A Broken Trust: Lessons from the Vaccine–Autism Wars

PLoS Biology, Public Library of Science, San Francisco, California, United States of America.
PLoS Biology (Impact Factor: 9.34). 06/2009; 7(5):e1000114. DOI: 10.1371/journal.pbio.1000114
Source: PubMed


Researchers long ago rejected the theory that vaccines cause autism, yet many parents don't believe them. Can scientists bridge the gap between evidence and doubt?

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Available from: Liza Gross
    • "In 2008, five cases of Haemophilus influenzae type B were reported in Minnesota, in children under age 5 who resided in different counties and had no relationship to one another. One of them died from meningitis (CDC, 2009; Gross, 2009). Of the five children, three were not vaccinated because the parents or guardians refused or delayed vaccination. "
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    ABSTRACT: One of the most successful prophylactic interventions in the history of public health, vaccination helped control some of the deadliest and most debilitating infectious diseases. As a result of vaccination programs, smallpox was eradicated worldwide, poliomyelitis was nearly eradicated and emerges as the next eradication target, and national programs helped reduce the incidence of tuberculosis in many countries. Other, more recent vaccines have already achieved a visible impact, as revealed by the ability of the hepatitis B vaccine to decrease the number of new hepatitis infections and the incidence of hepatocellular carcinoma. While vaccination, like any other medical intervention, may have adverse effects, significant controversies gravitated, in recent years, around its supposed link to autism. One of the articles that provided substantial support for this link was recently retracted amid evidence of ample scientific and ethical misconduct. As studies from several countries found that the incidence of autism was increasing even after the removal of thimerosal from vaccines, it appears that, in all likelihood, this trend was not caused by the mercurycontaining preservative, and potential causes have to be pursued somewhere else. Although many early vaccines were prepared empirically from live attenuated or inactivated pathogens, recent years have witnessed a shift toward a more rational strategy, in which concepts from disciplines including molecular biology, genomics, proteomics, and bioinformatics arc increasingly incorporated into vaccine design, transforming vaccinology into a dynamic and vibrant interdisciplinary field.
    No preview · Article · Oct 2011 · The American Biology Teacher
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    • "In some European countries and in the USA, childhood immunisation is mandatory yet MMR vaccine refusal has increased, similarly leading to measles outbreaks [6,7]. Repeated assertions by the Department of Health for England and Wales and the U.S Centers for Disease Control and Prevention that the MMR vaccine is safe have had limited effect on allaying parents' concerns in some sections of the community [8-10]. More than ten years after the publication of Andrew Wakefield's now discredited findings [11], there is some evidence that parent trust in MMR has improved [12], yet significant numbers continue to lack confidence in making an MMR decision [9,13-19] and many criticise what is perceived to be the poor quality of information provided [9,17]. "
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    ABSTRACT: In the UK public concern about the safety of the combined measles, mumps and rubella [MMR] vaccine continues to impact on MMR coverage. Whilst the sharp decline in uptake has begun to level out, first and second dose uptake rates remain short of that required for population immunity. Furthermore, international research consistently shows that some parents lack confidence in making a decision about MMR vaccination for their children. Together, this work suggests that effective interventions are required to support parents to make informed decisions about MMR. This trial assessed the impact of a parent-centred, multi-component intervention (balanced information, group discussion, coaching exercise) on informed parental decision-making for MMR. This was a two arm, cluster randomised trial. One hundred and forty two UK parents of children eligible for MMR vaccination were recruited from six primary healthcare centres and six childcare organisations. The intervention arm received an MMR information leaflet and participated in the intervention (parent meeting). The control arm received the leaflet only. The primary outcome was decisional conflict. Secondary outcomes were actual and intended MMR choice, knowledge, attitude, concern and necessity beliefs about MMR and anxiety. Decisional conflict decreased for both arms to a level where an 'effective' MMR decision could be made one-week (effect estimate = -0.54, p < 0.001) and three-months (effect estimate = -0.60, p < 0.001) post-intervention. There was no significant difference between arms (effect estimate = 0.07, p = 0.215). Heightened decisional conflict was evident for parents making the MMR decision for their first child (effect estimate = -0.25, p = 0.003), who were concerned (effect estimate = 0.07, p < 0.001), had less positive attitudes (effect estimate = -0.20, p < 0.001) yet stronger intentions (effect estimate = 0.09, p = 0.006). Significantly more parents in the intervention arm reported vaccinating their child (93% versus 73%, p = 0.04). Whilst both the leaflet and the parent meeting reduced parents' decisional conflict, the parent meeting appeared to enable parents to act upon their decision leading to vaccination uptake.
    Full-text · Article · Jun 2011 · BMC Public Health
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    • "Individuals often refuse or avoid vaccinations they perceive to be risky. Recently, rumours that the polio vaccine could cause sterility and spread HIV have hampered polio eradication in Nigeria[20], while misplaced fears of autism in the developed world have stoked vaccination fears[21]. Reporting the number of individuals who vaccinate may have a positive effect on the disease transmission by increasing the vaccination rate. Conversely, behavioural interventions can also have an enormous effect on the course of a disease[22,23]Our model considers the same contact rate after a media alert, as proposed by Liu & Cui[3], but there are fundamental differences in both models. "
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    ABSTRACT: There is an urgent need to understand how the provision of information influences individual risk perception and how this in turn shapes the evolution of epidemics. Individuals are influenced by information in complex and unpredictable ways. Emerging infectious diseases, such as the recent swine flu epidemic, may be particular hotspots for a media-fueled rush to vaccination; conversely, seasonal diseases may receive little media attention, despite their high mortality rate, due to their perceived lack of newness. METHODS : We formulate a deterministic transmission and vaccination model to investigate the effects of media coverage on the transmission dynamics of influenza. The population is subdivided into different classes according to their disease status. The compartmental model includes the effect of media coverage on reporting the number of infections as well as the number of individuals successfully vaccinated. A threshold parameter (the basic reproductive ratio) is analytically derived and used to discuss the local stability of the disease-free steady state. The impact of costs that can be incurred, which include vaccination, education, implementation and campaigns on media coverage, are also investigated using optimal control theory. A simplified version of the model with pulse vaccination shows that the media can trigger a vaccinating panic if the vaccine is imperfect and simplified messages result in the vaccinated mixing with the infectives without regard to disease risk. The effects of media on an outbreak are complex. Simplified understandings of disease epidemiology, propogated through media soundbites, may make the disease significantly worse.
    Full-text · Article · Feb 2011 · BMC Public Health
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