The MMR warrior

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Five years ago, Dr Andrew Wakefield was approached by parents who told him a tragic story. Their children had been developing normally until the toddlers were given the vaccine for measles, mumps and rubella, MMR. The parents said they then witnessed a regression in their children's behaviour and speech, as well as the onset of an unpleasant bowel disorder. Presented with similar accounts by numerous sets of parents, the London doctor decided to investigate. What he discovered was to provoke one of the most bitter vaccination controversies ever.

Today, he has a paper published in the Journal of Adverse Drug Reactions. It concludes that the vaccine for measles, mumps and rubella should not have been licensed in 1988 because inadequate research had been carried out. The conclusion is backed up by four senior figures in medicine regulation, including Dr Peter Fletcher, a former senior scientific civil servant and assessor to the Committee on Safety of Medicines. They say children given the vaccine in trials should have been monitored for much longer because adverse reactions could have taken several months to show. They also say there was little information on the effects of giving three live vaccines together, compared with giving them separately.

Wakefield's original theory was published in The Lancet in 1998. He then extended his work and further findings were published in the American Journal of Gastroenterology. His most up-to-date work on 170 children is soon to be published.

Last year, Professor John O'Leary, director of pathology at Coombe Women's Hospital in Dublin, uncovered evidence pointing to a link between the MMR vaccine and autism in children. His findings, presented to a US Congressional hearing earlier this month, backed up Wakefield's Lancet study. But, despite having been peer-reviewed, other experts insist there is no evidence to suggest a link. A three-year war has ensued between Department of Health scientists, who are struggling to maintain confidence in the vaccination programme , and researchers such as Wakefield and O'Leary .

Speaking from his London home, Wakefield explained that his duty is to his patients, regardless of how much his findings upset the Department of Health.

He said: "At first, we were sceptical but the parents' story was so consistent that we felt we had to investigate. When the parent tells you they believe the problems started after exposure to the MMR vaccine, do you say, 'That is very interesting but politically it makes me very uncomfortable'?

"I represent patients whose parents say to me, 'This is what happened to my child: At one point, my child was developing normally, then they encountered the MMR and they developed autism.' They say their children became badly behaved, developed terrible bowel problems and their communication regressed. They said there is an epidemic of this problem but the medical profession told them they were wrong.

"We had to take their story at face value and to investigate it. What we found, to our surprise, was that the parents were right."

Government scientists have heavily criticised Wakefield and his research. They claim his science has not been reproduced by either himself or other scientists - an allegation he disputes. The hostilities penetrate down to the hospital where he works, the Royal Free in London. While Wakefield is carrying out his research, Professor Brent Taylor - head of the department of paediatrics and child health at the hospital - does his best to convince the public that the link does not exist.

Professor Taylor told the Sunday Herald: "There are no serious side- effects and the MMR does not cause autism and inflammatory bowel disease. Nobody anywhere else in the world has been able to reproduce any of Wakefield's studies.

"Separate vaccines do not provide good protection for children. We do not want a new programme that could result in serious diseases which kill and maim people."

The publication of a paper in the Journal of Adverse Drug Reactions saying that the MMR should never have been licensed caused a damaging row between the editor and the head of immunisation in Scotland. Dr Ian Jones, director of the Scottish Centre for Infection and Environmental Health, wrote to the editor, Dr John Griffin, suggesting that the journal should not publish the controversial paper. This prompted Griffin to accuse Jones of trying to censor the journal.

Wakefield's claims that a major government vaccination programme is causing children to become autistic are so damaging that his trust usually bans him from speaking to the media. Whenever the MMR debate is re fuelled by new claims, receptionists at the Royal Free Hospital are put on alert and any journalists asking to speak to the doctor are redirected to the trust's official spokesman.

But, this weekend, Wakefield has been given permission to discuss his latest research. He is adamant that, despite being the subject of bitter personal criticism, his arguments will be based on his science. He does, however, express regret that the strength of government opposition is hindering the research.

He said: "I don't want to moan about what has happened to me. We have got to fight this on the science. You go into this sort of thing with your eyes open. Yes, you are taking on your colleagues, the health department and the biggest drug companies in the world but the question you have to ask is, 'Who do you represent?'

"My responsibility is to the patient and not to the Department of Health. I am not going to decide against investigating something because of the possible consequences for the Department of Health, because it may make things difficult for them.

"The frustration is more that we are restricted in our attempts to help the children in the way that we would like to. It is becoming incredibly difficult to get funding for further investigations and clinical trials."

Discussing the paper to be published today, Wakefield points out that while the government scientists had until now directed their criticism at him, they must admit that they are also criticising former members of their own department.

He said: "Government scientists were critical of our science but the work was peer-reviewed, unlike other papers, because of the controversial nature of the subject. This paper went to four reviewers who agreed to have their comments published.

"We agreed to have that done not knowing what they would say and that is the way that science should be conducted. They have come out being very supportive. These are people who are not anti-vaccine but eminent people involved in drug regulation. The regulators themselves are saying that the vaccine was not safe."

He added: "If they want to attack me, that's fine but now they are bringing in four eminent regulators. Are they going to denounce the very valid opinions of their own colleagues?"

Wakefield first suggested in 1998 that single vaccines should be made available on the basis of the fears of a link between the MMR and autism and inflammatory bowel disease. He says the findings of the latest report reinforces the need to make mono valent vaccines available now.

He said: "It is absolutely no good to come out with tired rhetoric claiming that the vaccine has been proven to be safe. I am afraid that that is not the case. Until this is resolved, single vaccines must be made available.

"The concerns have been dismissed by the Department of Health but doctors, practice nurses and health visitors are changing their minds.

"I have referrals at the moment from paediatricians who believe their patients have been damaged by the MMR. We get this time and time again. The change in attitude is very telling."

In May last year, Wakefield sent a copy of his latest paper to Dr Liam Donaldson, the Chief Medical Officer for England. He said: "I was giving them the option to provide supplies of monovalent vaccines because I did expect there to be a scare. I did that knowing that they could use it against us by attempting to undermine the paper but it would have been morally wrong just to let it appear on the news stands on Monday. What they chose to do with that information I do not know."

Wakefield suggests vaccinating against measles at 15 months, against mumps when the child is three years old and against rubella when the child is four.

"What they are saying is that I could be responsible for an epidemic - children would suffer and some may die. But my point of view is pro vaccine. Nobody is saying, 'Do not protect children against measles.' This is about the safest way to do it. There is no need for measles to come back if we vaccinate against measles at 15 months.

"I have been honest and have published data whether it is positive or negative. Thus far, the parents have been absolutely right and I am obliged to continue to take this to its natural conclusion. In the meantime, I think parents deserve the option of single vaccines."

This month, the Scottish parliament has come under increasing pressure from MSPs to reintroduce single vaccines. Wakefield hopes that this may become a reality.

"The Scottish parliament has a unique opportunity, having devolved from the power of Whitehall, to take important decisions. The people are closer to their representatives, who seem prepared to listen."

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