The Doctor Who Fooled the World

by Brian Deer

  By now he was an openly anti-vaccine campaigner, publicly declaring, “If I had a baby, I would not vaccinate them.” And with many taking such advice, and skipping protection, the Somalis were easy prey. WHO models showed that, to irrevocably break the bug’s transmission, 95 percent of a community need to be immune. Yet, among these African American citizens, the reported vaccination rate had fallen to 42 percent in the aftermath of his intervention.

  “Anti-Vaccine Activists,” headlined the Washington Post, “Spark a State’s Worst Measles Outbreak in Decades.”

  Wakefield told the newspaper, “I don’t feel responsible.” But, just weeks after the publicity for his earlier visits, his supporters had launched a group targeting the Somalis: the so-called “Vaccine Safety Council of Minnesota.” This had talked up vaccine risks and belittled clinical measles, with many of the same arguments that were fashioned in England for Richard Barr’s newsletters and fact sheets.

  “It’s funny how they try to make this ‘outbreak’ look like a big deal,” was how one supporter shrugged off a disease that could sometimes cause pneumonia, blindness, deafness, brain damage, or, very rarely, a lingering death. “With proper nutrition and rest, the measles is a nasty cold with a rash. It’s not fun but it’s also not a crisis.”

  Wakefield didn’t reappear. He was busy with Vaxxed. But his associates couldn’t resist. After reports of children getting sick, a friend of his, Mark Blaxill—who’d started a national group, SafeMinds, and who accompanied the ex-doctor to Donald Trump’s inauguration ball—flew to Minneapolis, like a tornado chaser, drawn to the thrill of the danger. “Parents have rights,” he was reported telling a meeting of mostly Somali Americans, in the same city restaurant where Wakefield had spoken. “Families have rights. And that’s what’s important to protect.”

  But this wasn’t how those working for eradication saw it. Minnesota was but a volley in a bounce back of disease to defy the WHO. In Europe, major outbreaks had been spattering from the East, like cluster bombs popping in a jungle. Romania, then Italy, Greece, Serbia, France, and Britain were hit. In South Asia, too: the Philippines, Vietnam, India, Thailand, and Myanmar.

  Wakefield appeared to be pleased with himself. “I have been in this battle, this war, for twenty-two years now,” he said, in a mood of calm ecstasy, at a public meeting in Paris, France, in February 2017. “And this is the first time, in all that time, that we are truly winning.”

  Through 2017 and 2018, measles cases soared around the globe. Poland, Kazakhstan, Georgia, Albania . . . Europe reported the worst figures in two decades, linked to faltering levels of immunization. Italy experienced a six-fold jump. In France, four hundred reported cases became twenty-five hundred. And Ukrainian government data showed that, in a single year, five thousand leapt to fifty-three thousand.

  “We risk losing decades of progress,” warned WHO deputy director-general Soumya Swaminathan, in a statement from Geneva in November 2018. “The resurgence of measles is of serious concern, with extended outbreaks occurring across regions, and particularly in countries that had achieved, or were close to achieving, measles elimination.”

  It wasn’t all Wakefield. In addition to the virus’s mysterious ebbs and flows, Italy was bewitched by a comedian, Beppe Grillo, who, before storming into politics, had made a film attacking vaccines, released weeks after the twelve-child paper. In Thailand and Indonesia, Islamic clerics condemned the use of pork gelatin in some shots. In Uttar Pradesh, India, a rumor went around that immunization caused impotence. And in a slew of countries, from Poland to Venezuela, political upheavals took a toll.

  Yet, seemingly everywhere, his name was invoked: as I learn most forcefully in Brazil. There, monthly measles reports jumped from none in December 2017 to six thousand the following November. And, as I climb into a taxi to cross São Paulo, a magnificently named epidemiologist, Cristiano Corrêa de Azevedo Marques, turns to me in the back seat, introduces himself, and states the problem, as he sees it.

  “It’s amazing, that paper of 1998,” he says, “is still having an effect here in the popular mind.”

  Brazil had been lauded as Latin America’s high achiever. Since the year 2000, its measles immunizations had tracked PAHO’s targets. But in 2017, the picture abruptly changed, and uptake graphs, previously flatlining success, slumped to little more than 70 percent, as parents became scared, or indifferent.

  “It was a shock to me,” says Helena Sato, a pediatrician and head of São Paulo state’s immunization programs, when we meet in September 2018 amid a cluster of hospitals and academic and research units at the state’s Centro de Vigilância Epidemiológica. “People just didn’t show up at the clinics.”

  “And that’s new?” I ask.

  “That was something that happened first last year,” she replies. “It was completely unexpected.”

  PAHO’s crowing may have encouraged complacency. If measles was eliminated, as media reported, then maybe parents saw no reason to vaccinate. But that was a decision that, in those changing times, was weighed with Wakefield’s fingers on the scale.

  Pediatric neurologist José Salomão Schwartzman didn’t doubt it. He blamed the ex-doctor and The Lancet. “Every day in my practice I hear this question, ‘Is there a relationship between vaccinations and autism?’ ” he tells me, six thousand miles from London, in his office at Mackenzie University, São Paulo. “Once you create an urban myth, it is very difficult for people to forget it.”

  Yet it wasn’t only echoes from far away, and years ago, that had spooked Brazil’s young families. Wakefield’s influence was here and now. He’d become the media, as he’d said he would. As he achieved resurrection in the United States, he spawned clickbait globally for countless online presences: now mixing English with a cacophony of languages (Mandarin . . . Spanish . . . Arabic . . . French) promoting him and his masterwork, Vaxxed.

  In Brazil, Facebook pages were easy to find: with names like “O Lado Obscuro Das Vacinas” (The dark side of vaccines) and “Vacinas—Por Uma Escolha Consciênte” (Vaccines—a matter of personal choice). The platform hosted his messages in a mix of Portuguese and English, consumed by tens, or hundreds, of thousands. And now, like in many countries, his reach was greater still: entering the lives of those who hadn’t even searched—through autism, baby care, or family groups—via messaging networks such as WhatsApp.

  Here were reports of Vaxxed’s New York premier; links to downloads subtitled in Portuguese; false claims that a “CDC whistleblower” admitted to “fraude”; Robert De Niro’s appearance on NBC’s Today; pictures of the black bus on its United States tour; and video bloggers hailing the “documentary.”

  Such material, moreover, wasn’t here and there, now and then. It was recycled, over and over, sometimes day after day, from bedrooms and kitchens, laptops and phones, by obsessed, anonymous individuals.

  Robert De Niro é Ameaçado Pela Máfia Farmacéutica

  Autismo após vacina da MMR

  Here too were videos of Wakefield lecturing (“I believe that vaccines cause autism,” he says) and his associate, Del Bigtree (now earning $146,000 a year, plus expenses, funded by the New York millionaire Bernard Selz), claiming conspiracy as the reason why so few doctors and scientists agreed with him.

  “The really sad thing is the amount of doctors that I’ve spoken to that say to me, ‘Del, I know that vaccines are causing autism. But I won’t say it on camera because the pharmaceutical industry will destroy my career, just like they did to Andy Wakefield.’ ”

  And it wasn’t just dissemblers who touted the agenda. Tech behemoths such as Amazon and Apple pushed the product, as the Times of London reported in a splash:

  Web giants profit from anti-vaccine fraud’s video

  But what did Wakefield care now about the Times?

  Favored jurisdictions were blessed with personal appearances. Polly Tommey drew the long straw and was dispatched to Au
stralia. And just as Blaxill had chased the tornado to Minneapolis, Wakefield turned up in Poland.

  He was having a great time. He’d found no cure for Crohn’s, or remedy for autism, no vaccine, no nothing in medicine. But now he was a man delivering fear, guilt, and disease to everywhere with an internet connection. “It was only yesterday that the president went on television to sing the praises of vaccines,” he laughed into Periscope, from a restaurant in Bologna, Italy. “So the film has got them terribly, terribly worried.”

  He was right about that. He’d gotten governments worried. By the turn of the year into 2019, the WHO was listing what it called “vaccine hesitancy” as among the top ten “threats to global health,” and the United States faced its worst tally of measles in more than thirty years.

  In the wake of my investigation, Britain had seen confidence rebound. But now planners watched graphs plunge once more. The National Health Service warned of a “time bomb” of disease, and the government’s health secretary said he would “require” social media to take down what he called “lies.”

  Internationally, talk of compulsion was now commonplace—although some governments had long invoked it. Poland, for instance, had levied fines on nonvaccinators under rules from the Soviet era. And most US states barred children from attending school if they weren’t immunized to a CDC schedule or been granted specific exemptions.

  France had taken the plunge in January 2018, when an existing list of three compulsory shots was expanded by eight more, including measles. Months later in Australia, a prevailing “no jab, no pay” law was toughened to cut tax benefits for the noncompliant. And, soon after, a populist coalition ruling Italy (home of websites such as “Movimento Contro Autismo”) upended the ideas of the joker Grillo and launched an “emergency” campaign to vaccinate eight hundred thousand children and young people.

  Initiatives varied. Fines, school bans, loss of benefits. Some systems, such as Britain’s, remained voluntary. But then came a game changer in the United States, when local public health chiefs went nuclear.

  The trigger was an outbreak in Rockland County, New York, a suburb of New York City. Some accounts tracked its origins to an epidemic in Ukraine, which in 2017 had seen the beginning of a toll of measles infections unmatched anywhere else. Gene sequencing traced the virus to likely pilgrims to Jerusalem, where, in the fall of 2018, the disease had spiked. Then, from the holy city of the Abrahamic religions, it was flown to America’s East Coast.

  Rockland’s response was, to say the least, brutal: akin to measures that I’d read of from an outbreak of bubonic plague in seventeenth-century London. County bosses issued an “emergency order” forbidding anyone under eighteen “to enter any place of public assembly,” if he or she couldn’t be validated as vaccinated against measles, unless holding an exemption from a doctor.

  Within days, the law was amended to any indoor place. But hard-line thinking hadn’t passed. In New York, the city decreed that parents living or working in any of four zip codes must take any child, aged six months or over, who hadn’t had MMR, for the shot within forty-eight hours.

  Such panic measures captured a global mood. But they harbored risks of which history had spoken. It was British enforcement of smallpox vaccination (with hefty fines, or even imprisonment, for noncompliance) that, in the 1860s, had spawned the first anti-vaccine movement. Individuals stood defiant. Tens of thousands joined rallies. And when the English crusader William Tebb spoke in New York City, to launch the Anti-Vaccination League of America, he was reported telling his audience, in October 1879, that if the US authorities “could only be persuaded to pass an anti-vaccination law,” it would strengthen the movement he championed.

  Brazil had a similar rite of passage. An “obligatory” smallpox vaccination law, passed by the national assembly in October 1904, erupted onto the streets of Rio de Janeiro in a week-long mass insurrection. Sticks, stones, and guns were ranged against troops in what would be remembered as the “Revolta Contra Vacina.”

  “The revolt did not result merely from a fear of medical treatment, but rather an ideological opposition,” writes American historian Thomas Skidmore in a textbook, Brazil: Five Centuries of Change. “The Revolta Contra Vacina was for many of its combatants a fight of the poor against state interference in their private lives.”

  Wakefield was some way from that big idea. But street demonstrations were spreading in Europe. Italy witnessed protests in June 2017, involving thousands in Rome, Milan, Bologna, and other cities. Hundreds protested in Paris months later. And, in the summer of 2018, a great column of protestors snaked through Warsaw, insisting on their right to say no.

  Here was no small legacy for an ex-doctor without patients. On videos, he grinned and chuckled. The resurgence of disease wasn’t entirely down to him. But, just like you can’t make gunpowder without sulfur, charcoal, and potassium nitrate, he knew he was essential to the explosion.

  To reprise the line from the New Indian Express: “Can one person change the world? Ask Andrew Wakefield.”

  THIRTY-TWO

  Cause and Affect

  The United Kingdom of Great Britain and Northern Ireland once preened as the ruler of the biggest empire in history. With ingenuities fueled by coal and a cool climate, it was the anvil of the worldwide Industrial Revolution. It was the cauldron of a language that all humanity would come to share in. It was the first home of football, or “soccer” as some called it. And it was the birthplace and nursery of scares over vaccines. Not once. Not twice. Three times.

  In the nineteenth century came fear of immunization against the often fatal or blinding smallpox. A century later it was the shot against pertussis, or whooping cough, in DTP. Then, from the late 1990s, it was Wakefield’s targets: first MMR, then pretty much any vaccine that might earn him applause and income. And because these began in England, it’s in England that I end: concluding the investigation of that twelve-child paper that will doubtless be remembered on my death.

  I caught a train to Merseyside, in the English northwest, to visit with the mother of another among the twelve. For the usual reason, I’ll call her Ms. Three. But her son, Child Three, in Table 1 and Table 2, had, in fact, been the first to be brought to Hampstead for recruitment to the vaccine research.

  He’d been referred to the Royal Free—like nearly all the others—through Newsnight’s woman in scarlet. Child Three’s sole GI problem was profound constipation. His blood tests for inflammation came back normal, and pathologists didn’t report colitis. Upon her son’s ileocolonoscopy, however, Ms. Three saw the swollen glands (“blotches,” she called them). Then, three months later, the boy’s records were altered, he was experimentally prescribed drugs carrying black box warnings, and tabulated in the journal with the “syndrome.”

  My journey was the third I made to Ms. Three’s home over the space of a little more than ten years. London to Liverpool—two hundred miles—then a twenty-minute bus ride through working class suburbs to a rented, two-story, mid-terrace house, with a gold-colored letterbox, number, and knocker, like every other door on the street. At the back was a yard like I’d never seen elsewhere: a rectangle of clipped grass that met fencing on three sides. No bushes. No flower beds. Nothing.

  Ms. Three was a quiet-spoken, slightly built lady, by this time fifty-eight years of age. Child Three was her second son (with two brothers and a sister), who by now was anything but a child. He was twenty-nine years old, on the cusp of middle age, and had long ceased living at home.

  He was a great-looking guy. Black hair. Blue eyes. Were his face to smile up at you from a dating app profile, you’d think he’d be snagged within minutes. He’d got what I call “the Liverpool look,” which I imagined I saw in the late Beatle John Lennon. In my mind, it seemed to speak to some mysterious, wry wisdom to be found on the streets of that city.

  But he’d no app profile. No right now encounters. No walking, hand-in-hand, beside the
Mersey. “He could be kissing your face off one minute, and within the space of half an hour he’ll just change,” says his mother, as we sit in her living room. “Sometimes I’m scared. I lock myself in the garden, because I know how hard he can hit.”

  His conversation, too, would be less than romantic. He’d lost any speech in his second year of life: which was also the time he began to eat carpets, and obsessively flick his fingers in front of his eyes. Now his core vocabulary was to tap his lips to mean “yes,” or “give me.” And he recognized, but didn’t use, a gesture for “no,” or “can’t”: when his mother would cross and uncross her hands, like a referee disallowing a goal.

  “If he wants somebody to leave, he will open the front door,” Ms. Three had explained, during the second of my visits. “If he wants a cup of tea, he will give me the cup, or he will put four tea bags in his cup and try to make his own . . . But the thing with [him] is he doesn’t know when to stop. When he gets to the top, he just keeps pouring, so it’s all over the place, it’s too dangerous.”

  Dangerous, he was: both to himself, and to others. Which meant that, by my last visit, he no longer came home. Rather, he lived among strangers in one of a string of seedy care homes, where he head-butted window glass, slit his own wrist, and broke the nose of a member of staff. Even on a cocktail of three antipsychotics, he was as unpredictable as any lifer jailed without blame: one minute listening to his music in sunshine, the next sending someone to the hospital.

  “What makes him happy is having a bath,” his mother tells me. “He’s had about twelve baths in six hours.”

  This wasn’t Asperger’s, or “neurodiversity.” The gulf of his aloneness was too vast. His wasn’t a difference to be celebrated by advocates (worn like a badge, as in “I’m a bit autistic”), or likened to being gay, or part Native American. It was what some parents called—to personal grief, and a little criticism—full-spectrum, “train wreck,” autism.