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Bit of a buzz on anti-vaccination websites about apparent court rulings in favour of MMR/autism cases. An example is  from a website called “why don’t you try this?” which cites as a source Whiteout Press (“if its blacked out, covered up of censored you can find it here”)  which in turn cites The Liberty Beacon which for its part cites Health Impact News Daily , that cite a press release from Autism Media Channel  at which point the trail goes cold because there do not appear to be any press releases on that website, although an article by anti-vaccination author David Kirby in the Huffington Post  seems a likely source for some of this baloney.

Anyway, back to the issues circulating in the apparent absence of any credible sources. According to the buzz, pharmaceutical companies and governments have admited that vaccines cause autism. There appear to be general themes presented – presumably to support this idea:

  • Andrew Wakefield has been vindicated by new research
  • The vaccine courts have awarded damages to children made autistic by vaccines

Wakefield is playing victim again. The material appears to derive from his own propaganda.

He has posted clips on YouTube explaining what a legend he is and how he has been victimised by the UK health authorities. Let’s take a look at some of what he has to say – these are snippets that are circulating on the aforementioned websites. To set the scene he starts by saying he is not seeking any attention, has been denied the opportunity to redress allegations made against him, that legitimate debate has been blocked by the government…it wasn’t me, I didn’t do it etc… Then he goes on:

The important thing to say is that back in 1996 — 1997 I was made  aware of children developing autism, regressive autism, following exposure in many cases to the measles mumps rubella vaccine. Such was my concern about the safety of that vaccine that I went back and reviewed every safety study, every pre-licensing study of the MMR vaccine and other measles containing vaccines before they were put into children and after. And I was appalled with the quality of that science. It really was totally below par and that has been reiterated by other authoritative sources since.

I compiled my observations into a 200 page report which I am seeking to put online once I get permission from my lawyers. And that report was the basis of my impression that the MMR vaccine was inadequately tested for safety certainly compared with the single vaccines and therefore that was the basis of my recommendation in 1998 at the press conference that parents should have the option of the single vaccines.

So fifteen years later he comes up with a report that must be so secret it could not be published revealing inadequate testing of the MMR vaccine. Now he is going to post it online.

Generally it is not considered necessary to conduct an efficacy trial for a vaccine that combines antigens that have previously been demonstrated efficacious (e.g. measles, mumps and rubella). It is the demonstration of non-inferior immunity that is required. Vaccine safety will be assessed against existing vaccines. Also, once a vaccine is in use it becomes unethical to conduct a placebo controlled trial and new vaccines are assessed against existing vaccines. So if anyone is looking for a placebo controlled trial for MMR vaccine that is not a crossover design they will probably turn up little.

One thing that is really important to point out is that MMR vaccines were first licenced in the US in 1971, the first measles vaccines in around 1963. There is no doubt that the regulatory requirements have changed over the past 50 years. Also, vaccine safety monitoring has changed dramatically. I think we must certainly acknowledge that safety monitoring in the 1970’s would have been no match for today’s systems. Despite this, even 50 years ago vaccination programmes were required to be monitored and the systems were adequate to identify many safety issues. Examples include concerns about the safety of whole cell pertussis vaccines and acute encephalitis after measles vaccination. So even 30-60 years ago, safety systems existed and they successfully picked up safety signals.

All this aside, Wakefield (like all good anti-immunisation activists) carefully avoids the vast global data from both passive safety surveillance systems and active safety monitoring studies that overwhelmingly demonstrate the safety profile of MMR vaccine and clearly refute any association with autism (and any other behavioural or neurological condition). .

Just one example that Wakefield ignores – A Cochrane review published in 2012 assessed the adverse effects associated with MMR vaccine in children up the age of 15 years. The authors included randomised controlled trials, a controlled clinical trial, cohort studies, case-control studies, time-series trials, case cross-over trial, ecological studies, and self-controlled case series studies involving approximately 14,700,000 children. Exposure to MMR was found unlikely to be associated with autism, asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn’s disease, demyelinating diseases, bacterial or viral infections. Conditions known to have an increased risk associated with MMR vaccines are aseptic meningitis within three to five weeks of weeks of Urabe-containing and Leningrad-Zagreb MMR vaccines (not the ones we use), febrile seizures within two weeks of MMR vaccines and idiopathic thrombocytopenic purpura (ITP) within six weeks. MMR vaccines continue to have an excellent safety profile worldwide.

He goes on then to criticise the National Health Service for depriving parents who had legitimate concerns about the vaccine to purchase single vaccines. He complains that the health authorities only served to protect their MMR programme with disregard for children. Then Wakefield introduces the well-known issue (as if it is a revelation) with the Urabe mumps vaccine component, this strain of attenuated mumps had an increased risk for vaccine associated meningitis. This issue was detected in Japan and Canada ~1988, verified in the UK, identified and the vaccine removed (1992 UK). What has this got to do with autism? Apparently this leads on to his conspiracy theories about cover-ups and how he (Andrew Wakefield) took the stand on MMR, and he was so deeply and justifiably concerned:

So the next question is beyond the fact that MMR vaccine is not safe and has not been adequately tested; not just my opinion but the opinion of many; is does MMR vaccine cause autism?

Now this question has been answered not by me but by the courts, by the vaccine courts in Italy and in the United States of America where it appears that many children over the last 30 years have been awarded millions of dollars for the fact that they have been brain-damaged by MMR vaccine and other vaccines and that brain-damage has led to autism. That is a fact.

Mmmm. So the scientific question of whether or not MMR vaccine increases the risk for autism has been answered by the courts!! Really!! Firstly, the Vaccine Injury Compensation Programme (VICP) is a no-fault system whereby cause does not have to be proven. Causation in law is not the same as that accepted in science and epidemiology. In some cases this can mean “slightly more than 50%” chance of a drug having caused an injury. Secondly, the courts are in no position to make scientific judgements, and thirdly…now brain damage leads to autism? What happened to the all-important bowel component of Wakefield’s MMR/autism disorder? The original claim by Wakefield was that MMR caused associated gastrointestinal disease and developmental regression. Maybe he has changed his theory. I heard that the Special Masters in the US Court of Federal Claims for the VICP concluded that MMR was not linked to the development of autism based on existing scientific evidence. However the Programme has indeed awarded compensation for many families and individuals for a variety of adverse events (remember this is a no-fault system, causality does not have to be proven). There is a difference here and Wakefield seems to be twisting the facts. 

In December 2012, two landmark decisions were announced that confirmed Dr. Wakefield’s original concern that there is a link between the MMR vaccine, autism and stomach disorders. The news went mostly unreported, but independent outlets like The Liberty Beacon finally began publishing the ground breaking news.

A closer examination of the issue of the courts and these cases was executed by Orac  earlier this year. Bottom line is the plaintiffs were awarded compensation for possible encephalopathy after MMR vaccine, not autism. From what I can see of the medical histories presented in these cases this seems reasonable.

But this is the very best part:

Now it is very important for people to bear in mind that MMR   doesn’t protect against measles. Measles vaccine protects against measles. The mumps and rubella components are irrelevant. So, if single vaccines were available; if the government had not withdrawn the availability of a vaccine, then there would be no outbreak of measles in Wales, there would be no discussion of measles cases and potential measles deaths. So, the blame for this must lie on the shoulders on those who withdrew the option of the single vaccine from the parents who were legitimately concerned about the safety of the MMR. Not because of me but what had happened because of that vaccine long before I came on the scene.

The error is so profound it really does not warrant a comment. Of course MMR protects against measles – AND mumps AND rubella.

MMR vaccine uptake is at an all-time high. So why are we now seeing measles outbreaks in highly vaccinated populations. It would be very interesting to find out how many of those children in the current outbreak have  actually been vaccinated. I suspect many. And this has been seen before.

Actually the UK has cohorts with very low coverage. He then goes on about vaccine failure, particularly mumps vaccine and some bizarre idea that by repeatedly using virus seed stock the vaccines have lost their potency. I can’t find any data on vaccine status of confirmed cases in the UK outbreak but they certainly have a cohort with the lower MMR coverage – those who were eligible for vaccine in the late 1990’s and early 2000’s, people aged around 10-18 years whose parents became freaked out about the vaccine thanks to Wakefield’s fraud. According to newspapers these are the most affected by the current epidemic. Perhaps Wakefield was channelling Blackadder in the 90’s and came up with a plan so cunning he could put a tail on it and call it a weasel!?

During the most recent measles outbreak in NZ most cases were unvaccinated. Can’t imagine it would be different in the UK. Below table 5 from the 2011 measles report from ESR. Important to point out that the denominator for one or two doses is most of the population and the denominator for not vaccinated is relatively small.

Immunisation status of measles cases in NZ 2011. Source ESR.

 

I can’t listen to any more… have skipped to the end which appears to be personal attack on the Health Authorities and lots more “it wasn’t me, I didn’t do it” and a challenge to David Salisbury who was the head of the UK National Immunisation Programme.

BTW, I was interested in how Wakefield’s forehead remained so motionless.