Editorial: Measles should be gone by now
A warning was issued this week that up to 340 passengers on two Air New Zealand flights between Christchurch and Auckland, on March 2 and 4, could have been exposed to measles. A similar warning was applied to a flight from Singapore to Auckland on March 4. Seventy-two people have so far fallen sick in Auckland this year and a measles outbreak which originated in the Philippines was transmitted to New Zealand via a recent hip-hop competition in Sydney. It is unfortunate that measles is still so common - an outbreak three years ago infected about 600. It could have been eliminated by now in the same way as smallpox and polio - by large-scale vaccination.
The fact that it hasn't is partly thanks to undue concern about the MMR vaccine and a now-discredited report that linked it to autism. First reports about that study in the late 1990s led some New Zealand parents to refuse to have their children vaccinated - a position that is still advocated by some today. The MMR vaccination rate of two-year-olds is now about 93 per cent, but it was 80 per cent as recently as 2009, and there are still pockets of vulnerability in the community because of this historical patchy coverage.
A lobby group, the Immunisation Awareness Society, now operating as WavesNZ (Warnings Against Vaccines Expectations), says it "does not advise people not to vaccinate but facilitates an informed decision making process". Such decisions should also now be informed by the knowledge that the lead author of the original study, the British doctor Andrew Wakefield, has been roundly discredited, described as a fraud, and has lost his licence to practise.
Wakefield's paper was published in The Lancet in 1998 and implied a link between the MMR (measles, mumps and rubella) vaccine and a "new syndrome" of autism and bowel disease. It was based on case studies of only 12 children with no controls. Over the next decade, studies consistently failed to find a link between the MMR vaccine and autism. A subsequent investigation by Sunday Times journalist Brian Deer found that all of the cases in Wakefield's original study had been misrepresented or altered. The Lancet retracted the paper partly in 2004 and fully in 2010. Wakefield, who before publishing his study had received £50,000 from solicitors seeking evidence to use against vaccine manufacturers, was struck off. The British Medical Journal has published an editorial describing the original paper as fraudulent.
Unfortunately, the fears raised by the Wakefield study and subsequent reporting of it have never gone away, and experience now shows that measles epidemics are most ferocious in areas where the concerns about autism gained most traction among parents. An obvious example is in Wales, where a local newspaper mounted what was effectively a campaign against the vaccine after Wakefield's paper was first published. In 2011 there were 105 cases of measles in all of Wales. Then a nine-month epidemic which started in November 2012 infected more than 1200 in just the southwest corner of that country, where the newspaper circulated. Eighty-eight people were admitted to hospital and one died. The age group hit hardest was the 10 to 18-year bracket - people who were not vaccinated as infants at the height of the Wakefield scare.
Various health agencies and institutions globally have now declared there is no evidence to link MMR with autism. The position of the New Zealand Medicines and Medical Devices Safety Authority is also that there is no evidence to support such an association. Some parents still resist getting their children vaccinated, even at the height of an epidemic. An inquiry was told that some Welsh parents refused to do so, despite being asked up to 15 times. But the dangers should always have been known. As Dai Lloyd, a Welsh doctor who treated many victims, told the Wall Street Journal: "Go around the cemetery [and] you can see the historical evidence of childhood slaughter from pre-immunisation days."