To vax or not to vax? That really shouldn’t be the question….

Last week I was innocently scrolling through Facebook looking for funny videos of puppies falling over when I came across an article about a study on the combined Measles, Mumps and Rubella (MMR) vaccine and Autism. Clicking on it I was pleased to find that yet another large scale study that found NO LINK BETWEEN THE MMR VACCINE AND AUTISM1The study in question looked at over 600,000 children born in Denmark between 1999 and 2010 and found that Autism development was highly influenced by the presence of siblings with Autism and a strong male bias in diagnoses2. When combined with a 2002 study looking at Danish children born 1991 through 1998, over 1 million children have been sampled3;  if the MMR vaccine was a causal factor in the development of Autism a peer-reviewed scientific study would have found it by now.

mmr aut
An article published on healthline.com, fact-checked and about as exasperated as I am that we are still having to prove that vaccines don’t cause Autism1

Surely there can’t be any parent out there who, without medical cause, would prevent their child from receiving the MMR vaccine, right? Wrong. There exists, deep within the dark annals of cyberspace alongside the climate change deniers and flat earthers, a group of people who seem intent on ignoring any and all scientific research that suggests that the MMR and other vaccines are safe and necessary for children. We call them the Anti Vaxers.

prat
Dr Andrew Wakefield was stripped of his credentials by the GMC in 20106

The Anti Vax community views Dr Wakefield, the disgraced scientist who, in 1998, published a paper suggesting a link between the MMR vaccine and Autism, as a whistleblower, oppressed and silenced by a  government conspiracy- he is practically a celebrity in Trump’s “post-truth” America4. The reality is, Dr Wakefield’s study of only 12 Autistic children was funded by solicitors suing the manufacturer of the MMR vaccine and was fraught with severe abuses of the children involved5. Invasive medical procedures were performed without appropriate licensing and medical need and data were both buried and altered. Dr Wakefield was a fraud, plain and simple, and his actions have indirectly caused the deaths of 100s of children who were not vaccinated because their parents were fearful it would give them Autism7. His actions also impacted the lives of Autistic people everywhere; I cannot go online and look at information about vaccines or scientific articles in the general sphere without reading comments from people who seem to think their kids would be better off dead than growing up with Autism. It is Dr Wakefield’s work that inspired organisations like Autismspeaks to “seek a cure” for Autism by funding prenatal research that has been labeled by some advocates as “eugenics”. I am sorry but I would much prefer to be alive today as the Autistic 22-year-old woman who has traveled across the world for an internship, directed a documentary and has achieved a 1st class BSc in zoology than dead. The Anti Vax movement has little to no regard for the fact that by using Autism as their main gripe with vaccination they are not only working from a completely flawed scientific base, they are also exacerbating the abuse and stigma towards a group of people.

The Anti Vax movement has been listed as one of the top ten threats to global health by the World Health Organisation (WHO) alongside Ebola and climate change8– not a typo… it’s 2019 and children dying from preventable diseases is one of the biggest threats to our planet. Great job guys, great job. It is hard to believe that we are on the cusp of eradicating life-changing diseases like Polio9 and Dracunculiasis10 while also witnessing a significant increase in the numbers of patients presenting with vaccine-preventable diseases such as measles.

In 2016 the NHS met their first-dose MMR vaccine guidelines in England for the first time11– this meant that 95% of children under 5 were receiving their life-saving protection against Measles, Mumps and Rubella. I am not exaggerating when I call the MMR vaccine lifesaving; Measles is more transmissible than Ebola or influenza12, sufferers develop a fever, cough and a characteristic red rash, complications range from mild diarrhea to life-threatening pneumonia, brain inflammation and bronchitis13. Before the introduction of the vaccine in 1963 3-4 million Americans were infected with Measles each year with 400-500 deaths, 48,000 hospitalisations, and 1000 suffering brain inflammation14. Don’t let the spots fool you, Measles isn’t chicken pox! UK measles notifications decreased dramatically when the Measles vaccine was first introduced and dipped again with the introduction of the combined MMR vaccine15 with rates trending against vaccine coverage (figure 1).

meas
Figure 1. UK coverage of measles vaccination and measles notifications from 1950 to 201614

Looking at this graph, it’s hard to imagine who could consider vaccinations a bad thing, it’s certainly not a mindset I share or particularly respect- children should not be dying of preventable diseases in the Western world in 2019. But, vaccination rates are beginning to drop and there still remains a group of parents who hold extreme anti-vaccination views who are unlikely to be swayed by quantitive research16. These views appear to be even more prevalent in the United States and other countries where popularism,  pseudoscience and conspiracy theories are more commonplace17.

The reality is, not that many people of the age to be vaccinating their children today have any personal experience of widespread endemic measles and the devastation it can bring, in fact, even our parents’ generation has little to no experience of this leaving only our grandparents and medical professionals with first-hand experience.  One of those doctors with first-hand experience of measles is my mother, when she was a junior doctor just out of university, she was working a rotation in A&E when a distraught father came running in with his young daughter, limp in his arms. She was unvaccinated, and in the late stages of a measles infection, too late stage for the situation to end happily. She died in her father’s arms, from a disease she should have been vaccinated for years before. Needless to say, there was never any question of my sisters and I not being vaccinated.

Social media has become the largest platform for the dissemination of Anti Vax propaganda and pseudoscience; in this area, the scientists and policymakers armed with peer-reviewed science and quantitative data are outmatched by the millennial mom sitting at her keyboard, armed with second-hand information about the friend of a friend’s cousin’s son who developed autism after he got his MMR jab. Parents looking for resources to inform their vaccination decisions after the MMR Autism controversy mainly utilised social platforms instead of scientific institutes and journals18. Social networking platforms such as Pinterest, Facebook and Twitter have been the method by which unsourced user-created Anti Vax content have been disseminated in the past 10 years, with varying proportions of posts being Anti Vax propaganda (youtube: 65%, Pinterest: 74%)19,20

There may be a glimmer of hope for pro-truth and sourced content advocates, last month Pinterest took the decision to ban content that promotes self-harm and has included Anti Vax material in that ban21. This may encourage parents seeking advice regarding the vaccination of their children to consult medical advice instead of just relying on unsourced information. Other social media platforms are yet to take up the ban; however, studies have indicated that empowering users armed with scientific sources to corroborate their viewpoint to correct misconceptions on social media sites is a powerful tool against misinformation22.

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Pinterest’s new community guidelines that prevent Anti Vax propaganda being spread

The vaccination of children isn’t a trivial issue to be squabbled over on social media sites, lives are lost when parents don’t vaccinate their children because of misinformation. We cannot just put a pin in this and ignore the problem- the scientific community needs to take urgent steps to improve its ability to communicate with the general public on a platform they engage readily with or we will keep slowly losing the battle against misinformation.

 

 

Link to Sources
  1. https://www.healthline.com/health-news/no-link-found-between-mmr-vaccine-and-autism#Reassuring-data-for-skeptical-parents
  2. https://annals.org/aim/fullarticle/2727726/measles-mumps-rubella-vaccination-autism-nationwide-cohort-study
  3. https://www.nejm.org/doi/10.1056/NEJMoa021134
  4. https://www.theguardian.com/society/2018/jul/18/how-disgraced-anti-vaxxer-andrew-wakefield-was-embraced-by-trumps-america
  5. http://news.bbc.co.uk/1/hi/health/3513365.stm
  6. https://www.nhs.uk/news/medical-practice/ruling-on-doctor-in-mmr-scare/#what-was-its-verdict
  7. https://s3.amazonaws.com/academia.edu.documents/44341544/UK_parents_decision-making_about_measle20160402-21488-182edw4.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1553195170&Signature=NGP28Woo0Pib7hEuQu5pTZrHSDo%3D&response-content-disposition=inline%3B%20filename%3DU.K._parents_decision-making_about_measl.pdf
  8. https://www.who.int/emergencies/ten-threats-to-global-health-in-2019
  9. https://www.researchgate.net/profile/Georges_Verjans/publication/330658512_2018_international_meeting_of_the_Global_Virus_Network/links/5c540f7c299bf12be3f23bcc/2018-international-meeting-of-the-Global-Virus-Network.pdf
  10. http://www.ajtmh.org/docserver/fulltext/14761645/99/2/tpmd180204.pdf?expires=1553008202&id=id&accname=guest&checksum=A47D128D278DF7A4B2161D974C40364F
  11. https://www.bbc.co.uk/news/health-41332766
  12. https://publichealthengland.exposure.co/50-years-of-measles-vaccination-in-the-uk
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1975146/?page=1
  14. https://www.cdc.gov/measles/about/history.html
  15. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/769970/UK_measles_and_rubella_elimination_strategy.pdf
  16. https://www.bmj.com/content/362/bmj.k3967
  17. https://www.theguardian.com/world/2019/feb/25/vaccine-scepticism-rises-in-line-with-votes-for-populists-study-finds
  18. https://www-tandfonline-com.ezproxy.nottingham.ac.uk/doi/abs/10.1080/10410236.2017.1384433
  19. https://onlinelibrary.wiley.com/doi/full/10.1111/cch.12442
  20. https://www.researchgate.net/profile/Jeanine_Guidry/publication/281363671_On_pins_and_needles_How_vaccines_are_portrayed_on_Pinterest/links/5b73055da6fdcc87df7a11bc/On-pins-and-needles-How-vaccines-are-portrayed-on-Pinterest.pdf
  21. https://www.theguardian.com/technology/2019/feb/20/pinterest-anti-vaxx-propaganda-search-facebook
  22. https://www.researchgate.net/profile/Leticia_Bode/publication/316251473_I_do_not_believe_you_how_providing_a_source_corrects_health_misperceptions_across_social_media_platforms/links/5b6f409492851ca65055f4d2/I-do-not-believe-you-how-providing-a-source-corrects-health-misperceptions-across-social-media-platforms.pdf

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