The modern-day foundation of how medical disinformation began

The modern-day foundation of how medical disinformation began | Image Credit: © Aleksey 159 - © Aleksey 159 - stock.adobe.com.

In 1998, former British physician Andrew Wakefield and colleagues published a paper in the Lancet that the MMR vaccine caused intestinal inflammation, which brought into the body, proteins harmful to the brain, and as a consequence caused autism. The paper’s hypothesis was considered flawed and it was later discredited and retracted.¹

In the British newspaper, Sunday Times, reporter Brian Deer found evidence of data selection, data manipulation, and 2 not-disclosed conflicts of interest with Wakefield’s paper.²

It was later written in The Washington Post that Wakefield reportedly stood to make financial gain including up to $43 million per year selling diagnostic kits for a non-existent syndrome he claimed to have discovered. He also held a patent to a rival vaccine at the time, and he had been employed by a lawyer representing parents in lawsuits against vaccine producers.³

It took until February 2010 for the Lancet to officially retract the paper, and at that point, the news had spread internationally creating a very real doubt in the public about MMR vaccines. Even American celebrities had gotten onboard with this false theory.

Still today, several years later, some people's attitudes remain uncertain around these vaccines and autism. According to a recent survey conducted by the Annenberg Public Policy Center of the University of Pennsylvania, 24% of US adults do not accept the fact that the MMR vaccine does not cause autism, saying the statement is somewhat or very inaccurate and another 3% are not sure.⁴

“Despite the fact that unprecedented measures like the retraction of the initial paper from the Lancet happened…despite mountains and mountains of data that have demonstrated no causal link between the two; despite the fact that the initial ingredient that was of question, thimerosal, was never present in the MMR vaccine to begin with—despite all these things that may seem obvious to folks like myself or to folks who have not had an issue trusting it, facts don't change people's minds. Oftentimes, it's anecdotes, it's emotional stories, it's experience,” said infectious disease epidemiologist Jessica Malaty Rivera, MS, principal, JMR Science, and science communications advisor, de Beaumont Foundation.

“The persistent false belief that the MMR vaccine causes autism continues to be problematic, especially in light of the recent increase in measles cases,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. “Our studies on vaccination consistently show that the belief that the MMR vaccine causes autism is associated not simply with reluctance to take the measles vaccine but with vaccine hesitancy in general.”⁴

An example of this autism/vaccine uncertainty, can be seen on the Centers for Disease Control and Prevention (CDC) webpage that is dedicated to vaccine safety, and has written in big, bold letters, Vaccines do not cause autism.

At the core of this false information is a basic mistrust of the US medical field and federal government, and that these individuals who are coming forward are telling the truth, without vetting or confirming the information they are putting forth.

The Rise of Misinformation and Disinformation
This aforementioned retracted paper and the principals involved can be seen as a catalyst for the rise of a whole cottage industry built upon the concepts of misinformation and disinformation. The former is more innocently performed, but does the work for the latter, which is the true deception.

“Misinformation refers to information that is false, that is shared, not always with the intention of harm,” said Malaty Rivera. “Sometimes it is shared inadvertently as an unknown, the truth factor being unknown; whereas disinformation has the intent to harm or confuse or deceive, and so it can be accidental to share misinformation, but oftentimes disinformation is intended to be shared, and the purpose is to create discord.”

“The difference between misinformation and disinformation has to do with the intent of spreading the information,” said Katrine Wallace, PhD, research epidemiologist and an adjunct assistant professor of epidemiology and biostatistics at the University of Illinois Chicago School of Public Health.

An example of misinformation vs disinformation might be in the form of a Facebook post. Misinformation is when someone shares another person’s Facebook post with erroneous factual information in the post, and disinformation is the author of the post who has the intention of spreading false information.

“Misinformation travels quickly, and undoing the harm of misinformation takes a lot longer than the spread of misinformation,” Malaty Rivera said.

What Has Vaccine Skepticism Wrought?
In the short-term, the belief that MMR vaccines caused autism saw a decreased rate of childhood immunizations in the United Kingdom and Ireland. In the long-term, reduced childhood immunizations have also been realized in the US.

In January 2023, the CDC reported that over the last 2 school years, the national coverage for childhood state-required vaccines among kindergarten students declined from 95% to approximately 93%. During the 2020-21 school year, vaccinations dropped to 94% and during the 2021-22 school year it dropped again to approximately 93%.⁵

While this does not sound like a large number, it still represents thousands of young children not getting their vaccinations. It is also a disturbing trend as some families may feel they do not need them or are fearful of vaccines.

“Compared with the 2020–21 school year, vaccination coverage decreased 0.4–0.9 percentage points for all vaccines. Although 2.6% of kindergartners had an exemption for at least 1 vaccine, an additional 3.9% who did not have an exemption were not up to date with MMR,” the investigators wrote in an MMWR.⁵

This is the lowest rate of vaccination in over a decade, the CDC states. And the MMWR report said that as many as 250,000 kindergartners are not protected against measles.⁵

“During the pandemic, anti-vaccine disinformation spreaders were online disseminating bad information, Wallace said. “The COVID-19 vaccines also became political during this time, everyone was at home and online communicating within echo chambers for a couple of years, so the small percentage of parents who had questioned childhood vaccines has unfortunately grown to the numbers we see today. It is already causing harm in communities where we have seen many measles outbreaks."

Last year, the CDC reported that over the last 2 school years, the national coverage for childhood state-required vaccines among kindergarten students declined from 95% to approximately 93%.

Here is a breakdown of the number of US measles cases through June 13 of this year.

Image Credit: CDC

As of June 13, here is the breakdown of the number of hospitalizations for measles cases in the US.

Image Credit: CDC

Measles
And what started over 25 years ago as an erroneously written paper on the MMR vaccine and the goal to reduce these immunizations has truly been realized. MMR vaccines are on the childhood immunization schedule and the reduction in the number of children in the US getting these vaccines has resulted in children and even adults contracting measles in greater numbers.

There were more than 1200 cases of measles reported in the United States in 2019—the highest number in decades. In 2022, there was 121 cases of measles. In 2023, there was a substantial outbreak in Ohio and Kentucky that had 85 children contract the disease, and 35 of them were hospitalized.⁵

Earlier this year, measles outbreaks arose again, and according to the CDC, that as of June 13, a total of 151 measles cases were reported by 22 jurisdictions: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York City, New York State, Ohio, Pennsylvania, Vermont, Virginia, Washington, West Virginia, and Wisconsin.⁶

The federal agency also writes on its site there have been 11 outbreaks (defined as 3 or more related cases) reported in 2024, and 67% of cases (101 of 151) are outbreak-associated. For comparison, 4 outbreaks were reported during 2023 and 48% of cases (28 of 58) were outbreak-associated.⁶

In the 2024 outbreak, 54% of those cases (82/151) required hospitalization, and 49 of the overall number of cases were in people who were 20 years of age and older. So, measles is not just a childhood disease.⁶

Measles is spread by breathing in contaminated air or touching an infected surface then touching the eyes, noses, or mouths. According to the CDC, the measles virus can live up to 2 hours in airspace after an infected person leaves an area and can linger on surfaces for hours. And, if you put a person with measles in a room with 10 people who have not been vaccinated or have not previously contracted measles, 9 of those people will also get the disease.⁵

“Measles is the most contagious and easily transmittable virus we know—far more than COVID or influenza,” said Patricia A. Stinchfield, RN, MS, CPNP, president, National Foundation for Infectious Diseases (NFID) in a previous interview with Contagion.⁵

And of course, we have seen the vaccine skepticism spread to another respiratory virus, COVID-19, and have witnessed the repercussions associated with disinformation during the pandemic.

This article was initially published by our sister publication, ContagionLive.

This is the first in a 2-part series, looking at misinformation and disinformation and what it has done to public confidence as well as vaccination rates and the beliefs around the federal government's response to COVID-19. In the next part of the series, we will have a discussion around revisionist history of the COVID-19 pandemic, where to get reliable medical information, and discussion strategies for families who are vaccine hesitant.

References:

1.Vaccines and Autism. Children’s Hospital of Philadelphia. Reviewed February 5, 2024. Accessed June 26, 2024.
https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-conditions/vaccines-autism
2.Lancet MMR autism fraud. Wikipedia. Accessed June 26, 2024.
https://en.wikipedia.org/wiki/Lancet_MMR_autism_fraud#cite_note-WakefieldCapitalize-10
3. Stein, Rob (11 January 2011). "Wakefield tried to capitalize on autism-vaccine link, report says". The Washington Post. Archived from the original on 30 June 2012. Accessed June 26, 2024.
4. False Belief in MMR Vaccine-Autism Link Endures as Measles Threat Persists. Annenberg Public Policy Center (APPC) of the University of Pennsylvania. June 3, 2024. Accessed June 26, 2024.
https://www.annenbergpublicpolicycenter.org/false-belief-in-mmr-vaccine-autism-link-endures-as-measles-threat-persists/
5.Parkinson, J.Measles Outbreaks: How Complacency Associated With Immunizations and COVID-19 are Driving Increases. Contagion. February 29, 2024. Accessed June 26, 2024.
https://www.contagionlive.com/view/measles-outbreaks-how-complacency-associated-with-immunizations-and-covid-19-are-driving-increases
6. Measles Cases and Outbreaks. CDC. June 14, 2024. Accessed June 26, 2024.
https://www.cdc.gov/measles/data-research/index.html