Measles Increase Highlights Lessons from MMR Legacy

European measles cases increased in 2011, according to a World Health Organisation (WHO) report released last week. This is a reminder of how severe and long-lasting the impact of the MMR controversy is, and of the responsibility of medical research scientists. Despite this, little has changed as a result of the episode, and it is surely time to reconsider how medical research is assessed.

The WHO report documented over 26,000 measles cases in 36 European countries since October 2010, including 9 deaths and 7,288 hospitalisations. Cases in the UK increased three-fold compared with 2010, and in France – where a measles epidemic was declared earlier this year – there were over 14,000 cases.

The report cites a lack of vaccination as the main reason for the increase, with most cases in those who had not been vaccinated or were unsure of their vaccination status. Although no ages of the patients were specified, the cases were “predominantly among older children and young adults”; this is a significant age group in relation to the MMR controversy.

The first scientific paper to suggest a link between MMR and autism was published in 1998. MMR vaccination uptake dropped off dramatically in the years following this. Since two doses are essential for immunity and these are usually administered around a child’s first and fourth birthdays, those of the correct ages in the late 1990s are now between about 14 and 18: older children and young adults.

MMR vaccine uptake dropped at the end of the 1990s

It therefore seems highly likely that the current rise of measles is a direct consequence of the alleged link between the vaccine and autism. Even though this link has been recognised as untrue in the scientific community for years and Andrew Wakefield – the scientist in question – was publicly and definitively discredited a year ago, this WHO report shows that the impact is, and could continue to be, long-lasting.

This enduring effect is a reminder of the responsibility researchers have when working on public health issues. The long term consequences of publicising incorrect science are severe; in the case of measles, it has cost lives. On the other hand, if genuine risks are discovered, there is a moral responsibility to inform people and prevent such costs; consider the result if swift action had not been taken with thalidomide.

Given this importance, and in light of the revealed fraudulence in Wakefield’s published research, perhaps the current system for research publication is not adequate for serious public health issues.

Currently, medical research is published in journals in the same way as all science; through peer review. In this system, work submitted for publication is reviewed anonymously by expert scientists, usually two or three, who assess the quality and validity of the research and the conclusions drawn. They may suggest revisions to the paper before it is considered satisfactory, but if these are addressed, the paper is usually published.

This system is often referred to as the ‘least worst’ way to ensure that published research is of a high standard, because it has serious flaws. Firstly, assessment by three individuals does not guarantee quality; it simply means these individuals are satisfied by what they have seen. More worryingly, the reviewers can only review what they see; data that have been manipulated or simply invented are likely to look convincing. In addition, the process relies on the submitting authors to declare any conflicts of interest that could compromise the data, such as financial or industrial interests.

These problems contributed to the initiation of the MMR issue. The data in Wakefield’s paper had been manipulated to fit the authors’ conclusions, but the reviewers had no way of knowing this. On top of this, Wakefield failed to declare serious conflicts of interest; he received funding for his research from the lawyers of families who claimed that the vaccine had harmed their child. It was therefore in his financial interests to find evidence, and it seems that he manipulated his data to ensure that he did.

measles facts

Measles is a leading cause of death in young children.

In 2008, there were 18 deaths every hour of every day worldwide.

Most deaths are related to complications of measles, such as meningitis, hepatitis and pneumonia.

Other serious complications include blindness and hearing loss.

Worldwide deaths decreased 78% between 2000 and 2008 due to vaccination.

Indigenous measles has been eliminated in North, Central and South America

The review system at The Lancet, the highly respected journal in which the paper was published, remains the same today, and so do the problems. It is obvious that dishonest scientists who stand to gain from providing particular evidence will present this evidence regardless of how it was produced, and will not declare their vested interests. This is unacceptable for research that has consequences for everybody’s health.

Surely if we should have learnt anything from the MMR case, it is that research into immediately relevant public health issues should be subject to much greater scrutiny. If scientists wish to claim that a current health programme is unsafe, their motivations and methods should be examined thoroughly. Authors could be interviewed in person, their lab records – which are legal documents – could be dissected by experts, and sources of funding and other potential conflicts of interest should be investigated independently rather than taken on faith.

These measures would have prevented the original MMR-autism paper from being published, and Wakefield would have been revealed as a fraudster 13 years ago. More importantly, the uptake of the MMR jab would not have fallen so dramatically, and infection rates would not have soared. More rigorous review may require more resources and money, but surely this investment would be worth preventing the publication of dangerously fraudulent research and its deadly fallout.

References and Further Reading

IMAGES: Top - U.S. Centers for Disease Control and Prevention, Middle – BBC News

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