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Abstract

Summary: Background: The public is concerned over the safety of vaccines for children. If such fears translate into avoidance of vaccines, the public health of the community is at risk. The 1998 study by Wakefield and colleagues, which linked the measles/mumps/rubella vaccine (MMR) to bowel disorders and autism, sparked global concern over the safety of the MMR vaccine. On February 2, 2010, the Lancet published a full formal retraction of the Wakefield study.
Objectives: The aim of this study was to elicit the beliefs of the Canadian public about the safety of the MMR vaccine immediately following the 2010 retraction.
Method: A random sample of Canadian internet users was surveyed between February 5 and February 9, 2010.
Results: Sixty-five percent of Canadian women and 72% of Canadian men surveyed believed a) that the vaccine was unsafe or else b) they were unsure whether or not the MMR vaccine could cause autism.
Conclusions: Given the state of public confusion over the safety of the MMR vaccine, physicians bear a responsibility to advise all patients about the risks of withholding childhood vaccination. Forceful and systematic disclosure of the significance of the retraction creates a precedent for participatory health and meaningful physician-patient communication.
Keywords: Measles Mumps Rubella Vaccine, MMR, autism, retraction, informed consent
Citation: Seeman N, Seeman M: Autism and the measles, mumps and rubella vaccine: need to communicate a health study retraction to patients. J Participat Med. 2010 Dec 17; 2:e18.
Published: December 17, 2010.
Competing Interests: The RIWI Corporation conducted the online survey for this article without compensation, in the public interest. Bob Seeman, a Director of RIWI, is the brother of Neil Seeman and the son of Mary Seeman.

Introduction

The study linking measles, mumps and rubella vaccine to autism created a tremendous amount of confusion and led many parents to opt out of the vaccine for their children. So widespread is international public confusion over the safety of this vaccine that it is critically important for physicians and other health care professionals to communicate to their patients the Lancet‘s February 2, 2010 full retraction^[1] of the 1998 study by Wakefield and colleagues.^[2] This discredited study, which had linked MMR to bowel disorders and autism, sparked a global health scare over the safety of the MMR vaccine. The Lancet had issued a partial retraction of the paper in 2004,^[3] signed by 10 of the 13 original authors. They wrote, “the possibility of such a link was raised and consequent events have had major implications for public health.”

The implications were indeed major. Vaccination rates in England decreased from 92% before the publication of the original Lancet article in 1998 to 79% in 2003.^[4] In the US, as of January 2009, 11.5% of parents reported refusing at least one recommended vaccine for their children.^[5] Childhood vaccination rates in the US in 2009 declined by almost four percentage points in commercial health plans, according to the National Committee for Quality Assurance (NCQA).^[6] The NCQA interpreted this decline in its report of October 13, 2010: “A possible cause of this drop is commercial plan parents may refuse vaccines for their children based on the unproven, but increasingly popular, notion that vaccines cause autism. Celebrity activists are outspoken advocates of this view.”

Aim

The aim of the present study was to investigate the beliefs of Canadians about the safety of the MMR vaccine immediately after the 2010 retraction.

Method

A survey was conducted (February 5 to February 9, 2010) to obtain a random sample of Canadian internet users’ perceptions of the safety of the MMR vaccine. Out of 10,868 Canadian internet users who read the online questions, 5,470 unique respondents completed the survey, a response rate of 50.3%. The respondents are representative of the internet user population in Canada in terms of age and sex.

Response to the survey was randomized by the survey’s access to thousands of ‘nonsense’ domain names (Uniform Resource Locators, or URLs) that reach hundreds of thousands of random global internet users weekly and that are not currently being used for commercial or any other purposes. Thus, the patent-pending and statistically peer-reviewed survey method, documented in detail elsewhere,^[7] captures potential respondents navigating the internet, who all have a relatively equal probability of landing on the web page that posted the survey. The survey included a privacy policy statement explaining that the collected information would not identify individuals, businesses, or households. Respondents were advised that the information would be kept anonymous and that they had the option of refusing to answer. Only Canadian internet users were able to respond (geographically identified anonymously by their Internet Protocol, or IP, address). Each respondent was able to answer only once.

Participants were asked to respond to the question, “Do you think the measles, mumps and rubella vaccine causes autism in healthy young children?” The response options were limited to: “yes”, “no”, “don’t know/unsure” and “skip”. Respondents were asked their age (under 18, 18-30, 31-50, 51-65, over 65) and their sex.

Results

The findings indicated that everyone, except women in the age groups 18-30 and 31-50 years, posted more “yes” than “no” replies (see Figure 1).

Figure 1: Replies to the question: “Do you think the measles, mumps, and rubella vaccine causes autism in healthy young children?” All men and women gave more “yes” than “no” replies, with the exception of women between ages 18 and 50 (with asterisks).

The data in Figure 1 indicate that much of the public, in spite of the broad media attention paid to the retraction of the seminal article on the possible vaccine/measles relation, still thinks that the measles-mumps-rubella vaccine causes autism.

Furthermore, the data in Figure 1 show that (for all ages) 44.9 ± 4.98% (mean ± SE) of the men replied “yes”, in contrast to 32 ± 2.96% of the women, a difference that was significant at a level of P = 0.0011 (student’s t).

A regression analysis for the effect of age in the “yes” data for men showed a nonlinear regression of r = -0.3 (data not shown), with most of the effect occurring in the under-30 age groups as suggested by the data in Figure 1. In the case of women, there was no clear regression of the “yes” data in relation to age, other than the fact that women between 18 and 50 mostly did not believe that there was an association between the vaccine and autism.

Although we attempted to examine other potential variables such as level of education, use of the internet and other media, and respondents’ location in Canada, the data were insufficient for a statistically reliable regression analysis (ie, insufficient matching respondent data were captured on the aforementioned variables).

Discussion

Given the data shown in Figure 1, it is important for health care professionals to assure their patients of the safety of the MMR vaccine. Health care professionals need to abide by local statutory requirements,^{[8] [9]} which include, in US and Commonwealth nations, the long-established Common Law obligation to inform parents of the likely consequences of not obtaining vaccination for their child.^[10] After the February 2, 2010 Lancet retraction, the Common Law is clear on a doctor’s ethical obligation when offering the vaccine: A physician must disclose all the information that reasonable parents or guardians would wish to know before they choose to accept or reject treatment on behalf of a child.^[11]

Before the 2010 retraction, if a parent had asked about the link between the MMR vaccine and autism, a physician would have been right to advise parents of the limited evidence and resulting public concern, as suggested by the original Wakefield study.^[12] Since the retraction, a physician should now advise parents of the retraction and its significance.

Thirty-one percent of the women in the sample seemed to believe that the MMR vaccine causes autism. An additional 34% of women in the study were unsure whether the vaccine is safe or can cause autism. The corresponding figures for men were 47% and 25%, respectively. Thus, 65% of Canadian women and 72% of Canadian men, as represented by this sample, either wrongly believe that the vaccine is not safe or are unsure about whether it puts someone at risk for autism. The difference in perceptions between men and women is possibly because women are more likely to be the caregivers who interact, on behalf of their young children, with knowledgeable physicians.

Conclusion

In spite of the retraction of the seminal article on the subject, a large segment of the public continues to think that the MMR may cause autism. This builds on growing worldwide anti-vaccine sentiment due to the well-publicized but unsubstantiated link between influenza immunization and autism.^[13]

If physicians were routinely to inform their patients about the retraction of the paper by Wakefield and colleagues, the results reported here may well change.

It is especially important to inform parents who have refused the MMR vaccination for their children about the Lancet retraction. The findings of this study are a reminder that mere dissemination of facts by public health authorities is insufficient to ensure that the public receives and understands the message. More intimate one-to-one physician-patient communication of the facts is important.

References

1. ^[1]Retraction–Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 2010 Feb 6;375(9713):445.↩
2. ^[2]Wakefield AJ, Murch SH, Anthony A, et al. Lancet. 1998 Feb 28;351(9103):637-41. ↩
3. ^[3]Murch SH, Anthony A, Casson DH, et al. Retraction of an interpretation. Lancet. 2004 Mar 6;363(9411):750.↩
4. ^[4]Get the vaccines. Chicago Tribune. March 1, 2010. Available at:
   http://www.chicagotribune.com/news/opinion/editorials/ct-edit-vaccines-20100301,0,5844328.story. Accessed November 22, 2010.↩
5. ^[5]Freed GL, Clark SJ, Butchart AT, Singer DC, Davis MM. Parental vaccine safety concerns in 2009. Pediatrics 2010;125:654-9.↩
6. ^[6]Autism Fears Suspected as Children’s Vaccinations Decrease in Private Plans. National Committee for Quality Assurance; October 13, 2010. Available at:
   http://www.ncqa.org/tabid/1259/Default.aspx. Accessed November 20, 2010]↩
7. ^[7]Seeman N, Ing A Rizo C. Assessing and responding in real time to online anti-vaccine sentiment during a flu pandemic. Healthcare Quarterly, 13 (Sp) 2010: 8-15. ↩
8. ^[8]Health Care Consent Act, SO 1996, c. 2↩
9. ^[9]Hospitals Act, RSNS 1989, c. 208.↩
10. ^[10]Walker (Litigation Guardian of) v. Region 2 Hospital Corp, NJ No 242, 116 DLR (4th) 624 (CA), 1994.↩
11. ^[11]Hopp v. Lepp, 112 DLR (3d) 67 (SCC), 1980.↩
12. ^[12]Videto v. Kennedy, 125 DLR (3d) 127 (Ont CA), 1981.↩
13. ^[13]Alvarez-Pasquín AJ, Heijbel H, Yarwood J, Van Damme P, VACSATC partners. VACSATC (Vaccine Safety: Attitudes, Training and Communication): why such a project?” Euro Surveill. 2009;14(16):1-4.↩

Acknowledgement

For related work, Neil Seeman was supported by a grant from the Ontario Ministry of Health and Long-Term Care.

Copyright: © 2010 Neil Seeman and Mary Seeman. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author(s), with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.