MMR vaccine rates lag amid rising measles cases. Experts blame a discredited study.

When a measles outbreak hit Columbus, Ohio, late last year, public health officials learned that the vast majority of cases — 80 out of 85 — were among unvaccinated children.

Columbus Public Health researchers went to talk to parents to ask them why they didn’t vaccinate their children with the measles, mumps, rubella (MMR) vaccine or why they were delaying the vaccination. What they found was surprising.

“What our team heard from many parents is that they are not necessarily vaccine-averse and their children have had other age-appropriate vaccines, but they have specifically delayed the MMR vaccine or waited as long as possible before to have to get it because of fears it could lead to autism,” Kelly Newman, director of public relations & communications for Columbus Public Health, ABC News said.

What Newman is referring to is a myth that was born out of a now-debunked UK article in 1998 that claimed MMR vaccines cause autism.

The article has since been discredited by health experts, retracted by the journal in which it was published, and its lead author, Andrew Wakefield, lost his medical license. More than a dozen studies have since tried to find a link and failed to do so.

However, the damage is done. There have been multiple measles outbreaks – in the UK and the US – over the past two decades, vaccination rates have fallen from their highs, and a recent Gallup poll found that 10% of Americans do believe vaccines cause autism.

“We eliminated measles from the United States in 2000, and since then measles has come back,” Dr. Paul Offitt, director of the Vaccine Education Center and attending physician in the Division of Infectious Diseases at the Children’s Hospital of Philadelphia, told ABC News.

He added: “I think the sum of it all for me is that while it’s very easy to scare people, it’s hard to scare them.”

What is the 1998 study and what does it say?

Wakefield and his colleagues published a case study in the medical journal The Lancet in 1998, suggesting that the MMR vaccine caused intestinal inflammation, which in turn led to the development of autism.

In the case study, Wakefield presented 12 children, all of whom had recently received the MMR vaccine and were complaining of intestinal problems. Eight of these children then developed autism within a month of receiving the MMR vaccine.

Offit said the study is a clear example of correlation without causation.

“He could also do a case series of eight kids who had recently developed leukemia after eating a peanut butter sandwich, it was really that level of science,” Offitt said. “This was an irresponsible post and it caused a firestorm.

According to the Nuffield Trust, an independent health think tank, prior to the 1998 report MMR vaccination rates in the UK were 91%. However, by 2004 vaccination coverage had fallen to 81%.

In the U.S., 90.8 percent of children aged 24 months received at least one dose, which is higher than in recent years but not as high as the peak of 91.5 percent in 2003, according to the CDC.

Also, only 93.5 percent of kindergartners received the two-dose vaccine for the 2021-22 school year, the lowest rate seen in at least 10 years, CDC data show — though some of that may be a pandemic-related delay factor.

Wakefield is discredited

In February 2004, The Sunday Times published an investigation accusing Wakefield of a conflict of interest.

It is alleged that some of the parents of the children in the paper sued the vaccine manufacturers before it was published, and that Wakefield received funding to try to find a link between the MMR vaccine and autism, which was not revealed in the Lancet article.

This led to withdrawal of support by 10 of the 13 authors.

Another investigation by the same journalist found that a year before the paper, Wakefield had filed a patent for a single-dose MMR vaccine advertised as “safer” than the current two-dose vaccine, raising further questions about his motives.

In 2007, the General Medical Council, which regulates doctors in the UK, launched an investigation. Wakefield was found to have misrepresented medical records. Some of the children in the paper received the vaccine after they had already developed signs or symptoms of autism.

The Lancet formally retracted the paper in February 2010. Three months later, the GMC ruled that Wakefield had acted “dishonestly and irresponsibly” in conducting his research. He was struck off the UK medical register and banned from practicing medicine, effectively ending his career as a doctor.

Wakefield has continued to stand by his research and the findings of the 1998 report. He has denied allegations of fraud or that he sought to profit from the study subjects.

However, vaccine experts said Wakefield has received the criticism it deserves.

“This article has been rightly ignored, it has been recognized as fraudulent,” Dr. Gregory Poland, head of the Mayo Clinic’s vaccine research group, told ABC News. “He was stripped of his medical license. I mean there can be no greater rebuke of the medical profession to him than to admit the fraud inherent in this article and the incredible harm it has done.’

Why measles can be so dangerous

“If I get a chance to talk to parents, I don’t just look at the overwhelming evidence that there is no link between the MMR vaccine and autism. I’m also talking about measles,” Dr. Peter Hotez, co-director of the Texas Children’s Hospital Vaccine Development Center and dean of the National School of Tropical Medicine at Baylor College of Medicine told ABC News.

Measles is one of the most contagious diseases known to man. According to the CDC, just one infected patient can spread measles to 10 close contacts, especially if they are not wearing a mask or not vaccinated.

Complications from measles can be relatively benign, such as rashes, or they can be more severe, including viral sepsis, pneumonia, or swelling of the brain or encephalitis.

In the decade before the measles vaccine became available, an estimated 3 to 4 million people were infected each year, 48,000 were hospitalized and between 400 and 500 people died, according to the federal health agency.

By comparison, complications from the MMR vaccine are so few that Hotez calls them “needle-pricks” compared to complications from measles.

According to the CDC, one dose of the MMR vaccine is 93% effective, and two doses are 97% effective.

“Is it healthy to get these diseases ‘naturally’?” No,” Poland said. “There are documented probabilities of complications and even deaths. Are vaccines perfect? No man-made product is like that.”

“But wisdom lies in the balance of risks and benefits, and that balance falls strongly and emphatically in favor of vaccines,” he added.

What we know about autism

Wakefield was never able to replicate his findings, and numerous studies and meta-analyses have found that MMR vaccines do not cause autism.

According to the CDC, several factors have been identified as potential autism risks, including biological, environmental and genetic factors.

Hotez, whose youngest daughter, Rachel, has autism and an intellectual disability, said knowledge about what can cause autism has increased over the years.

“We have identified about 100 genes that are involved in autism, many of which were identified by the Broad Institute at Harvard, MIT,” he said. “And we actually did whole genome sequencing on Rachel, my wife and I, to identify Rachel’s unique autism gene.”

Hotez also noted that some people cite the rise in autism cases as evidence that vaccines cause autism. But he argues that this rising incidence is actually indicative of how clinicians have become better at diagnosing autism and broadening the criteria for placing someone on the autism spectrum.

To combat some of the misinformation, Hotez even wrote a book that he titled “Vaccines Didn’t Cause Rachel’s Autism” and cited a set of studies showing that children who received the MMR vaccine were no more likely to have autism than children who have not received the MMR vaccine.

“It is as impenetrable as possible that there is simply no link between the MMR vaccine and autism,” he said.

How to convince parents to vaccinate their children

Since Wakefield’s publication, there have been numerous outbreaks. From December 2014 to April 2015, there was an outbreak that started at the Disneyland Resort in California.

Additionally, there was a 2019 outbreak that mainly affected the Pacific Northwest and New York, in which 1,274 were confirmed in 31 states, the largest number reported since 1992.

Of course, the most recent was the outbreak in Columbus, Ohio. Experts say there will be more in the future if pockets of unvaccinated people remain and as anti-vaccine sentiment spreads.

“It always has been, always will be,” Poland said. “And as immunization rates fall because there are no requirements due to delays due to the pandemic, we will lose what has been built up in this so-called herd immunity.”

Offitt said she talks to parents all the time who are hesitant or skeptical about vaccines, but the important thing is to answer each of their questions and concerns as carefully as possible.

“People really want to trust their doctors,” he said. “I mean, when they’re sick, they won’t go to Andrew Wakefield, they’ll go to their doctor.”

Columbus Public Health’s Newman said officials have taken a multi-pronged approach, including community outreach and engagement and emphasizing the importance of vaccination. One mother even expressed that she regretted not vaccinating her child.

Offit added that vaccines have made us forget the complications caused by measles, polio and smallpox.

“Outbreaks in Columbus, Ohio, for example, several dozen children were hospitalized. It is a dangerous game,” he said. “Choosing not to get a vaccine is not a risk-free choice. It’s your choice to take a different risk and a more serious risk, and unfortunately, we’re learning what those risks look like.”