To summarize a long and detailed series of careful analyses conducted over more than a half decade, Deer first revealed in the February 22, 2004 edition of the Sunday Times that Wakefield had in fact been paid to fabricate the findings linking MMR to autism.75 Specifically, English attorney Richard Barr had financed Wakefield’s studies and put him in contact with the twelve children profiled in the Lancet study. These families were either already part of Barr’s brewing lawsuit or were being recruited for that purpose. While the study was conducted at a London hospital, none of the children were from the area. Indeed, one of the twelve was flown in from the United States specifically to be included in the cohort under investigation. Given the prevalence of autism, such extraordinary measures were certainly unnecessary at a minimum.
Rather than adhering to the scientific method of testing hypotheses, Wakefield was on a paid mission to prove a link that simply did not exist. Therefore, it was necessary to bend the data towards his needs. For example, Wakefield’s data consisted of “associations” made by the parents of autistic children (many being the same parents who were actively seeking remuneration) that vaccination was linked with the onset of autism. At a minimum, this is poor science and itself would raise questions regardless of the source of funds.
That Wakefield was accepting money from an attorney was not necessarily an issue. Indeed, many scientists serve as expert witnesses for both civil and criminal trials around the world. However, the fact that Wakefield had failed to disclose that he was paid by the attorney behind many MMR lawsuits was an early sign of a larger problem. This was not a simple oversight. At a March 1998 meeting of the British Medical Research Council, Wakefield was queried as to the source of his data. He not only failed to report the link with the subjects of the preexisting lawsuit but also claimed “no conflict of interest.”76 These assertions were later proven as false by Deer, who revealed that by that time, Wakefield himself had already personally received more than £50,000 for his work in the lawsuit.77
Roughly a year after Deer began researching the supposed link between MMR vaccination and autism, his work was the subject of a November 18, 2004 documentary, MMR—What They Didn’t Tell You, broadcast on Britain’s Channel 4 television network.78 The documentary included new investigative research and revealed not only that Wakefield had created near panic for the parents but also that he had filed for patents and intended to launch his own measles, mumps, and rubella vaccine products as an alternative to conventional vaccines. It seems that Wakefield was not opposed to vaccines but rather was simply opposed to those vaccines for which he did not own the intellectual property.
Deer and his team further revealed discrepancies between the findings reported by Wakefield and the outcomes reported by other laboratories—including Wakefield’s. The documentary was received by the scientific and public health communities with considerable relief, since Wakefield’s spurious report had triggered both parental anxiety and decreased immunization rates, particularly among high-income and well-educated Britons. Critical review was also positive with the British Guardian, who gleefully proclaimed, “Deer went for Wakefield like a bull pup with a taste for trousers.”79
Perhaps unsurprisingly, given this public outing of his methods and motivations and his proven association with attorneys such as Richard Barr, Wakefield sued Channel 4, the producers of the documentary, and Brian Deer himself. This lawsuit was later found to convey as much merit as Wakefield’s Lancet study and was dismissed by the judge, who cited that “the Claimant wishes to use the existence of the libel proceedings for public relations purposes, and to deter other critics, while at the same time isolating himself from the downside’ of such litigation.”80 The judge further ruled that this was a tactic repeatedly employed by Wakefield and that the now-disgraced scientist had also sought to prevent the public health system from fighting against his disproven ideas.
The coup de grace delivered by Deer against Wakefield was reported in a February 8, 2009 article in the Sunday Times. Wakefield had not been satisfied with simply biasing his findings by selectively using children referred by Richard Barr. Wakefield had actively faked the findings, altering the data to support his thesis. The data had been so heavily modified that they’d allowed a small-scale study of twelve children to have outsized implications.81 A further tragedy revealed by Deer’s investigative reporting was that the twelve children in question had been subjected to a grueling and unethical series of medical procedures, including lumbar punctures, general anesthesia, and intrusive bowel imaging.
A detailed investigation by the British Medical Journal concluded that Wakefield’s study was a fraud.82 Upon learning of the practices employed by Wakefield, the coauthors on his paper disowned the work and any connections with Wakefield. The Lancet conducted its own investigation, starting in July 2007.83 In a twist of irony, given the passion of the publication’s founder to combat medical incompetence and privilege, the journal’s leadership agonized about the public humiliation of acknowledging its insufficient review of the original Wakefield paper. However, the journal publically retracted the paper, an exceedingly rare event in scientific publishing circles. Likewise, Wakefield was stripped of his medical license, with the board of ethics citing multiple lapses. These actions are the scientific equivalent to the public stripping of honor and medals suffered by Albert Dreyfus, who was a far more sympathetic and innocent character.
Although publically outed as a money-grubbing fraudster, Wakefield shifted the focus of his entrepreneurial zeal from hocking his own vaccines to writing books. After many losses in court, the now-unemployed charlatan began playing the role of the martyr, portraying himself as the helpless victim of a rapacious Brian Deer. During a January 5, 2011 interview of Andrew Wakefield by CNN’s Anderson Cooper about the forced retraction and the outcomes of the British Medical Journal investigation, which has just been published, Wakefield turned the interview into a plug for his own book. The interview was watched in disbelief by Seth Mnookin, himself a writer for the New Yorker, Washington Post, New York Times, and many other prominent periodicals, who at the time was finalizing his outstanding book about the vaccine-denier movement, The Panic Virus.84, 85 CNN had lined up Mnookin to appear with Wakefield, but the disgraced English doctor refused to appear with Mnookin, a long-time critic of Wakefield. Mnookin was interviewed separately by Cooper that night. Rather than plugging his own upcoming book, Mnookin carefully addressed each of Cooper’s questions, revealing the extent of Wakefield’s fraud and the risks to public health from avoiding vaccination. As one example of the danger of false correlations, Mnookin compared the rise of autism diagnosis with a corresponding rise in microwave popcorn sales in the same period (for the record, there is no connection—which was Mnookin’s point). All of this was detailed in Mnookin’s blog the next morning.86
Wakefield was still not done. In 2016, he wrote and directed a documentary, Vaxxed, which was entered into the lineup of the high-profile Tribeca film festival. This film was described by reviewer Eric Kohn as “a self-aggrandizing approach” by Wakefied “designed to trick you” and was given a grade of D.87 Kohn related his view that in his biased work, Wakefield had boldly maintained the pharmaceutical industry was masterminding a conspiracy to profit from products that cause autism. Kohn’s review further described the film as “Shakespearian hubris” meant to propagate falsehoods, writing that Vaxxed was “a tale of sound and fury signaling nothing but its own homegrown idiocy.”
Learning that Vaxxed had been scheduled to appear at Tribeca, legitimate documentary filmmakers revolted, demanding its exclusion. Likewise, the medical community reacted with outrage, as typified by a statement from pediatrician Dr. Mary Anne Jackson, who stated, “Unless the Tribeca Film Festival plans to definitively unmask Andrew Wakefield, it will be yet another disheartening chapter where a scientific fraud continues to occupy a spotlight.”88 The next day, Robert De Niro, who founded the festival and is the parent of an autistic child, reversed himself by wit
hdrawing the film from the festival in response to the uproar.89
Still Wakefield persisted in his desire to profit from the charade. Realizing additional monies could be made in high-priced speaking engagements, Wakefield, stripped of his medical license, moved to Texas and hit the lecture circuit. He began giving talks to groups of receptive audiences, for a price. His ideas were particularly popular among wealthy Americans, and his devotees included Hollywood celebrities with autistic children, including Alicia Silverstone, Charlie Sheen, and Jenny McCarthy.90
Notable anti-vaccinators from the political sphere included Robert Kennedy, Jr. and Donald Trump. Despite Trump’s busy schedule on the campaign trail, he made time to meet with Andrew Wakefield in August 2016 and invite him to one of Trump’s presidential balls, where Wakefield “called for the need for an overhaul of the Centers for Disease Control and Prevention.”91 Indeed, in the days before Trump’s inauguration, Kennedy, a long-standing and outspoken critic of vaccines, announced from the lobby of Trump Tower he had accepted a position in the Trump administration to chair a vaccine safety panel. This statement was walked back a bit by a Trump spokesperson, who conveyed that such an offer had not yet been finalized.92 In response, the senior fellow for global health at the Council for Foreign Relations and Pulitzer Prize–winning journalist Laurie Garrett responded with a scathing response, contemplating the millions of lives that could be at stake were such a reckless action to proceed.93 Sadly, long before Garrett’s impassioned plea, the body count had begun to climb.
Recurring Nightmares
The March 24, 2011 edition of the Star Tribune, the largest daily newspaper in Minnesota, reported the third visit by Andrew Wakefield to Minnesota since December. Wakefield’s message of skepticism about vaccination, the report went on, had been particularly embraced by a displaced Somali community in Minneapolis.94
It may come as a surprise to many, but the chilly climes of Minneapolis host “the largest Somali community in North America, perhaps in the world outside of East Africa,” reported CNN in February 2017.95 A 2014 article in the Journal of the American Board of Family Medicine reported that “the Somali community is more likely to believe that MMR vaccine causes autism and are more likely to refuse the MMR vaccine than non-Somali parents.”96 For example, the rates of vaccination among Somalis in Minnesota dropped from 92 percent in 2004 to 42 percent in 2014. Consequently, this population has suffered disproportionately from outbreaks of measles. Periodic outbreaks had begun in 2011, coincidental with Wakefield’s visits. Perhaps sensing legal liability, he was reported by the Washington Post to have stated, “The Somalis had decided themselves that they were particularly concerned [about vaccine safety and] I was responding to that.”97 He further claimed no responsibility for the 2011 outbreak or a more vigorous measles outbreak that began in 2017 and racked up more than four dozen confirmed cases in the span of two months.98
Although the anti-vaccinator response is particularly high among Somali Minnesotans, it reflected a disturbing trend that has persisted since Wakefield’s fraudulent publication linking MMR vaccine with autism. According to a 2008 publication in the medical journal Pediatrics, the rates of MMR immunization declined in the United States following Wakefield’s discredited publication in the Lancet.99 Although the overall trend did improve as news of the fraud was revealed by Brian Deer and communicated via mass media and word of mouth, the myth has persisted in isolated communities, such as the Somali population. However, the anti-vaccinator movement is not unique to Somali or Minnesota. At least twenty of the fifty American states allow their children to be exempted from vaccination based on philosophical or personal belief. A study of California communities revealed that the largest rate of personal belief exemptions from mandatory vaccination prevailed in white, affluent neighborhoods.100
As such, it may come as no surprise that the highest rates of measles, mumps, and rubella in the United States are occurring among unvaccinated people in California, as well as among groups that have historically rejected technology, such as Amish communities. A prominent example is the rise of measles, mumps, and rubella in American universities. As conveyed in the introduction to this book, vaccine-preventable infectious diseases are breaking out in universities across the United States. One of the most troubling aspects of this recent trend is the increasing frequency with which immunized students are themselves the victims of their classmates’ failure to be immunized. For this, we need to take a moment and review the concept of herd immunity.
Arthur William Hedrich was born on July 7, 1888 in Chicago, where he would serve as a public health officer. Interested in the spread of epidemics, he continued working while seeking an advanced degree under Lowell Reed at Johns Hopkins University. Although only two years older than Hedrich, Reed had become a superstar in the field of public health by blending cutting-edge mathematics with epidemiology. In 1928, he unveiled the Reed-Frost model, which was developed in collaboration with a more senior Hopkins investigator, Wade Hampton Frost.101 This equation provided the foundations of modern epidemiology as it predicted how infectious diseases spread in a community over time. In that same year, Arthur Hedrich defended his doctoral thesis, titled “Epidemic Studies: The Monthly Variation of Measles Susceptibility in Baltimore Maryland from 1901 to 1928.”102 Rather than return to Chicago, Hedrich remained at Johns Hopkins to continue his research.
Expanding upon this first study in Baltimore, and combining these findings with data from Boston, Hedrich revealed that measles infections tended to peter out when something like two thirds of the population had already become infected.103 This might not seem like a terribly exciting finding, but it saved the lives of millions and formed the foundation of modern mass-vaccination campaigns. For each infectious agent, there is a particular fraction of the population that, if rendered resistant to the disease because of immunization or generated immunity from a prior infection, will convey protection upon the larger community. This key fraction confers what is known as “herd immunity.”
A simple way of thinking about herd immunity is that even if an infected individual comes into the community, he or she is unlikely to convey the disease to susceptible individuals since “the herd” of protected people will squelch the pathogen before it can spread. Such an outcome is a statistical probability and changes with alterations in frequency and distance of travel (particularly big problems in an age of common air travel). Consequently, we now know that the fraction of the population needed to ensure protection from a highly contagious disease like measles is often greater than 95 percent.104 (There remains considerable debate as to the ideal fraction of people who need to be immunized to protect the larger population.) What we do know is that if the level of protection falls below this critical level, then the entire population becomes susceptible to the disease and epidemics will invariably follow.
Compounding the problem of herd immunity, a vaccination received during childhood conveys protection for a finite amount of time. Taken together, this means that a population of densely packed individuals, such as those in a large city or on a college campus, may be more susceptible to infectious diseases conveyed by the unvaccinated. This is exactly the scenario unfolding at college campuses around the United States. The good news is that the outbreaks have been relatively tame thus far, due to a combination of luck and diligent public health care services found at most major universities. However, the increasing frequency of these epidemics could suggest that our luck may be running out. As one example, we briefly turn to a mumps outbreak in Missouri.
An assessment of the incidence of mumps in the United States conveys the extraordinary benefits of vaccination.105 Whereas 5.5 per 100,000 Americans reported the disease in 1987, the number plummeted to fewer than 0.1 by the early 2000s. What one can presume to be the “Wakefield effect” then kicked in, characterized by a spike in mumps incidence, reaching an incidence of 2.5 in 2006. Mumps tends to wax and wane naturally, and the 2006 spike was followed by two years of relative calm
before a return of the disease in 2008–11, followed by another brief lull and an increase starting in 2013. In 2014, mumps came to prominence in the media when it took its toll on the National Hockey League, infecting both players and referees. In that same year, mumps returned to school, with high-profile outbreaks at America’s largest college campus, Ohio State University.106 From Columbus, the disease spread to the west, overtaking the University of Illinois in 2014 and the University of Missouri starting in 2016.107, 108 In the latter case, the case incidence continued to increase, even between academic years, exceeding more than three hundred cases in 2016 at the flagship campus in Columbia and spreading to Southeast Missouri State and other campuses soon thereafter.
Due to the inadequate vaccination rates and the relatively low durability of protection conveyed by the current mumps vaccine (which you may recall is a weaker form of an earlier vaccine), mumps appears to be a disease that will return to the lexicon of horrors facing the American population for the foreseeable future. This is not welcome news, for, as we will see, measles, mumps, rubella, and other vaccine-preventable diseases pose a distraction for public health workers preparing for even greater threats arising at an unprecedented rate.
Paraphrasing the subtitle of Stanley Kubrick’s 1964 political satire Dr. Strangelove, we will need to stop worrying about vaccines and instead embrace them with even more vigor and love in the coming years. Hence, we will close our story with examples of why we need vaccines now more than ever and why vaccines might, ironically, provide an opportunity to decrease the incidence of autism for future generations of children.
10
When Future Shocks Become Current Affairs
The name Entebbe periodically enters the news. A small town of fewer than seventy thousand on the shores of Lake Victoria in southern Uganda, the town first came to international prominence in 1952 as the setting for the airport where Princess Elizabeth II and her husband, Prince Philip, ended an African safari upon learning of the untimely death of her father, King George VI.
Between Hope and Fear Page 32