4 Single vaccines – the middle way?
Much of the campaign surrounding doubts about the MMR vaccine has centred on a call to replace MMR with single vaccines. This is seen as part of a precautionary argument, just in case Wakefield turns out to be right about an association between the MMR vaccine and autism. After all, the spectre of government reassurances about the ‘safety’ of BSE-infected meat and the subsequent climb down still loom large in public consciousness. Comparisons to the BSE crisis were reinforced by Wakefield, who termed the intestinal inflammation he had found in autistic patients as ‘new variant inflammatory bowel disease’ – an unambiguous allusion to ‘new variant CJD’.
Wakefield's hypotheses for MMR-induced damage have always focused on the measles component of the vaccine. If he believes this, why should separate measles vaccine pose any less of a risk? His call for single vaccines is based on a notion that giving too many vaccines at once overloads the immune system. In some cases, it is claimed, the attenuated strain of the measles virus present in the vaccine causes chronic measles infection and leads to the ‘leaky gut’ which renders the developing brain susceptible to damage.
The hypothesis that the immune system is overloaded by combined childhood vaccines has never had scientific currency, but in light of the MMR controversy, a team of researchers led by Paul Offit re-examined the issue (Offit et al., 2002). Modern vaccines contain fewer antigens than in the past. Collectively, the immunisation programme recommended for infants in Britain exposes them to less than 100 antigens whereas the immune system is theoretically capable of responding to about 1010 antigens. Other studies tested the hypothesis that if the MMR vaccine did damage the immune system, an increased level of hospitalisation for infectious diseases would occur following the vaccine. Again, no association was found (Miller et al., 2003). It is, however, worth reflecting at this point on the difficulty in collecting and interpreting trends where there are a multiplicity of interdependent variables – a situation which confounds many epidemiological studies.
The main stance of the Department of Health has been that single vaccines expose children to the possibility of infection while waiting to complete the immunisation schedule. Fitzpatrick (2004) associates the momentum of the single-vaccines campaign with the Labour government's policies which have continuously emphasised parental choice, especially with regard to schools and hospitals. By not making available single vaccines as an alternative to MMR, the government's stance has been seen as an active denial of choice, counter to the policy of patient empowerment.
In stark contrast to the unwavering stance of the government, Wakefield is often portrayed as the ‘listening doctor’ in the press – an image he has taken care to cultivate. In response to criticism of the Lancet paper, he said: ‘the approach of the clinical scientists should reflect the first and most important lesson learnt as a medical student – to listen to the patient or the patient's parent, and they will tell you the answer’ (Wakefield, 1998).
In the battle for hearts and minds that characterises the MMR controversy, the sympathetic Wakefield clearly trumps the perceived heavy-handed authoritarian approach of the health establishment.