Measles outbreaks: Getting to the root of the problem

Measles outbreaks across the United States have been identified with Texas being the 11th state so far to report an outbreak. The Philippines with over 2 million unvaccinated children has declared an outbreak of measles after nearly 2,000 cases and 26 deaths since January alone. In Madagascar, more than 50,000 people have been infected by the disease since October — more than the total number of measles cases reported in Africa in 2018. Moreover, in Europe, measles cases tripled between 2017 and 2018, with over 59,000 cases and 72 deaths, according to the World Health Organization (WHO). The recently published report, Progress towards Regional Measles Elimination — Worldwide, 2000-2017, in the WHO Weekly Epidemiological Record showed that over 109,000 vaccine-preventable deaths still occurred last year.

Measles is a highly contagious disease, which is caused by the measles virus associated with skin rashes and a high fever, and, in some cases, serious complications, including pneumonia, seizures, and even death. At least 95 percent of a population must receive two doses of the measles-containing vaccine to protect the entire population to achieve “community immunity” (also known as herd immunity), and in many areas with outbreaks, this is not happening. Vaccination coverage has dropped, which means that there is not enough people are being vaccinated and the current outbreaks are mainly caused by a large number of unvaccinated people.

In medicine, it’s easier to understand the difference between treating the symptoms and curing the condition. However, for other things, if you only fix the symptoms, the problem will probably return and need to be fixed over and over again. 5 Whys is a powerful tool for finding the causes of problems, by asking “Why?” at least five times.

Measles outbreaks are happening. (the problem)

  1. Why? There are large pockets of unvaccinated people. (First why)
  2. Why? They do not want to get vaccinated. (Second why)
  3. Why?They think the vaccines are not safe / cause autism. (Third why)
  4. Why?They read somewhere that vaccines cause autism. (Fourth why)
  5. Why? Andrew Wakefield (Fifth why, a root cause!)

The origin of the modern anti-vaccine movement can be traced back to a single unethical and unscientific study that has since been labeled fraudulent, manipulative, and unethical. This 1998 Lancet publication by Andrew Wakefield — the founder of the modern anti-vaccine movement — has been described as “the most damaging medical hoax of the last 100 years.”

Thankfully British investigative journalist Dr. Brian Deer (awarded the honorary degree of Doctor of Letters by York St. John University) pursued a landmark public interest investigation on the allegations that linked the three-in-one measles, mumps and rubella vaccine (MMR) with claims of a terrifying new syndrome of bowel and brain damage in children. Deer discovered that the public alarm had no scientific basis whatsoever. Wakefield had been secretly paid to create evidence against the MMR vaccine while planning business schemes meant to profit from the scare. Also, he misreported and changed information about the children in the study to dishonestly change the results. Besides data falsification, Wakefield failed to disclose that he had been paid more than £400,000 (US$ 515,000) by lawyers trying to prove the MMR vaccine was unsafe and children in the study were claimants of a pending lawsuit against vaccine manufacturers.

Wakefield was later found guilty by the British General Medical Council (GMC) of three-dozen charges, including dishonesty and abuse of developmentally delayed children he included in his study. Citing dishonest and unethical behavior, Wakefield was stripped of his medical license; his research paper was retracted from publication in 2010, and his position as scientific director taken away.

Despite widespread scientific condemnation and robust scientific evidence proving the safety of the measles vaccine, Andrew Wakefield, has not backed down from its conclusions and has continued his misinformation campaign. Wakefield now lives in Texas and is involved in a combination of organizations and charities related to autism and trying to prove a link between the condition and using vaccines. In 2016 he directed and appeared in a film called “Vaxxed” that paints himself as the victim of high-level conspiracies and shows a well-weaved narrative of context-free statistics, emotional clips, and conspiracy theories claiming that ‘the pharmaceutical industry has controlled all of the television.’”. He continues to travel and preach his message of anti-vaccination and anti-science, and in one instance, he traveled to the State of Minnesota to target its Somali community.  The community, which had traditionally had a vaccination rate higher than others in the state, saw it drop from 92 percent to around 40 percent which led to Minnesota’s largest measles outbreak in 30 years, with over 80 percent of cases involving unvaccinated Somali-American children.

The science on vaccines is robust and clear. In science, a single published paper does not constitute a definitive fact. A study must be reproducible, and its results must be confirmed by further research before it is widely accepted. After Wakefield’s work was published (and retracted), numerous studies have been conducted, none of which have been able to reproduce his result. The overwhelming majority of experts in the field say Wakefield is wrong and several studies have been performed that disprove the notion that MMR causes autism.

Melvin Sanicas is an infectious disease physician.

Image credit: Shutterstock.com

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