What about Wakefield’s suggested link between autism and disorders of the bowel? For this one, there is actually some evidence: autistic people are more likely (according to a 2021 review of eight studies) to have inflammatory bowel disease, ulcerative colitis, and Crohn’s disease. But there are two important things to bear in mind: first, this is just a correlation and we don’t know why the bowel disorders would be linked to autism; and second, given all the evidence we saw above, it’s vanishingly unlikely that it has anything to do with the MMR vaccine.

Lessons learned?

There’s some good news. MMR rates have ticked up back to a high level in the UK – evidence consistent with the public being reassured by the resounding proof of no links between the vaccine and developmental disorders. And Wakefield himself, unlike many scientific frauds, has been punished: he was struck off by the General Medical Council in 2010, meaning he can no longer practice medicine in the UK (Wakefield himself still stands by his research).

He’s still around, of course: during the COVID pandemic he continued his anti-vaccine stance by falsely arguing on social media that the vaccines change the DNA of those who take them. But he’s had his day: he’s been eclipsed by a range of new anti-vax figures.

One of the object lessons of the Wakefield affair was that that even well-spoken, well-credentialed experts writing in authoritative, peer-reviewed scientific journals can lie. Just because something’s published in The Lancet doesn’t make it true – or even worth discussing. And although many mainstream media sources have learned to be more careful with claims relating to vaccines, the “alternative” media is a different story. Popular podcasters and YouTubers, often with millions of listeners and subscribers, were taken in throughout the pandemic by a series of shysters and fabulists—modern Wakefields—who spread demonstrably untrue claims about the dangers of vaccines to their massive audiences.

The Lancet, too, has been stung again and again by scientific fraud, multiple times since Wakefield. During the COVID pandemic the journal had to retract a Harvard study after two weeks after the authors admitted they could “no longer vouch for the veracity of the primary data”. Two weeks is a lot shorter than the twelve long years it took for Wakefield’s paper to be retracted, which represents progress. But the fact that the paper was published in the first place (another by the same authors appeared, and then was also retracted, from the prestigious New England Journal of Medicine) speaks to serious, still-remaining failings in our scientific peer-review system.

Vaccines are different

The great tragedy of vaccination—one of the greatest ever inventions in the history of medicine—is that there’s something about it that always inspires fear in some subset of the population. Maybe it’s the invasive nature of the needle; maybe it’s the fact the vaccine contains some part of the disease it’s aiming to prevent; maybe it’s the fact we have to decide whether or not to give the shot to our young and vulnerable children.

Whatever it is, something makes vaccination particularly susceptible to overblown fears. The number one lesson from the saga of Andrew Wakefield’s fraudulent study is that the idea of vaccination is such a tinderbox that even the smallest spark—a study with a sample size of twelve, with barely any details and the most tenuous of theories to link the jab to autism—can create a huge blaze of false and dangerous claims.

But it can only do so if it’s given oxygen to burn. The Lancet, the Royal Free Hospital, and innumerable journalists made huge errors in giving Wakefield the publicity he craved.

History repeats itself. Post-COVID, anti-vaccine movement is experiencing something of a resurgence, with wildly misleading claims about the mRNA vaccines, often based on highly questionable studies, being repeated in the media and by politicians and celebrities. Upsettingly, there’s some evidence that the general atmosphere of vaccine fears that arose during the pandemic has produced more worries about MMR specifically. The twenty-fifth anniversary of one of the worst scientific frauds of the modern era gives us an opportunity to reflect on where things went wrong – and try not to make the same mistakes again.

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