Pendulum swings back to MMR

welcome unanimity in UK media treatment of a recent paper on measles, mumps, rubella (MMR) vaccine in the Archives of Disease in Childhood. This was a review by David Elliman of St George’s Hospital and Helen Bedford of the Institute of Child Health, London, of all the evidence concerning alleged links with autism and inflammatory bowel disease. They concluded that there were no such links –— but positive danger in using separate vaccines against the three different infections. These findings appeared to be reflected as fairly in the Daily Mail’s “Experts back the MMR triple jab” as in The Guardian’s “Child health experts dismiss fears over MMR jab”. So too with the Daily Express’s “Now a scare over single jabs for kids” and The Independent’s “Children ‘put at risk by single vaccines’”. However, closer inspection of these and other headlines revealed a significant divergence between broadsheets and tabloids. The Daily Mail, for example, positively invited readers to be puzzled and worried. “Parents face further confusion over childhood vaccination today,” its news story began, implying problems not just with MMR but with immunisation in general. After a cursory summary of Elliman and Bedford’s work, the report concluded: “The anti-MMR pressure group JABS rejected their findings last night”. The Daily Express began by telling readers that “doctors” had “urged parents to immunise their children and stressed that there was no evidence to prove the safety and effectiveness of single vaccines for each disease”. But it then continued with: “The advice came as new fears emerged in France, where doctors claim that aluminium, a key ingredient of many vaccines, may cause muscle damage”. The metal occurred in diphtheria, whooping cough, meningitis C, hepatitis and tetanus vaccines. These and other tabloid accounts received far less prominence and column inches than habitual immunisation scare stories. By contrast, reports in the broadsheet newspapers were prominent and comprehensive. Arguably the best of the broadsheet pieces was that which appeared in The Times. It not only summarised the key points of the Elliman/Bedford paper, but also pointed out that whereas there were 76,000 measles cases and 16 deaths per year in Britain before the introduction of MMR vaccine in 1988, only 100 persons developed the disease last year and there have been no deaths since 1992. The Times went to the heart of the controversy that has continued since 1998 when The Lancet published Andrew Wakefield’s claim that the triple vaccine may cause autism. It highlighted comments by Elizabeth Miller of the Public Health Laboratory Service, in a commentary in the Archives of Disease in Childhood, regarding publication of that and a subsequent paper by Wakefield. “There was a failure of the peer review process to identify basic flaws in the design and execution of these studies,” Miller was quoted as saying. “Unfortunately, once a paper is published in such a journal and widely quoted in the media, the work achieves a respectability that carries considerable weight in the public mind. Publication in respectable medical journals of [these] papers...is a disservice to patients and health professionals alike.” The Guardian too referred to Elizabeth Miller’s commentary (ignored by the tabloids). In this case, the newspaper focussed on her comparison between the MMR controversy and the BSE/CJD affair. The latter, she said, had “fuelled concerns of some parents that government experts might have got it horribly wrong, or worse still that there has been a cover-up.” In reality, the evidence about the safety of MMR vaccine was “mountainous” – in contrast to the situation with BSE/CJD. Peer review and and the methodologies used by scientists to assess evidence may appear tedious to news editors but do parents really want to be told that they face “further confusion”, that experts have “dismissed fears”, that there is a “new scare” and that “top docs” say one thing and health lobbyists another? Or would they appreciate instead rather longer articles explaining upon what basis expert A and expert B have based their assertions? To help readers in this way really isn’t difficult — as most of the broadsheets demonstrated on this occasion.