Due to the worries that MMR is not safe many parents have refused to vaccinate their child. However, the government and many in the scientific community still feel that MMR is the safest option for children. This case study will compare the different arguments for and against the MMR vaccination and evaluate the scientific data behind the opposing views to reach a conclusion on whether the MMR vaccination is safe.
How was MMR tested for safety?
Some people who are against the use of MMR claim that it has not been tested for safety thoroughly enough. However, the government says it was comprehensively tested before it was introduced.
MMR began to be used in the UK in 1988, but before then it had been used for a decade in the USA and Sweden and Finland for six years, where there had been no significant issues with the vaccination. Before the vaccination was licensed in the UK it underwent six separate clinical trials involving 1184 children and doctors found there was nothing wrong with it. To be certain of the vaccination’s safety in the UK, the Department of Health’s Committee of Safety of Medicine (CSM) recently reviewed the decisions to license MMR vaccine. They were satisfied that sufficient information on safety was considered. Now, more than 100 countries use the MMR vaccine and more than 500 million doses have been given worldwide (3).
This shows how carefully and thoroughly MMR was tested before it was allowed to be used.
What about the Side Effects?
One of the first problems concerned with whether the MMR vaccination is safe are the side effects. After the vaccination, children will possibly be affected by fever, a measles-like rash, going off their food, a mild form of mumps (swollen glands, headache, fever), and rarely, small bruise-like spots. One in every 1000 immunised children will have a fit caused by a fever called a febrile convulsion (8) and sometimes children are allergic to the vaccination and have an anaphylactic reaction (this happens in about 1 in every 100,000 immunisations of MMR (7)). In both of these cases the baby would have to spend a few days in hospital. There is also a link to encephalitis (swelling of the brain) however this happens in less that one child in a million who have the vaccination (8). Some parents feel that if there is any risk that there child will be affected by the vaccination they should not have it.
However, the risks of the side effects of the actually diseases are far greater than the risk of the child suffering from the effects of the immunisation.
This table, from the National Health Service (NHS), shows the chances of children being affected and with every condition it is less after the vaccination. The NHS is a very reliable source, with the best experts in the country working for it, its methods being constantly inspected by the government and it has the whole country – with its broad spectrum of ages and ethnicities – as its database making its data very dependable. The results shows how dramatically less the chances are of side effects than the complications of the actual diseases measles, mumps and rubella.
The World Health Organisation, the health body of the UN, is responsible for providing leadership on global health. It recommends the MMR to all countries because of the data that shows children are more at risk without the jab. The WHO is also an extremely reliable source, all its studies involve a huge number of professionals considering many studies over long periods and it has the best interest for the global community’s health. Its opinion is therefore a reliable source on which to base you decision.
Therefore when comparing it is clearly safer to have the vaccination with the smaller risks than the actual diseases themselves have.
Is there a Link to Autism and Bowel Disease?
In February 1998, Dr Andrew Wakefield, a senior lecturer of experimental gastroenterology at London's Royal Free Hospital suggested, that MMR was linked to autism and bowel disease. He tested 12 autistic children with severe bowel disease to try and find a cause of the developmental disorder. His article was published in the distinguished medical journal The Lancet (10) and in the conclusion Wakefield and the other doctors wrote:
“We have identified a chronic enterocolitis [inflammation of the small intestine and colon] in children that may be related to neuropsychiatric dysfunction [behavioural disorders, such as autism]. In most cases, onset of symptoms was after the measles, mumps, and rubella immunisation.” (10)
His scientific explanation of his theory was his suggestion the measles virus part of the vaccination could damage the child’s bowel, particularly the small intestines, called the ileum, and the colon. The ileum is the part of the body where all food is absorbed into the bloodstream through small finger-like projections that cover the inside of the ileum, called villi. Wakefield proposed that the measles virus part of the vaccination led to ulceration along the ileum and colon so the whole digestive system was making the gut walls weaker and less affective. He suggested that this damage in the tissue due to the bowel disease might allow toxins, normally destroyed by chemicals in the gut, to be absorbed into the blood stream through the villi. Once in the blood stream the toxins would be able travel through the whole body and therefore possibly enter the brain. This would cause severe damage and possibly autism. Therefore Wakefield believes that MMR could cause or play a part in causing autism.
However, Wakefield couldn’t completely prove his theory and said:
'I'm not saying that the vaccine is definitely to blame but I've seen patients with a new bowel condition who also have autism and it's one explanation that deserves our attention.' (16)
When subjected to peer review the science behind this argument was questioned by many, especially as although well regarded in gastroenterology he was no expert in the brain and how different chemicals affect it. Professor of Chemistry of the body, from Columbia University, Dr Michael Gershon said it is “implausible”. He told London’s Science Museum in their Antenna Science News Section:
“For Wakefield’s theory to work a set of miracles would have to happen. The liver would have to forget to function as a filter. It normally removes foreign molecules from the blood. Autistic patients, however, are not jaundiced so there's no reason to suspect liver failure.
The blood-brain barrier, which is impermeable to large molecules, would have to part, like the Red Sea did for Moses and the Israelites, to let toxins from the bowel into the brain.” (16)
Since Wakefield’s first proposal was published and subjected to peer review many other studies were done to test to see if he was right. Not one found the same theory. But many did studies which found that there is absolutely no link between the MMR vaccination and autism:
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Dr Petola, a leading professor in children’s infectious diseases at the University of Helsinki, conducted a study in Finland, published in The Lancet in 1988, which followed up any children who developed bowel symptoms 24 hours after the MMR jab. Out of the only 31 children who did and which they followed, none developed autism in the 9 years after MMR (11).
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Dr Kaye, of Boston University, did another epidemiological study for the British Medical Journal, which is the most respected medical journal in the UK. They examined 305 British children diagnosed with autism between 1988 (when MMR vaccination was introduced) and 1999. It showed that the numbers of children vaccinated with the MMR vaccine was constant (at 95% of the population being vaccinated) but that the numbers of children under 12 years old diagnosed with autism rose 7 percent during this period. If the vaccination caused autism, the increase in autism should have flattened off within a few years of the vaccine being introduced. As this was not the case, there was no evidence for the MMR causing the increase in autism (12).
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Another Finish study in 2000, published in the Paediatric Infectious Disease Journal, looked at 1.8 million children who receiver the MMR jab. They found that there was no increase in the rates of autism or bowel disease amongst those being vaccinated compared the children who were not (13).
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The New Scientist also reported in 2001 that when MMR vaccination was withdrawn in the city of Yokohama in Japan for safety concerns in 1993 (before Wakefield’s study), the rates of autism continued to rise. After studying the 31,426 children born in one district of Yokohama between 1988 and 1996, they found the cases of autism continued to multiply - ranging from 48 to 86 cases per 10,000 children before withdrawal to 97 to 161 per 10,000 afterwards - as the graph shows (14). This indicates that the increase of autism is nothing to do with MMR, otherwise autism diagnosis would have gone down after MMR was stopped.
These epidemiological studies are far more accurate and reliable than Wakefield’s original study. This is because they used a much greater number of children in their studies. For example, Wakefield only tested 12 children, whereas the Finish study in 2000 looked at 1.8 million children who had received the MMR vaccination.
They were done over longer periods of time, like the Yokohama study which accounts for autism diagnosis and MMR over 18 years. They were all done by professional in their fields (Wakefield although a doctor in gastroenterology, is not an expert in neurology and the causes of autism). They used valid and reliable methods that were subjected to peer review in various respected scientific journals and agreed on by most other professionals. Many doctors did not agree with Wakefield, which is reflected in the number of studies done to prove him wrong.
In 2004, ten of Wakefield’s co-authors of the original paper retracted their support for the findings saying there was not enough evidence to support their claim which undermined any support for Wakefield’s theory.
When comparing the opposing arguments it shows that although Wakefield found a correlation between children having the MMR vaccination and an increase in children with autism and bowel disease, MMR is not necessarily a cause. There is far more evidence from the other epidemiological studies compared with his only one, showing that MMR does not cause autism. More independent studies would have to be taken to show the effect he suggests that the measles part of the virus has on the gastrointestinal tract to confirm his very limited study.
This was concluded by the World Health Organisation vaccination safety panel GACVS (the Global Advisory Committee on Vaccine Safety) a very reliable source as is part of the United Nations, who after a detailed review of eleven epidemiological studies taking into consideration study design (including ecologic, case control, case-crossover and cohort studies) and limitations, to see if MMR is linked to autism decided that:
“No evidence exists of a causal association between MMR vaccine and autism or autistic disorders. We therefore continue to recommend its worldwide use.” (15).
Are separate vaccinations a better alternative?
In 2002, 75% of the UK’s parents wanted the government to provide free separate measles, mumps and rubella vaccinations for their children because they were worried about the safety of the combined MMR (17). They prefer the choice of separate vaccinations as there has never been any link to the autism and because they feel the combined MMR, with three vaccines at once, will overload their child’s immune system.
However, there is no scientific evidence to prove either of these things; the only recommendation for the separate vaccinations is from Dr Andrew Wakefield who suggested it in a 1998 press conference as an alternative to the combined MMR – even though this was not included in the scientific paper it was only his opinion.
At the moment, parents wishing to have separate vaccinations have to have them done privately. However, the vaccines given are unlicensed in the UK, which means they have not passed the same rigorous safety trials that the combined MMR vaccination has been subject to, and are only even allowed into the country through a loophole in the law.
The combined MMR has had 500 million vaccine doses worldwide and has a very strong safety record; however there has been little research on the safety of single vaccines (18). No other country in the world uses the separate vaccinations, and when Japan did use the separate vaccinations, after they withdrew the combined MMR in 1993, vaccination rates fell and 79 children died of measles between 1992 and 1997, whereas nobody in the UK did during the same period (19). This source is very reliable as it uses a very large database across a whole country over a five year period.
The idea that three vaccines will overload the child’s immune system is also not based on scientific finding. A baby’s immune system fights off thousands of different bacteria that bombard it every day. Professor Offit, from the Infectious Diseases division of the Children’s Hospital of Philadelphia and the University of Pennsylvania, wrote in Pediatrics, a specific medical journal for children’s health, the vaccinations do not overwhelm a child’s immune system. He is a reasonably reliable source as he is an expert in his field specializing in children and infectious diseases at a leading, well respected university and hospital.
After much study of the immune systems response of antibodies to the amount of antigens in vaccinations, he claimed that theoretically a child’s immune system could respond to 10,000 vaccinations at a time and that if 11 vaccines were given to infants at one time only about 0.1% of the immune system would be used. He concluded:
“Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or "use up" the immune system. On the contrary, young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment” (19)
The MMR combined vaccination does not even all work at the same time – each of the viruses have different incubation periods. This means the time taken between exposure to the pathogen (the disease causing organisms) in the vaccination and the time it takes to cause symptoms. In MMR, the measles part of the vaccination works after 1 week, followed by mumps between 3 and 4 weeks after vaccination and finally rubella after approximately 6 weeks (20). This means, that even though the babies body is capable of fighting far more than one antigen at once, with MMR the different attenuated virus cells work at different times so the baby is never exposed to the symptoms of all three simultaneously.
Separate vaccinations are also far less practical than the combined MMR. It means that instead of two vaccinations, the child has to have six over a period of five years. This is unpleasent for the child to have extra discomfort and it is difficult for the parents to complete. It also means the child is exposed to the diseases for another crucial five years, in which they are most exposed to pregnant women, who it is very important don’t get rubella. These extra years where children are not vaccinated delays protection and leaves them very exposed.
The World Health Organisation GACVS (Global Advisory Committee of Vaccine Safety) after a detailed review of MMR decided that there is no evidence to support the routine use of monovalent (separate) measles, mumps and rubella vaccines over the combined vaccine because it would put children at increased risk of incomplete immunization and a greater time unvaccinated for no benefit (15).
This is very clear when you take into account all the factors against single vaccinations: they are not safety tested or licensed in the UK, they do not overload the child’s immune system, they are less practical and there is a greater risk of incomplete immunization, that the combine MMR is the safest option.
What about mercury in vaccinations?
A form of the very toxic metal mercury is found in some vaccines. The form is called ethylmercury and is present in some vaccines in a compound called thiomersal, which is used as a preservative to keep the vaccine free of contamination. Dr Bernard Rimland from the Autism Research Institute said in 2001 that levels of thiomersal were way above safety limits and that mercury could cause autism (22). Since then many studies have been done, including one by the Committee of Safety of Medicines which found no link between thiomersal and neurotoxitcity, causing autism.
However, there is no thiomersal in any live, attenuated vaccination including MMR. Many people have got confused between two different possible links to autism. The NHS has issued a statement confirming that there is no need to worry about the safety of thiomersal levels when considering the MMR vaccination (23).
Are homeopathic substitutes an alternative?
There are a few homeopathic clinics throughout the UK that offer a homeopathic alternative to the MMR vaccination. They use other methods to try and stimulate immunity in a child which consist of a number of oral preparations which are supposed to reduce the incidence and severity of the diseases. These oral preparations are called ‘nosodes’ and are an extremely diluted mixture of the pathogens which cause measles, mumps and rubella and specific plant extracts. They are shaken and diluted so much so that, unlike normal vaccinations, no trace of the pathogen will remain in the body. This solution would be taken as a long course monthly from the age of one month to 26 months (24).
However, there is no scientific evidence to prove that these alternatives can actually provide immunity to the diseases and ‘nosodes’ have not been subject to any of the rigorous safety tests applied to normal vaccinations. Moreover, the British Homeopathic Association recommends (25):
“There is no evidence to show that homeopathic medicines can be used instead of vaccination. The Faculty of Homeopathy recommends that immunisation is carried out in the usual way, unless there are strong medical contraindications”
The British Homeopathic Association are the head of homeopathy in Britain and are very well regared for there opinion, particularly as they try not to be bias towards homeopathy but recommend regular treatment if it is needed. Therefore this is a reliable source.
Therefore when you compare the two arguments it indicates that the real vaccination is safer and more effective than any homeopathic substitution, if even the British Homeopathic Association cannot recommend it.
Conclusion
Having looked at the many different studies done it is clear to see how many people have got confused over the safety of the MMR vaccination and naturally any issue regarding children’s health is always a very emotive topic.
Those who argue that MMR is not safe’s main argument is that when a child’s safety is at possible threat, absolutely no risk should be taken. Therefore, if there is one study that finds a link to autism, or there are any chances of side effects from the vaccination then it should not be administered as an absolute precaution. They feel that until the vaccination is guaranteed to be 100% risk free it should not be used. They follow the precautionary principle that if there is any risk associated, no chance should be taken.
Yet, on balance it is clear that the risks associated with MMR are as low as reasonably achievable and in conclusion I think that:
- After looking at how carefully the vaccination was tested in many countries on thousands of children before it was licensed in the UK, the vaccination has been checked for safety thoroughly enough.
- If you balance the risk of side effects from the vaccination against the risk of complications from the diseases it is far safer for the child to have the vaccination than the disease.
- When you compare the limited Wakefield study against the many other more reliable studies that find there is no link to autism, it is safe to say there is not sufficient enough evidence that MMR does cause autism through bowel disease.
- Studies show that the combined MMR does not overload a child’s immune system, which can cope with many pathogens.
- Separate vaccinations are actually less safe than the combined MMR as they lengthen the time the child is at risk by not having immunity. They are also less practical because it adds extra discomfort and the course is more difficult to complete which would reduce the vaccination rate.
- MMR does not have thiomersal in it so there is no need to worry about the possible link of the harm of mercury.
- Homeopathic alternatives have had no scientific testing to show they work and even homeopathic societies recommend the vaccination.
Therefore, I think that after weighing up the risks against the far greater benefits, overall the MMR vaccination is safe and should be continued to be administered throughout the UK.
Bibliography and ReferencesIn this Case Study I evaluated a number of scientific views and studies which I found from a variety of different media - including websites, government bodies, and science journals – each with varying credibility in evidence which I weighed up directly after the source in my arguments. I have also given them a more detailed reference in the table below.
Important facts and images were chosen from these reliable sources below. Data marked as such “ (1) ” in the case study, would correspond to the “ 1 ” in the table below.
Because they were such key scientific facts and important pieces of evidence I only used reliable publications. So, these included textbooks, such as OCR Twenty First Century Biology, educational websites such as BBC Bitesize and the Science Museum Antenna Section, scientific journals such as JAMA, Lancet and BMJ which are written and subjected to peer review by other specialists in the relevant fields, leaflets provided for parents in my doctor’s surgery in London and a detailed website by the NHS, the government’s health organisation, and statements from government officials.
