POSSIBLE LINKS BETWEEN VACCINATION AND AUTISM - A SUMMARY
A NEW TYPE OF AUTISM FOLLOWING VACCINATION?
· A significant number of children have "become autistic" in the late 1980's and early 1990s. These children were developing normally when they suddenly markedly degenerated with loss of previous language and skills and the permanent acquisition of acute multiple food allergies.
· Parents report that this degeneration followed on from immunisation. This is regarded as coincidence by the Department of Health (DoH).
· The Department admitted in correspondence on 19th March 1998 that "...early studies on autism, carried out before MMR vaccination was introduced, showed that many children with autism were reported to have developed normally and then regressed the mechanism by which this occurs is not yet known ... Whilst research in this area is still in the early stages, there is no evidence at present to suggest that the mechanism may be through an inability to cope with vaccines." (source, Helen Campbell, Senior Scientific Officer, Immunisation and Communicable Disease Branch, Health Promotion Division, DoH).
· But the DoH has no coherent proven alternative explanation for degeneration after vaccination into autism.
· Damage to some children has been very severe. The more acute cases of autism include problems such as complete absence of speech, poor language comprehension, double incontinence, hyperactivity with multiple food allergies and intolerances, and extremely poor sleep, with dramatic consequences for their families in terms of quality of life.
MEASLES, MMR AND MEASLES-RUBELLA VACCINES
· The single-constituent measles and rubella vaccines were introduced in the UK in 1968 and in 1970 respectively. Mumps measles rubella (MMR) was introduced in October 1988, and an immunisation campaign with combined measles-rubella (MR) was children now believed to have been damaged was with the MMR vaccine.
However, in a much smaller number of )s cases, it has involved pre-MMR measles-only vaccine. The problem with vaccination, if there is one, may therefore not be confined to MMR alone.
· The DoH states that there was no increase in autism when MMR was introduced. However, as autism is being linked, by parents and by some researchers, to MMR's predecessors as well, this defence may be irrelevant.
· Parents' suspicions over vaccines are not confined to the measles etc. virus content but also to the other constituents of the vaccines, their quality control and even their storage. Each element needs to be firmly eliminated by research.
· Despite the DoH's assertion that autism will typically be noticed around the time of vaccination but is unconnected with it, no cases can be found when children degenerated immediately before vaccination. If any can be found, then parents' groups would like to hear of them.
ADVERSE EVENTS & DAMAGE
· There has been a past tendency for surveillance of children, following vaccination, to be only in terms of days, or at most two or three weeks. And even some adverse reactions within this short time scale have been dismissed by health officials as unconnected with vaccination.
· But there is no scientific proof that all adverse events must necessarily be immediately after vaccination. There are now powerful arguments that adverse events such ~ degeneration into autism may take two or three months to take full effect. The sequence of interconnected effects could conceivably take as long as perhaps two or three months to cause damage.
UNDER-REPORTING OF ADVERSE EVENTS - THE "YELLOW CARD" SYSTEM
The DoH primarily relies on the Medicines Control Agency "Yellow Card" surveillance system to pick up practitioners and pharmacists. However, far. too few cards are actually filed. Doctors may not recognise symptoms seen several months after vaccination as being connected, or may be reluctant to do so. They also may feel that they are unable to prove the link, particularly in the face of the DoH assurances that there is no link - a chicken-and egg situation.
· The Public Health Laboratory Service published a paper in March 1995 in The Lancet, Vol.345, admitting an estimated five-fold level of under-reporting.
· In a bulletin published in December 1996, the West Midlands Centre of Adverse Drug Reactions Reporting found in a survey of 1420 adverse reactions, some 477 would have fulfilled the Committee of Safety of Medicines' criteria for reporting, but only thirty Yellow Cards were actually filed, accounting for only 6.3 % of the identified reportable reactions.
· The Medicines Control Agency has contradicted itself on this issue, stating in correspondence on 21st August 1998 that many serious reactions do get reported, but also stating in Adverse Drug Reaction Information Service Guidance On Interpretation Of Yellow Card Data, Drug Analysis Prints, 1997 edition, that only 10-15% of even serious reactions are reported.
· Official statistics given in response to enquires from Members of Parliament or the media, are not factored up to reflect true levels, and are therefore very seriously misleading.
· A circular argument results, whereby adverse reaction figures are kept low, these are quoted as justification for repudiating suggestions that a child's damage was connected to vaccination, then the child's case is not added to the statistics, and then these remain low. The poor Yellow Card system explains how the Medicines Control Agency failed to pick up what may eventually prove to be a major health scandal.
THE CHILDREN AT RISK
· The vast majority of children have been safely immunised without adverse consequences. However, it is over-extending logic to take this as proof that there is no problem for a small minority.
It remains very possible that children, with a particular genetic predisposition, or as a consequence of previous illnesses, or previous treatments such as antibiotics, or some other factor such as low levels of particular vitamins, may react strongly to particular vaccines or with some variation in the quality of particular batches of vaccines, or experience an auto immune reaction.
· It is biologically possible that this could result in a vaccination-triggered sequence ending in autism or other damage. The DoH attitude seems to be "if it's safe for most, it follows that it must be safe for all".
· To be damaged, a child may need to experience or possess several, or even all, these factors. The relationship will be complex. Yet DoH statements have treated this simplistically, as though autism had to immediately follow vaccination, and be directly and only very obviously linked to it, to have been caused by it.
CONTRAINDICATIONS AND PATIENT RECORDS
· Very few contraindications to vaccination are officially recognised. The literature giving advice on contraindications is spread confusingly between the immunisation "Green Book" issued to doctors, the advice sheets issued to health professionals, and the basic leaflets available to parents. In the background are numerous technical articles.
· The parents' leaflets are designed to soothe away doubts and to reassure. Very little meaningful information reaches the parents. No information actually stresses the potential risks.
· There is also scope for confusion in multi-doctor practices, where Doctor A may have been treating a child, then Doctor B recommends that the child is vaccinated, but without first checking the child's health records.
· The records themselves are frequently an unreadable mess of pieces of paper crammed into a small card folder, much of it unreadable, and perhaps not fully complete if locum doctors have been involved.
VACCINE BATCH QUALITY PROBLEMS?
· There are undoubtedly problems with particular batches of vaccines. In just one batch ten cases of damaged children, geographically scattered, have been registered with one parents' action group, all with the same vaccine batch number. As there are 5,000 doses of vaccine in each batch, then this would indicate a very high risk, or one in 500, from that batch.
· Also, many parents have probably not yet realised the possibility of vaccination having caused their child's regression into autism or other damage, and are not members of any group. The ten cases identified above are therefore unlikely to represent more than a proportion of the total number of children damaged by this particular batch.
POTENTIAL NUMBER OF DAMAGED CHILDREN
· Degeneration into autism in the two or three months following vaccination is only one of a range of problems suspected by parents. The specialist solicitors Hodge Jones and Allen have been approached by some 5,000 families to date, and are now understood to have over 1,800 cases of suspected damage on their books, of which over 1,000 are autism.
· Other problems within these children include Crohn's Disease, epilepsy, other forms of brain damage, hearing and/or vision problems, behavioural and learning problems, and a number of deaths (source: Dawbarns Factsheet, June 1997) (these were the solicitors that preceded Hodge Jones and Allen).
· There are also other solicitors firms acting for other children, plus unidentified children yet to be referred to any solicitors because parents do not appreciate what could have taken place biologically. It is therefore difficult to estimate the potential maximum total number of children that could be damaged by vaccination, including degeneration into autism, during the late 1980s and early 1990s. The numbers are likely to be several thousand, and potentially even more.
LACK OF DOH DATA ON AUTISM LEVELS
· The DoH does not have any comprehensive database on autism and has been criticised for this by the House of Commons Health Committee (Second Report of the Health Committee, Jan 1997, para 105).
Some DoH health professionals quote a non-increase in autism, but there is no data to confirm this. In contrast, other DoH officials have recognised the rise in autism but offered no explanation.
· There is considerable anecdotal evidence to suggest a sharp growth in autism from the mid- or late-1980s onwards. The picture is confused, because part of the increase is due to better recognition of the condition, but this probably only explains away some of the growth in numbers. No one knows exactly how much.
· However, the Department of Education has confirmed that the numbers of children "statemented" (requiring special education provision) rose from 153,228 in 1991 to 232,995 in 1997, a startling 52% increase. In mainstream primary and secondary schools, numbers rose from 62,000 in January 1991 to 134,000 in January 1997, an even steeper increase of 116%, in just six years.
· It is fully acknowledged that the underlying reasons for these education statement numbers and these steep increases, which (repeat) are not just autism, are undoubtedly extremely complex. However, it gives some idea of the sharp recent increase in the need for statementing and the significant increase within these much larger numbers of children that could be potentially involved in concerns over autism.
OFFICIAL REACTION TO EMERGING RESEARCH
· The DoH strongly criticised the suggestion that autism and vaccination could be connected, following a review at the Medical Research Council.
However, careful reading of the assurance of the Chief Medical Officer (CMO) exposes more room for doubt than appeared at the time.
· The wording in the CMO's statement of 27th March 1998 was"... based on the brevious material that I have seen and on the opinions of experts present at the MRC meeting, I have concluded that there is no link... (and) I was not convinced that any of the studies support suggestions that measles of MMR vaccines are implicated in Crohn's Disease or in autism.
(my emphasis). The CMO has, however, limited his review to a very narrow field, as little substantive available to the Medical Research Council seminar, whilst very few experts indeed appear to have actually given evidence. How much evidence has been seen by the Departments officials is not known, but there appears to be a disregard towards unpublished evidence and a hostility to all theoretical arguments that suggest a link.
· The CMO also stated on 26th March 1998 that "Since autism has never been linked with measles vaccine, and the only difference between it and MMR vaccine is the addition of rubella and mumps viruses, there is little biological plausibility for these two additional viruses to cause autism ... Similarly, it is difficult to accept that the rubella and mumps components of MMR have caused a bowel disturbance allowing leaked proteins to damage the brain within hours of immunisation..." (source, DoH factsheet, my emphasis).
· The second quote betrays two serious misapprehensions. Firstly, autism actually HAS been linked with measles-only vaccine, even if only through unpublished work or circumstantially. The point about mumps and rubella is therefore arguably irrelevant. Secondly, it is not being suggested by parents that only hours are involved, but rather weeks or months, for damage to occur. This is another fundamental misunderstanding by the CMO's advisers.
Also, the CMO's conclusions were "based on the evidence presented at the MRC seminar yesterday" (DoH press release 98/109 of 24th March 1998). However, it is believed that no actual evidence was presented to the seminar. The Department, in effect, looked inside an empty box and found no contents. It is thought that very few leading-edge researchers were even originally invited, and that none, other than Dr Wakefield, actually attended. As Dr Wakefield was not presenting evidence, only a working hypothesis, the MRC seminar's findings were a foregone conclusion, and the media seriously misled.
· The DoH's criticisms of the Royal Free work were endorsed by the peer-review in The Lancet, Vol.351, February 1998, pp 611-12, of Drs Chen and Dc Stefano. However, these doctors work for the US Vaccine Safety and National Immunisation Program.Prevention, so can hardly be said to be neutral in their stance.
· Their peer-review was hostile, but only very generalised. They did not actually offer any evidence to contradict Dr Wakefield, nor did they acknowledge the work of other researchers, mainly in the US, whose published and unpublished work suggests a possible linkage between vaccination and degeneration into autism.
· The DoH, in criticising Dr Wakefield, has pointed to the use of MMR overseas, and claimed that there are no problems in for example the United States. The facts however tell a very different story. There are several dozens of parents' action groups in the USA, Canada, Australia, New Zealand and elsewhere, expressing interest in current research. Some of these have suspected a linkage, however difficult to prove, between autism and other problems and MMR or other vaccines, and are urgently assembling available research.
Although the DoH has two major research programme streams, the NHS Research and Development Strategy and the Policy Research Programme, neither has included any research on the causes of autism.
ThE DEPARTMENT'S EVIDENCE AGAINST A LINK?
The DoH has repeatedly quoted a study by Gilberg et al in Gothenburg, Sweden, in 1994, as proof that there was no increase there in autism following MMR introduction. However, the study, "Is Autism More Common Now Than Ten Years Ago", British Journal of Psychiatry, 1991, 158, 403-9, does not even mention vaccination
· The paper does not state coverage of MMR, there is no information on vaccination uptake, and it is essentially a study of one group of children born between 1975 and 1988. MMR was only introduced seven-ninths of the way through the study. The paper actually acknowledges in increase in autism.
· The study also misses out incidence of Asperger's Syndrome cases, and excludes children under age four. Cases were identified by tracking down from health professionals, not through methodical survey. It is almost seized upon and misinterpreted as "good data on the incidence of autism" by Dr Elizabeth Miller at the Public Health Laboratory Service.
· The Department has also referred in correspondence to a comprehensive review of published studies on suspected vaccine adverse events, conducted by the American Institute of Medicine. More than 7,000 abstracts and 2,000 books and articles were reviewed. But interestingly, the review concluded that the evidence was inadequate to accept or reject a causal relationship between measles-containing vaccine and demyelinating diseases of the central nervous system. The Department announced that "inadequate evidence cannot be interpreted as supporting the possibility of a link". But this is a curiously lopsided and prejudiced viewpoint, as the conclusion of the Institute review had been that the evidence was inconclusive either way.
THE PRESENT SITUATION
· The parents of children believe they know their own children best, and that the Medicines Control Agency has been complacent, missing their children 5 cases.
· They also believe that the MCA and the Joint Committee on Vaccination and Immunisation have not been subject to adequate independent scrutiny.
· Parents also believe that the DoH and others, such as the World Health Organisation, even if because of sincerely-held beliefs, are placing all their focus upon the overall vaccination programme and the risks of not vaccinating, at the expense of those that have been damaged.
· In June 1998, it was made public that the Medicines Control Agency was considering the evidence provided by one group of children's solicitors (Hodge Jones and Allen), and that the MCA has set up a working group of independent experts to evaluate the histories of these children "in the context of all the relevant available evidence" (source, Tessa Jowell MP, Minister of State for Public Health, letter to the Rt Hon Dafydd Wigley MP, 12th June 1998). There is no indication of any outcome of its work to date.
David Thrower, Oct 1998