7 Concluding remarks
The MMR controversy is inherently complex and there are many additional facets of the debate that go beyond the scope of this course. The issues discussed here have sought to provide a social context for the MMR debate. It is unrealistic to expect scientific aspects to be separable from the myriad other factors that interact with science in a public context.
Decisions about MMR extend beyond science to emotional, ethical and political considerations. Stephen Pattison (2001) points out that ‘scientists must take care not to treat fear and reservation as ignorance and then try to destroy it with a blunt “rational” instrument’. I agree with him that to do so is to trivialise concerns of parents engendered by a lack of trust in official pronouncements of ‘safety’.
At the time of writing (August 2004), the MMR controversy is far from reaching closure. Wakefield is still a key player in the MMR debate, as Chief Medical Scientist for Visceral, a US-based charity which funds research into links between environmental factors and autism. Parents continue to agonise over the decision to allow their children to be immunised with the triple MMR jab. Sadly but inevitably, a small percentage of children will develop regressive autism, whether by coincidence or as a result of some as yet unknown cause.
The controversy surrounding the MMR vaccine has contributed to a lack of public confidence in combination vaccines, undermining a public health policy which has made a very real contribution to protection against infectious diseases. Yet autism remains a poorly understood, tragic condition, and it is important to keep an open mind about what its causes might be. It is perhaps too simplistic to declare that Wakefield's original paper should never have been published. It is clearly undesirable for peer review to operate as a form of censorship: researchers should be allowed to raise concerns that contradict mainstream opinion without being ostracised. Yet the MMR debate has had a life of its own, extending far beyond the technical issues and scientific uncertainties. Could and should the controversy have been better managed? Should lay concerns be considered in conjunction with scientific evidence when making decisions about health policy? If you were faced with a decision on whether to immunise your child with the MMR vaccine, on what evidence would you base your decision?
My son was scheduled to have the MMR vaccine at the height of the flare up of the debate in 2001. My biochemical training and everything I'd read in the scientific research suggested that there was no evidence for a link between MMR and autism. So why was it still such a difficult decision? Parenting is not an inherently rational enterprise. After much soul searching, I did decide to have my children immunised with the MMR. For me, the risks to my children of suffering the ill effects of contracting the diseases themselves, or passing disease on to someone else, outweighed the risk that there might be something after all to the hypothesis that autism is linked to the MMR vaccine. But it was an anxious time – before and after the vaccination. I can empathise with parents who decide that the balance of risk is against MMR immunisation for their children.
Might future controversies be managed better if, for example, uncertainties and dissent are dealt with more even-handedly, lay understandings are acknowledged more explicitly, and the wider social context is articulated and explored?