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The History Of MMR's Safety

by MELANIE PHILLIPS, Daily Mail

In the final part of today's investigation into the MMR vaccine, Melanie Phillips examines the history of the jab's safety in Britain.

Referring to the reviews by the MRC and the Institute of Medicine, as well as by the American Academy of Paediatrics and the Irish Department of Health and Children, the draft observed that these had unanimously concluded that a causal link between MMR and autism was 'neither proven nor disproven'.

The draft also agreed with the finding of these studies that, although the epidemiological evidence did not support the proposed link, it 'could not exclude the possibility that a very small number of children are affected differently from the large majority'.

It added that 'more extensive research would be necessary to provide the consistency and biological plausibility required to establish a causal link between viral infections and autism'.

In other words, in its early draft, the Medical Research Council concluded that the jury was still out on a link between MMR and autism, and more research was needed.

By the final, published version, this conclusion had vanished.

Many believe the only way to resolve this whole controversy is through fresh, undisputed clinical research.

'We don't think any more epidemiological studies have any purpose,' says Judith Barnard of the National Autism Society. 'They are a very blunt tool and do not pick up very rare occurrences.

'Scientists funded by the statutory agencies are firmly of the belief that Wakefield's studies are bad science, so we want to see more research by other people. And not, as the Medical Research Council is now doing, looking at more patient records, but more physiological studies.'

Since the Medical Research Council funds such studies, I asked its strategy manager, Dr Dukes, why this wasn't being done. 'We have not received any specific proposals to look at the effects of MMR,' he said. 'No scientists have approached us.'

But I have spoken to one highly regarded autism researcher who was one of a group that did offer the MRC precisely such a proposal, but which was unaccountably turned down flat. And this researcher says there have been others.

Now the Government has given the National Institute for Biological Standards and Control £300,000 to try to replicate Wakefield's research.

But the scientist who heads the institute, Dr Phil Minor, is being paid to advise GlaxoSmithKline, makers of the MMR vaccine, in the forthcoming lawsuit.

And one of his colleagues, Dr Mohammed Afzal, leader of the Institute's MMR programme, has been giving free legal advice to law firms representing the companies involved in the case.

This may be one reason why the Government has serious problems in regaining public confidence in the safety of MMR.

Parliamentary answers two years ago listed six members of the Joint Committee for Vaccination and Immunisation, and seven members of the Committee on the Safety of Medicines, who had declared financial or other interests in the drug companies involved.

According to parent David Thrower, more recent data issued by the Committee on the Safety of Medicines reveals that 19 members of these two committees now have such interests.

Perhaps the greatest cause for concern lies in the history of MMR in Britain.

In 1992, the particular type of MMR being used was withdrawn, as it was discovered that the Urabe strain of mumps vaccine in the mix was causing an alarming amount of aseptic meningitis, a disease that can kill infants.

The Department of Health then switched to an alternative MMR vaccine made by a different manufacturer.

But it had known of concerns about Urabe before it first introduced that vaccine in 1989.

Months previously, Canada had suspended its use of the Urabestrain MMR after discovering the risk of aseptic meningitis, and switched to an alternative vaccine. However, the Department of Health went ahead nevertheless and introduced it into the UK.

Dr Elizabeth Miller, head of the vaccines division of the Public Health Laboratory Service, was involved in eventually identifying the Urabe risk in Britain.

Although the Department of Health knew about the Canadian evidence before it introduced the Urabe vaccine here, she said, the risk was considered low, at one in every 100,000 doses. It was also unclear at the time, she said, whether the alternative vaccine posed a similar risk.

Nevertheless, she said, the department identified Urabestrain MMR as something for which surveillance needed to be introduced. So paediatricians had to complete a card every month saying whether there had been any adverse reactions.

This surveillance ran for two to three years. A few cases of aseptic meningitis were reported, but the apparent risk worked out at about one in 250,000 - even rarer than the reports from Canada.

However, among these cases, there appeared to be a cluster in Nottinghamshire where the risk was much higher. So Dr Miller conducted a study identifying every case of aseptic meningitis, regardless of whether they showed up in the surveillance reports.

'We linked this to the vaccine records and found many cases of aseptic meningitis linked to the vaccine that had not been picked up,' she said.

As a result, in 1992, Urabestrain MMR was suddenly withdrawn in the UK and replaced with the type of MMR vaccine used today. The revelation of this débacle poses some extremely urgent questions. Why did the department introduce Urabe- strain MMR, knowing there to be a question mark over its safety? Was this not tantamount to gambling with the health of Britain's children?

And what price the Government's vaccine safety surveillance when it failed, for two to three years, to detect the risk eventually picked up by Dr Miller?

How can we be sure there are no other adverse effects from the current vaccine, when doctors accept that the normal surveillance system fails to unearth most adverse reactions?

Above all, how can we trust the Department of Health's assurances that MMR is safe, when the original vaccine safety trials failed to spot the risk of aseptic meningitis from the Urabe- strain mumps component?

The Government says repeatedly that MMR is the safest way to protect our children. But why should we trust them when they got it so badly wrong before?

Tomorrow, I will look at the extraordinary way in which warnings about MMR have been brushed aside, and how Andrew Wakefield and his fellow researchers have refused to be silenced.

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The Case For And Against The MMR Vaccine

by MICHAEL HANLON, Daily Mail

The MMR vaccine was introduced in October 1988 to provide a one-shot immunisation against three diseases - measles, mumps and rubella.

Since its widespread introduction, recommended by the World Health Organisation, rates of these diseases have fallen close to zero in immunised western populations.

FOR

Two doses of MMR gives 99 per cent protection against measles - the most serious of the diseases immunised against.

Most doctors believe giving the three vaccines at once is a good idea.

If given one at a time (three single vaccines followed by a booster for each), they have to be carefully spaced out.

The fear is that many parents would fail to complete the course. Children could also be vulnerable to infection between inoculations.

If more than 15 per cent of the population fail to vaccinate their children, measles epidemics could return to the UK.

Government-commissioned study (published in the Lancet in 1999) investigated claims that MMR was linked to autism and bowel disease. It concluded there was no link. Another study commissioned by the Department of Health and published in January this year also gave MMR the all-clear.

The scientific establishment remains convinced that MMR is the safest option. Professor Peter Lachman, President of the Academy of Medical Sciences, said: 'Even if there are dangers, all the evidence suggests that the chances of something nasty happening to you as a result of not getting vaccinated are around 100 times greater than something nasty happening to you if you do.'

AGAINST

Parents first voiced concerns over links between MMR and autism and the bowel condition Crohn's disease in the mid-1990s.

There were several cases of healthy children developing these conditions after being given the vaccine.

Increasing numbers of parents decided not to have their children vaccinated with the triple vaccine. They were supported by a handful of doctors happy to administer the vaccines in single doses.

Dr Andrew Wakefield, a consultant gastroenterologist, drew national attention to a possible link between the illnesses and the MMR method of vaccination in a study in 1998.

Dr Wakefield resigned from his post at the Royal Free and University College Medical School in North London earlier this month after being told his research did not 'fit in' with the college's strategy.

Dr Wakefield claims combining three live viruses in one injection could be dangerous.

He has speculated that the MMR vaccine damages the bowel, releasing toxins that travel to the brain and trigger autism.

He recommends children are vaccinated against mumps, measles and rubella one at a time.

Paul Shattock, of the Autism Research Unit in Sheffield, who is carrying out a large- scale study of 5,000 autistic children in Britain, supports Dr Wake-field's findings.

There is growing interest in his work in Canada and the U.S. Where similar concerns about MMR have been raised.

Statistics on autism seem to back up the suspicions of those opposed to the MMR vaccine.

Some research suggests a ten-fold rise in cases in the past ten years.

This corresponds to the introduction of MMR.

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How The MMR Vaccine Works

The West Midlands is in the midst of a measles outbreak, with health officials warning of the "real risk" that a decline in MMR vaccine coverage could see the virus spread rapidly nationwide.

According to the UK Health Security Agency (UKHSA), three-quarters of the 347 cases in England between 1 October and 23 January were in the West Midlands. London accounted for 13% of cases, while 7% were in Yorkshire and the Humber.

The majority of those cases (67%) were in children under the age of 10, while 24% have been in young people and adults over the age of 15.

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Dr Vanessa Saliba, a consultant epidemiologist at UKHSA, told the i news site that the ongoing outbreak in the West Midlands "remains a concern".

"MMR vaccine coverage has been falling for the last decade," she said, "with 1 out of 10 children starting school in England not protected and so there is a real risk that this outbreak could spread to other towns and cities."

How common is measles?

There were around 1,600 suspected cases of measles in England and Wales in 2023, according to UKHSA – a significant rise from 725 cases in 2022, and 360 in 2021.

Europe is also seeing a rise in measles cases. The World Health Organization (WHO) has warned of an "alarming" 30-fold increase in measles cases across the continent in 2023, said The Guardian, with more than 30,000 people infected, compared to 941 in 2022.

Why are we seeing outbreaks?

Falling MMR vaccination rates are contributing to the spread of the disease. In Birmingham, which is seeing the worst of the current outbreak, the vaccination rate for under 5s is 75%, when "ideally it should be 95%", said the BBC.

In other major cities in the UK, such as Liverpool, Manchester and Nottingham, the vaccination rate is similarly low among the under 5s. In London, only 74% of five-year-olds have had two MMR doses. In some boroughs, such as Hackney, nearly half of children under five are not fully vaccinated.

Across the UK, the number of young primary school children who have had both doses of the MMR vaccine is below WHO targets. Only 85% of children in 2022-23 had received two MMR doses by their fifth birthday, the lowest level since 2010-11, said the BBC.

According to NHS figures, 3.4 million children under the age of 16 are not fully vaccinated with MMR.

What is the MMR vaccine and how does it work?

The MMR vaccine gives protection against measles, mumps and rubella, three serious but – thanks to vaccines – preventable diseases.

Before the introduction of the MMR vaccines in the UK, in 1988, these illnesses were extremely common and for many led to long-term health problems or, in some cases, death.

In order to be fully vaccinated against measles, mumps and rubella, children receive two doses of the MMR vaccine. In the UK, the first dose is given at about a year old. Another booster dose is given to children at around three years and four months.

As the UKHSA explains, the MMR is a "live" vaccine that works through the body's immune response. Once injected with the vaccine, the immune system responds by producing cells that "recognise" each of the three viruses. If the vaccinated person come into contact with any of these diseases in the future, these cells will "wake up" and begin to produce antibodies that protect you from illness.

The vaccine is extremely effective. According to Oxford University, "two doses are 96% effective against measles, around 86% effective against mumps, and 89% effective against rubella".

Why have vaccination rates fallen?

Vaccination rates have been falling in the UK since the 1990s, with concerns over the safety and effectiveness of vaccines being one contributing factor.

So-called "vaccine hesitancy" increased dramatically both in the UK and across the world after a now discredited study by Andrew Wakefield was published in 1998, linking the MMR vaccine to autism.

Wakefield's study was retracted by the journal that published it, and Wakefield was struck off the General Medical Council register in 2010. Nevertheless, its impact on parental trust in vaccination has been "massive", wrote Professor Devi Sridhar, chair of global public health at the University of Edinburgh, in The Guardian.

With health services "increasingly strained", access to vaccination clinics for many parents and carers has become more challenging, with many struggling to get their children vaccinated "even when they understand the value" of it.

And because measles, mumps and rubella have, for many years, been near total elimination (due to the effectiveness of the vaccine and the success of public health initiatives), Sridhar added, a certain amount of "parental complacency" has crept in.

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