https://doi.org/10.36866/pn.124.12

Dr Angus Brown, University of Nottingham, UK

The COVID pandemic has polarised public opinion regarding vaccination. Faced with the most serious global medical crisis for a century, it seems inexplicable that a significant proportion of the population are refusing vaccination, the only treatment proven to minimise the effects of the virus.

It is in the US that this issue is most visible, opinion divided primarily along political lines, with Republican voters more likely to express anti-vaccination sentiment than Democrat voters. The obscene situation where developed countries are destroying unwanted vaccines while developing countries suffer the ravages of the disease due to vaccine shortages may be considered the legacy of one man, Andrew Wakefield, whose fraudulent claims linking vaccination with autism in order to increase his academic profile, has led to one of the most serious threats to global health of the modern era.

The contrasting fates of charismatic arch frauds Lance Armstrong and Andrew Wakefield offer an
insight into the public’s attitude to lying. Both men’s fame was founded on a series of escalating lies, which were vigorously defended, dissenters were confronted, their claims dismissed and they were ultimately threatened with legal action. Both men’s lies were publicly exposed; they were sanctioned by their respective professional governing body, ending their careers. Armstrong’s downfall was swift and complete. Stripped of all titles he was expunged from the record books, a punitive warning to potential cheats. Viewers of the three-week Tour de France, with up to five hours of daily coverage, are more likely to hear mention of Liberace than Lance. Wakefield met his match when new head of department Mark Pepys considered him a fraud and a fantasist, and made it his first order of business to rid the Royal Free Hospital in London of Wakefield’s toxic mix of charisma and ruthless ambition. Wakefield relocated to Texas in 2004, Armstrong’s home state, where the anti-vaccine movement embraced him as a seeker of the truth, and he currently enjoys enormous support as the world’s most prominent anti-vaccine campaigner.

Brian Deer, a Sunday Times investigative journalist, was responsible for exposing Wakefield’s fraud concerning claims that the MMR vaccine caused autism. This book describes his investigations, forensically unravelling the litany of fraud and lies perpetrated by Wakefield. Deer’s prose style is not to my taste, but this should not detract from this extraordinary story. Unfortunately Deer also employs epithets for key characters and barely has a good word to say about anyone mentioned in the book, those attaining the lofty title of “Professor Sir” reserved for particular contempt. This is juvenile, Deer resorting to ridicule when he realises scientists and doctors are as venal and mendacious as his fellow journalists. An advantage of Deer’s scientific ignorance is that he explains the medical facts in a very straightforward manner. However, the complex timeline, coupled with the interweaving roles of multiple characters, mandates a second reading of the book to establish a firm understanding of the chronology of events.

Wakefield is portrayed as a frustrated mid-ranking clinician with lofty ambitions of fame and fortune, working in a mediocre department in the early 1990s. Wakefield shrewdly realises a path to success lies in the Research Assessment Exercise, and focuses on creating a headline-grabbing story. He uses the future Nobel Prize winners Warren and Marshall, who showed against the prevailing accepted medical wisdom that peptic ulcers are caused by bacteria and could be easily cured with antibiotics, as his model. Wakefield lacks their medical insight and fabricates a tale in which children develop symptoms of autism within two weeks of receiving the MMR vaccine. It is important to note that initially Wakefield was not against vaccinations, but rather advocated immunisation against measles, mumps and rubella be given as individual vaccinations from which he would benefit financially, having patented a single dose measles vaccine. Wakefield vacillated on what he considered the agent of autism, settling initially on the partial live measles virus present in the MMR vaccine, then on thimerosal, a mercury-based compound contained in the MMR vaccine. He proposed that the MMR vaccine caused autism by penetrating the gut, with cognitive regression a secondary effect. His primary evidence was an electron microscopic image of the measles virus in the gut of a Crohn’s disease sufferer.

No other laboratories were able to replicate this result when they used the sensitive PCR technique to detect the virus. The study that brought Wakefield the attention he craved was published in The Lancet in 1998. The dubious funding, clinical misconduct, data manipulation and patient coercion that underlay this paper are all described in great detail, so there can be no doubt as to the depth and extent of Wakefield’s fraud. What is also evident is the role of fellow clinicians, scientific collaborators and ambitious hospital managers who acted as enablers, hitching their wagons to Wakefield as a fast track to career advancement, patient care and clinical ethics be damned. However, the publication of the paper attracted a little too much adverse attention for Wakefield’s liking. The claims of the study were of such fundamental importance they demanded to be replicated and independently verified. Although Wakefield was given the opportunity to do this he stalled and then refused, precipitating his removal from the Royal Free in 2001. The pathway to publication of the study in The Lancet reveals a web of nepotism where conflicts of interest were ignored. Even when scrutiny of The Lancet paper becomes sufficiently intense to prompt an inquiry the self-serving committee members find no fault with the paper.

The paper was eventually retracted in 2010 and Wakefield was struck off in the same year. This should be where Wakefield’s fate matches that of Armstrong, but the US has always embraced the charismatic anti-establishment loner to a greater degree than the UK. After his move to the US, Wakefield’s stance varied depending upon circumstance, telling US TV that he believed that there was a link between the MMR vaccine and autism, and then telling the Guardian that “I do not make the claim that MMR is a cause of autism”. The shifting tone of Wakefield’s pronouncements makes it difficult to pin down his exact claims, and Deer suggests Wakefield himself was unable to articulate his theory precisely and varied his claims depending upon his audience, relying on his charisma to disarm sceptical interviewers.

Distrust of vaccines is not a new phenomenon. Indeed the comically reckless and criminally negligent manner in which Edward Jenner first demonstrated controlled vaccination in 1796 has tainted the practice ever since. This is largely due to the complexities involved in understanding how vaccines work, and the seemingly dangerous paradox of injecting an agent related to a disease-causing pathogen in order to prevent illness. The first public demonstrations against vaccination occurred in the mid 19th century, when the British government ordered vaccination in their fight against smallpox. Despite the success of vaccination programmes, particularly smallpox, the public has never been fully convinced that vaccines are safe. At least part of this rests on the noble intention of parents in protecting their children. Many people fear hypodermic syringes, the greatest cause for vaccine hesitancy, and adverse reactions to vaccination are common. The difficulties in extrapolating population statistics, e.g. the vaccine is 70% effective, to the effect on an individual also confuses. These are legitimate concerns, and are an important part of the dialogue between the public and the medical profession.

The anti-vaccination movement has been infiltrated by those using it to further their own ends. The movement is based on ignorance and recalcitrance, fuelled by misinformation, political agendas, government distrust, financial gain, it is immune to logic and reason. There is enormous political capital to be gained in manipulating a large proportion of the population, a shared distrust of vaccinations the common bond used to steer opinion. It is in the US that Wakefield’s fate spirals out of his control. He becomes dependent upon wealthy donors, some with autistic children, who represent a powerful lobby, whose personal tragedies drive a zealotry intent on exposing “the truth” that “they” are hiding, namely that all vaccines are dangerous. In order to receive financial support from these wealthy donors Wakefield must form a Faustian pact and adopt their extreme views on vaccination, declaring “If I had a baby, I would not vaccinate them”, in 2017.

Do the countless deaths resulting from his advocacy of vaccine hesitancy prey on Wakefield? Apparently not, when he proclaims, “I do not feel responsible”. How does he sleep at night? Rather comfortably you may imagine, in the multi-million dollar Florida mansion he shares with model Elle McPherson, but I’m not so sure. It is one thing to make peace with lies of your own invention, quite another to live a lie imposed upon you by the desperate, the deluded and the frankly dangerous.