This blog is in response to a post about childhood immunizations. I did not write about it in my book, as the subject has been extensively written about elsewhere. However it is indeed a very important subject, and I am very pleased to write about it now.

Shortly after I started in general practice in the early 70’s, there was a big scare about the pertussis (whooping cough) part of the childhood immunization programme. I can’t even remember the details now, but there had been many reports of side effects, mostly minor ones but also some serious neurological ones, after the addition of pertussis to the vaccine. Up to that time immunization against polio and tetanus had been very well accepted. All of us at the time knew of children crippled by polio – there was one girl in my class at school confined to a wheelchair – and the very idea that polio vaccination was not a good thing was unthinkable. But the pertussis element did appear to have  side effects, and soon there was a big public campaign against it. So then when I had my two children in the following years I considered long and hard whether to give them the vaccine. I read some of the literature, but this was before “evidence based medicine” had become established, and it was very difficult to find out what the true effect of the pertussis jab was. I felt, like Sue perhaps, that I wouldn’t want to be responsible for harming my children – somehow, failure to prevent wasn’t as culpable as harming them. So I didn’t give them the pertussis jab.

The following year, as parents, sometimes influenced by doctors like me, were deciding against giving  the pertussis jab to their children, the percentage of those being immunized plummeted to way below the herd immunity needed to prevent the disease. So there was an epidemic of pertussis nation-wide, and along with many other children, my two got it. It was indeed a horrible disease, a dreadful cough which made them terribly sick, and it went on for months. Babies died from it. Fortunately my children recovered completely, but not all did. A little later, a lady registered with our practice who had had pertussis in infancy (long before the vaccine was developed). Her lungs had been severely damaged, and now, in her early thirties and pregnant with her second child, she was in a bad way. She was very carefully looked after by the lung specialists in pregnancy and delivered her little girl, though not without a lot of medical input to keep her oxygen levels up. Afterwards she continued to deteriorate, though slowly, but the end came when her daughter was eleven, and she died in one of her serious lung infections. Her husband continued bringing up the child very competently, but I thought what a tragedy, and I felt very guilty about not recommending the jab to children earlier.

In the 1980’s an improved pertussis immunization was developed. It was thought that a pertussis endotoxin in the original formulation had been responsible for the side effects, and the new acellular vaccine included only a few selected pertussis antigens. Indeed this one did not have nearly so many side effects. The wheel turned, and immunization levels soared with incentives for family doctors to ensure high rates, and pertussis again disappeared. The pertussis jab became very well accepted and no one objected to their children having it. Later, the measles vaccine was introduced and this too was well accepted. But when combined with mumps and rubella, the story repeated itself and there were scare stories in the media about MMR causing neurological or developmental delay.

To understand what happened, it is necessary to look at normal development in an infant. At birth babies are in effect quadriplegic – they have no control whatsoever over their arms and legs. Gradually over the first six months they gradually acquire the ability to control their arms and hands, body posture to sit up and later, to walk. Human babies are very unusual in this delayed maturation, and it is explained by the fact that babies had to be born earlier in order for their heads to grow outside the womb – if they continued to develop such big brains before birth their heads would be too big to pass through the birth canal and both mother and baby would die. So babies were “expelled” from the womb earlier and earlier as the trend towards bigger brains set in, but this meant that they were developmentally much less mature, and had to develop control over their bodies after birth. If you wish to read more about this, read Elaine Morgan’s book ¹. For our purposes however the point is that the neurological system develops mostly outside the womb, and we can see it – and enjoy it. But if a child is severely brain damaged at birth it is not always obvious until weeks or months afterwards when the expected brain-muscular coordination just doesn’t happen. The realization that something might be wrong often comes at about the time babies are given their jabs. “My child was normal until he had the jab but straight afterwards we could see he wasn’t developing normally” said one parent – very understandably. But this is not necessarily cause and effect – it may be an association of events that happen at the same time, so a failure of development of the neurological system happens at the same time as an immunization is given. For instance, the pertussis jab is given in the first few months and this is the time that serious development delays and brain damage are first noticed. However, despite a full investigation, and a court case, no definite association between developmental delay and the pertussis vaccine was ever found. And there never was a scare in the USA, where pertussis became very rare from the start of immunization.

The MMR is given in the second year of life. And this is when a further neurological development takes place – the development of social understanding and language. Failure of development here leads sometimes to autism, and in milder cases Asperger’s syndrome. So again there is a co-incidence of timing, and many a parent noticing the sudden lack of progress in speech and socializing will blame it on the recent vaccination. A pressure group “Jab” was formed by parents who just could not understand how their beautiful baby who had been developing so well, suddenly stopped developing language and social understanding. It was possible that some babies had indeed been affected by the vaccine and it is understandable that parents turned to an organization which might not only “explain” what had had happened but also possibly provide some funding to help them cope. Inevitably lawyers will be brought in and the search for evidence will now be very important

Enter Andrew Wakefield, who in  1998 wrote a famous paper² for the Lancet about the MMR vaccination. He was a young medical researcher, but not a paediatrician. He was a former trainee gastrointestinal surgeon with a non-clinical medical school contract, and was already interested in a possible association between MMR, bowel problems and autism. As a result he was approached by a firm of solicitors to look for evidence for a lawsuit against the vaccine manufacturers, and was put on a payroll for £150 an hour to further his research. This was two years before his paper was published, and eventually he received £435 643 plus expenses, from them. But this fact was not disclosed to the Lancet, as it should have been. In it, Wakefield put forward a hypothesis that MMR caused a bowel-brain syndrome which resulted in children getting a special form of autism called regressive autism, together with an inflammatory bowel disease – a new syndrome or disease, which he had been the first to identify. He found a series of 12 children who were supposed to have suffered from this new syndrome and wrote the paper about them. The paper was well supported by a team at the Royal Free hospital, and seemed genuine – and the Lancet, an extremely influential medical journal, published it.

The paper fuelled a storm of controversy and concern amongst the public, understandably so. Many parents felt this was the evidence they had been waiting for. Andrew Wakefield became famous straightaway, and the mainstream press took up the story. It was said, on not much evidence, that “single-shot” measles vaccination was free of these complications, and so began the drive for many people paying large sums of money in order to get the vaccinations done separately, as the clinicians in the NHS refused to believe that the MMR vaccination did indeed cause these problems. The result was a bit of a stand off with arguments back and fore, but inevitably vaccination rates again plummeted. In South Wales one local paper took up the cudgels against the MMR vaccine and ran story after story on possible links, and the fall off of MMR immunization rates in that area was much worse then elsewhere. The result was predictable, and in 2013 there was a very severe epidemic of measles in which many children were very ill indeed. Sadly, one young man, a student living on his own, did not call a doctor when he felt ill, and died. The post mortem confirmed measles as the cause of death.

The arguments continued and as in the pertussis case earlier many parents were still worried and asking for the single vaccine. But an investigative journalist called Brian Deer, supported and funded by the Cochrane Collaboration, which is a very important body which looks into evidence of what works and what does not work, and the medical journal the BMJ, looked into the paper in detail³. He identified which patients were in the study, and interviewed the parents of every child. As a result he found evidence that the information in the study was seriously flawed and that there had been deliberate fraud on the part of the authors. First of all only one child clearly had regressive autism, and three of nine children reported with regressive autism did not have autism diagnosed at all in the NHS records. Secondly, despite the paper claiming that all 12 children were “previously normal,” five had pre-existing developmental concerns documented in their notes. Thirdly, some children were reported to have experienced first behavioural symptoms within days of MMR, but the records which Brian Deer saw documented these as starting some months after vaccination. Fourthly, in nine cases, unremarkable colonic histopathology results—noting no or minimal fluctuations in inflammatory cell populations—were changed after a medical school “research review” to “non-specific colitis” indicating an inflammation of the colon.” There were other discrepancies too.

But a very big concern was that patients were not recruited because of their clinical symptoms, but were recruited through anti-MMR campaigners, and the study was commissioned and funded for planned litigation i.e. it wasn’t a normal scientific study at all.

Subsequently Andrew Wakefield appeared before the GMC at a mammoth hearing, which ran for 217 days between July 2007 and May 2010. It found that none of his cases was free of misreporting or alteration, and what was in the NHS records could not be reconciled with what was published, to such devastating effect, in the journal.

The Lancet retracted the paper, and Andrew Wakefield was struck off for fraud. He still maintains his innocence and works as a private consultant in the USA, still saying that single dose measles vaccine is best. Meanwhile in the USA, 11 children in one state alone have died of measles.

So I learned my lesson a long time ago, and I totally support the current child immunization schedule, which is as safe as it possibly could be, and saves many lives and even more distressing illnesses and complications. In my view, every child should be immunized.

References
1. Elaine Morgan The Descent of the Child: Human Evolution from a New Perspective by Elaine Morgan (6 Oct 1994)
2.Griffith AH. Vaccine. 1989 Jun;7(3):199-210.
3.Wakefield AJ, Murch SH, Anthony A, Linnell, Casson DM, Malik M, et al. Ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retracted]. Lancet1998;351:637-41.
4. How the case against the MMR vaccine was fixed BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c5347 (Published 6 January 2011)