MMR

The MMR jab is a combined vaccine for measles, mumps and rubella. One version of the vaccine available in 2010 in the UK is made by Merck. Another version is made by GlaxoSmithKline (GSK) and is marketed under the name Priorix.

The MMR vaccine became controversial in February 1998, when a research team headed by Dr Andrew Wakefield suggested that it might be linked to an increased risk of autism and bowel disorders. It was GSK's version of the MMR vaccine that was at the heart of the Wakefield case.

Dr Wakefield claimed:

• ‘This is a genuinely new syndrome and urgent further research is needed to determine whether MMR may give rise to this complication in a small number of people.’

• The combination of the three virus strains in the vaccine may overwork the body's immune system and cause the bowel disorder to develop.

Adverse reactions to the vaccine, according to manufacturers

Adverse reactions following administration of the combined vaccine or one or more of its component vaccines, according to Merck's MMR vaccine package information leaflet, include, but are not restricted to:

atypical measles; pancreatitis; diarrhea; vomiting; parotitis; nausea; diabetes mellitus; anaphylaxis; arthritis; arthralgia; myalgia; encephalitis; encephalopathy; Guillain-Barré Syndrome (GBS); febrile convulsions; afebrile convulsions or seizures; ataxia; polyneuritis; polyneuropathy; ocular palsies; paresthesia; aseptic meningitis; and death.

GSK's Priorix information leaflet lists adverse reactions including bronchitis, diarrhoea, vomiting, colitis, gastroenteritis, herpes zoster (varicella), herpes simplex, viral infection, lymphadenopathy, arthritis, thrombocytopenia, thrombocytopenic purpura, and meningitis.

Doubts about MMR safety

Among those who doubt the safety of MMR is Dr Peter Fletcher, former chief scientific officer at the UK's department of health. A 2006 article in the Daily Mail reports:

after agreeing to be an expert witness on drug-safety trials for parents' lawyers, he [Fletcher] had received and studied thousands of documents relating to the case which he believed the public had a right to see.

He said he has seen a "steady accumulation of evidence" from scientists worldwide that the measles, mumps and rubella jab is causing brain damage in certain children.

But he added: "There are very powerful people in positions of great authority in Britain and elsewhere who have staked their reputations and careers on the safety of MMR and they are willing to do almost anything to protect themselves."

MMR studies

In March 1998, the Medical Research Council set up a panel of experts, headed by the GP, Dr Michael Fitzpatrick, to examine the claims. They concluded there was ‘no evidence to indicate any link’ between MMR jab and bowel disease or autism in children.

A 14-year study by Finnish scientists concluded in April 1998, claiming to find no danger associated with the MMR vaccine.

In April 2000, ‘Dr Wakefield and Professor John O'Leary, director of pathology at Coombe Women's Hospital in Dublin, claimed there was ‘compelling evidence’ of a link between autism and MMR. However, it did not ‘confirm that the virus causes autism, or even that the source of the virus found is the MMR vaccination, which contains "dead" versions of the measles and mumps viruses.’ The Department of Health said the claims were ‘unverifiable by usual scientific means.’

In January 2001, Dr Wakefield announced that the vaccine had never undergone proper safety tests. In a study published in the journal Adverse Drug Reactions and Toxicology Review, Dr Wakefield said original safety checks on the vaccine were poorly conducted and only lasted for four weeks. The Department of Health rejected the claim again.

In February 2001, the British Medical Journal published a major statistical analysis concluding the soaring rate of autism in recent years was almost certainly not due to the MMR injection.

In September 2001, researchers from St George's Hospital in London and the Institute for Child Health gave the vaccine ‘the all-clear after examining all the studies into MMR that have been carried out.’ The research is published in the journal Archives of Disease in Childhood.

In December 2001, the Medical Research Council announced the results of its research which was commissioned by the Department of Health. They found no link between the vaccine and autism.

In February 2002, Dr Wakefield and Professor O'Leary publish a paper in the journal Molecular Pathology. It suggested a possible link between the measles virus and bowel disease in children with developmental disorders.

In February 2002, a team from the Royal Free Hospital published a study on the British Medical Journal website saying there is no link between MMR and autism.

In March 2005, researchers at the Yokohama Rehabilitation Center and the Institute of Psychiatry in Japan said they had strong evidence that the MMR vaccination is not linked to a rise in autism after they found a rise in the incidence of autism after the withdrawal of the measles, mumps and rubella jab in their country in 1993.

In May 2006, Dr Stephen Walker in America reported that his research team had found measles virus in the guts of autistic children with bowel disease. The study appeared to confirm the findings of Dr Andrew Wakefield. Walker said: "Of the handful of results we have in so far, all are vaccine strain and none are wild measles. This research proves that in the gastrointestinal tract of a number of children who have been diagnosed with regressive autism, there is evidence of measles virus. What it means is that the study done earlier by Dr Wakefield and published in 1998 is correct. That study didn’t draw any conclusions about specifically what it means to find measles virus in the gut, but the implication is it may be coming from the MMR vaccine. If that’s the case, and this live virus is residing in the gastrointestinal tract of some children, and then they have GI inflammation and other problems, it may be related to the MMR." He claimed the finding did not show that the MMR vaccine caused the condition.

In February 2008, ‘a team led by London's Guy's and St Thomas's Hospital looked at any differences in the immune response from the MMR jab to see if that could have triggered autism. They found no difference between children with autism and those without, and concluded the study showed there was no link.’

Comments on the above studies

2005 Japanese study

In Japan, the MMR was replaced by single vaccines. Children given these single vaccines formed the control group in the 2005 Japanese study. These single vaccines contain similar ingredients to the MMR, albeit that they are given separately. For example, the single measles vaccine contains the live measles virus, which has been identified as a possible causative factor in Crohn's disease. Therefore the Japanese study does not show that MMR is safe. It does show that MMR is no more likely to cause autism than single vaccines. But it does not exclude the possibility that both the MMR and the single vaccines may cause autism.

The rationale behind giving single vaccines is that they are less likely than combined vaccines to overwhelm the child's immune system. But this is an assumption that is not proven. As of 2009, according to Dr David Haslam (chairman of the college of the council of the Royal College of GPs and a supporter of MMR), there is no proof that single vaccines are safer than combined vaccines, and there are fewer studies of single vaccines.

Dr Viera Scheibner, a long-term researcher and critic of vaccinations, issues the following caution about Andrew Wakefield's backing for single vaccines in an article co-authored with Bronwyn Hancock:

researchers ... and parents, particularly in the United Kingdom, are calling for the three vaccines (measles, mumps and rubella) to be administered individually as if this were the solution to the problem. However it is not just the combined vaccines, such as MMR or DPT that cause autism, and therefore the separate administration of the vaccines will NOT resolve the problem. In fact we know of cases of autism occurring after the individual vaccines. Indeed, the risk may, to the contrary, be even increased. Dr Wakefield has not referred to ANY research that has looked into the relative risk of developing autism after the separate vaccines as opposed to the combined MMR (and we are not aware of any), so there is no basis for such a recommendation.

Critics of Scheibner point to her lack of medical training. But what appears to be beyond doubt is that as of May 2010 there is no research on possible links between autism and single vaccines. Thus a study needs to be done on the comparative incidence of autism in populations given the MMR, with two control groups: one given single vaccines, and another unvaccinated.

MMR and freedom of information

In January 2009 the Daily Mail reported on a Freedom of Information ruling on MMR data:

Confidential documents on the introduction of the MMR vaccine should be released by the Department of Health, says the Information Commissioner. Richard Thomas ruled that their release was in the public interest, despite months of foot-dragging by officials.

He said minutes from three committee meetings before the introduction of the Measles Mumps and Rubella jab in 1988 should be published under the Freedom of Information Act.

The article says the information is expected to include data from the pre-licensing studies of MMR before the nationwide immunisation began in 1988. Jackie Fletcher, who runs the vaccine awareness group Jabs, said parents who believed their children were damaged by MMR, want to know the basis on which the vaccine was originally approved.

MMR litigation

In June 2007, a group claim by parents against vaccine manufacturers for damages on behalf of children allegedly damaged by the MMR vaccination collapsed when legal aid was withdrawn. The litigation, which at one time peaked with 2,500 children in the group, had been in progress for several years.

A high court judge, Justice Keith, ruled that all but two claims against various pharmaceutical companies must be discontinued, under threat of being struck out, because the withdrawal of legal aid by the Legal Services Commission had made their pursuit impossible. But the judge said his ruling did not amount to a rejection of any of the claims that MMR had seriously damaged the children concerned.

The collapse of all the other cases because they had no public funding came a month after the FOIA Centre revealed that another high court judge who had blocked legal aid has a brother who sits on the board of a drugs company embroiled in the litigation. The ruling by Sir Nigel Davis – whose brother, Sir Crispin Davis, was a non-executive director of GlaxoSmithKline – to dismiss the attempt to restore legal aid left many families without lawyers to represent them.

BBC drama featuring criticism of MMR banned

In 2006, two episodes ("One Angry Man" and "Heart of Darkness", series 5) of the BBC legal drama series, Judge John Deed, contained a storyline critical of MMR. Just one viewer complained, whereupon the BBC banned the re-broadcast or distribution on DVD of the two episodes in their original form.

The following information regarding these episodes of Judge John Deed has been placed in the public domain by the BBC:

Judge John Deed, BBC1, 10 February 2006

Complaint

A viewer complained that various aspects of the storyline combined to convey the message that the MMR vaccine was harmful to children’s health.

Ruling

We agreed that the episode conveyed the message complained of, and was therefore in conflict with the obligation of due impartiality on matters of public controversy. Steps were already being taken by Drama and Editorial Policy to ensure that future episodes would observe the requirements of impartiality insofar as they apply to drama of this kind, and it was agreed that the episode in question would not be re-broadcast, except in a context in which the requirements of impartiality were met. On that basis, we considered the complaint to be resolved.

A Freedom of Information request to the BBC as to the identity of the sole complainant and requesting disclosure of the correspondence on this subject between the complainant and the BBC was refused by the BBC on the grounds that "The BBC’s independence and impartiality would be at risk through disclosure of further information on editorial complaints".