10 Reading 3: Towards a better map: Science, the public and the media
10.1 Media coverage of the MMR controversy
Hargreaves, I., Lewis, J. and Speers, T. ‘Towards a better map: Science, the public and the media’, Economic and Social Research Council.
Unlike the other two stories, the MMR coverage conforms to a more conventional news pattern in which a story breaks, generates discussion and debate, then fades away. Of the 561 stories on MMR recorded over a seven and a half month period, 56 percent of the entire sample appeared in one month between 28 January and 28 February. Coverage was most concentrated on television, after Panorama broadcast a programme at the beginning of February on Dr Andrew Wakefield's latest research into the possible links between autism, bowel disease and the MMR vaccine (71 per cent of television coverage appeared period between 2nd and 16th of February).
While the other two stories involve a variety of angles and themes, the reporting of the MMR story was fairly consistent, revolving around the same set of messages and ideas. The story also followed a fairly clear narrative, with the Prime Minister playing a central role. The main focus of the story is the possibility of a link between the MMR jab and autism (or bowel disease linked to autism), a fact mentioned in over two thirds of stories on this issue. It is this link – and hence the more general idea that the MMR jab may be unsafe -that clearly provided the impetus for the story.
However, the source of these claims – Andrew Wakefield's research – is mentioned in only a quarter of these stories, with the broadsheet newspapers accounting for most of these references (suggesting that this was an aspect of the story that was often dropped by those media with less space available).
The bulk of evidence suggests that the MMR vaccine is safe – as opposed to the well established risks of the diseases themselves. The use of such evidence to was often used to ‘balance’ Wakefield's claim – although not, perhaps, as widely as might have been expected. Television took the lead in this respect: half the television reports on the issue referred to such evidence, while less than a third (32 per cent) of the broadsheet press reports did so. Similarly, over a third of all TV reports mentioned that the MMR vaccine is regarded as safe in the 90 countries in which it is used – a point made in only 11 per cent of reports overall.
Attempts to balance claims about the risks of the MMR jab tended merely to indicate that there were two competing bodies of evidence rather than offer more substantive evaluations of the case for or against a link. The following example are typical:
“Ministers continue to insist the MMR jab which some doctors have linked to autism is the best way of protecting children” (ITV News, 5th Feb, 2002).
“Although health chiefs insist that the MMR vaccine is safe, many parents have been put off by uncertainty over possible links to autism and bowel disorders” (Daily Mail, 5th Feb, 2002).
“The government has mounted campaigns to persuade parents the MMR jab is safe after some research linked it to autism and bowel disorders in children” (The Sunday Times, 28th April, 2002)
The MMR vaccine was introduced in 1988 by Edwina Currie, then Tory Health Minister. In February 1998, Dr Andrew Wakefield and his colleagues from the Royal Free Hospital published a paper in the Lancet (Wakefield A J et al, 1998) based on a study of 12 children with an unusual bowel syndrome (linked to autism). Wakefield et al purported to have discovered traces of the measles virus in their guts. Although this experiment has been repeated a number of times since then, no other researcher has had similar results. The paper in the Lancet did not present evidence linking MMR to bowel syndrome or autism, but at a press conference publicising the research, Dr Wakefield argued that giving children the vaccines in three separate doses would be safer – a suggestion not supported by his many co-authors nor by any scientific evidence.
The evidence provided by Wakefield's research – limited as it is – involves a link between the measles virus (as opposed to the MMR vaccine itself) and a form of bowel disease linked to autism. The connection between the MMR vaccine and autism is a speculative claim made by Wakefield with questionable scientific data to support it.
Despite this, Wakefield's claims were not comprehensively or systematically challenged in media coverage. It is beyond the remit of this study to account for this failure: what is certainly true is that the weakness of empirical evidence in support of Wakefield's claim was never fully aired.
Recent coverage was prompted by two simultaneous events; a measles outbreak in South London and an episode of Panorama broadcast on 3 February 2002, asking ‘How safe is MMR?’ Dr Wakefield, Professor O'Leary and colleagues then pre-published a paper in Molecular Pathology to accompany the Panorama edition, which focused on this research.
Even if we accept the link in Wakefield's data, on the basis of the empirical evidence, it is not clear that a single measles vaccination would be safer than the MMR jab. There is no data establishing a link with autism that compares the MMR vaccine to the measles virus. Nonetheless, the media coverage quickly moved to the speculative link- without, in most cases, exploring Wakefield's actual data. Because the risks involved with non-vaccination are fairly clear, the idea of offering three single vaccinations as a potentially safer alternative thereby gained a great deal of currency – especially on television and in the tabloids (where 71 per cent and 62 per cent of stories mentioned the proposal to offer single jabs).
This government's reluctance to offer single jabs (on the basis that might reduce overall levels of vaccination, when the bulk of evidence suggested MMR was safe and no evidence directly implicated the MMR vaccine), pushed attention onto the Prime Minister. The fact that Tony Blair had a young child was seen as a test of the government's integrity on this issue.
The Prime Minister's refusal to disclose whether Leo Blair had been vaccinated with the MMR jab tended to increase speculation on the matter, and around a third of all the MMR reports (32 per cent) referred to it.
The following transcript from ITV news, broadcast on 4th February, is indicative of the way the story developed:
“It was reported over the weekend that Leo Blair has had the jab although Downing Street still won't officially confirm it. In Tonight's poll most respondents think that Tony Blair should go public. 80 per cent also want alternatives to MMR. This Liverpool clinic does just that – offering single jabs for each disease to worried parents.”
Parent (holding child): “You should be able to have your children vaccinated singly at your own doctors. I object strongly to being told what and when to inject into my children.”
Dr Pat Troop, Deputy Chief Medical Officer: “We have no concerns about our current vaccine. I think it will send a very strong signal that parents will say, hang on we think that maybe there is a problem around this vaccine – why else would you offer us a single vaccine – and confidence would go.”
This report also demonstrates how the argument against single jabs is more difficult to make in a limited amount of time than a simple appeal to parental choice. Indeed, the framework constructed here very clearly places the burden of proof on the side of those defending the MMR vaccine (one of the earliest studies examining the relationship between science coverage and public opinion found that the appearance of a dispute often works to benefit opponents of technology – Mazur 1981: 114).
The decline in public confidence suggested by this report led to another recurring theme – the idea that vaccination levels were falling as a consequence of parental anxieties. This point was made in 42 per cent of MMR stories, despite the limited evidence available to confirm it. In February 2002 the rate of MMR vaccinations had dropped by approximately six percent in the previous five years (it is unclear how much this is due to a lack of confidence in the vaccine). A number of media reports used data rather selectively, which, although often technically correct, implied a more dramatic fall in the take up of the MMR jab.
So, for example, the Today programme reported that the MMR vaccine was down to ‘70 per cent uptake in some areas’ (2nd Feb, 2002), the Mail reported that ‘Uptake of the triple vaccine has fallen to ‘dangerously low levels’ in some areas, according to the Public Health Laboratory Service’ (2nd Feb, 2002), while ITV News reported that ‘in parts of London that figure is down to 65 per cent – meaning only two children in three are having the MMR jab. With so many children left unprotected medical experts fear there is a distinct possibility of a measles epidemic…’ (5th Feb, 2002).
Other media simply made claims without any supporting evidence. The Sun, for example, reported:
“growing concern of possible links between MMR and autism and bowel disorders have seen a massive drop in the number of parents opting for the treatment. The connection was made by Dr Andrew Wakefield in 1998. No scientists confirmed his findings but many parents say their children changed dramatically after the injection”.
(The Sun, 5th Feb, 2002)
This example from The Sun is also indicative of the nature of the balance struck between competing claims. Since most health experts were fairly clearly lined up in support of the MMR vaccine, balance was often provided by pitching medical experts against parents: an approach facilitated by the work of parental pressure groups on this issue. This created a serious difficulty for scientists and health professionals, who are only able to propose dry generalisations against the more emotive and sympathetic figures of parents concerned for the welfare of their children.
Our own survey suggests that more parents would, given a choice, still opt for the MMR vaccine over three separate vaccinations or no vaccinations at all. The media coverage, on the hand, suggested anti-MMR parents outnumbered those in favour by more than 5 to 1.
There is, of course, a danger here of a significant decline in take up of the MMR vaccine becoming a self-fulfilling prophecy, a point we explore below. The key question we should ask is whetherthe coverage enabled members of the public to make informed decisions about MMR, either as citizens (on a matter of public policy) or as parents of young children.