Letter Dated:19th April 2017
With reference to the article “MMR vaccine and autism – the movie ‘they don’t want you to see’”, published on the Sunday Times of Malta on the 16th April, the Malta Association of Public Health Medicine, the Malta College of Family Doctors, the Malta Paediatrics Association, the Maltese Advisory Committee on Immunisation Policy and the Primary Health Care Directorate would like to express their grave concern that such a misleading article was published and distributed to thousands of readers across Malta.
Worldwide, measles is still one of the leading causes of death among children younger than 5 years of age despite the existence of a safe and effective vaccine. Andrew Wakefield was the lead author of a fraudulent 1998 paper published in The Lancet that reported the case histories of 12 children who had received the Measles, Mumps and Rubella (MMR) vaccine and allegedly developed symptoms of inflammatory bowel disease or autism. The paper, which provoked public fears about vaccines, was officially retracted in 2010 after the UK General Medical Council concluded that Wakefield was guilty of serious professional misconduct. His licence to practise as a doctor was subsequently revoked. Since then, an analysis of several large-scale, rigorously designed epidemiological studies that together include 1.25 million children has found no link between MMR vaccine and autism or autistic disorders, and the MMR vaccine is today unequivocally regarded as safe.
In a recently released film (“Vaxxed”, 2017), Andrew Wakefield purports that the US Centre for Disease Control (CDC) manipulated data in a 2004 study to cover up evidence that the MMR vaccine is linked to autism. Ms. Borg’s article mentions a 2014 paper by Brian Hooker, which outlined senior CDC scientist William Thompson’s claims that a correlation between vaccination and autism in African-American boys had been suppressed in a CDC paper. Hooker’s paper was retracted from the journal Translational Neurodegeneration due to undeclared competing interests and concerns about the validity of the methods and statistical analysis. In 2015, the CDC confirmed that any such initial correlation did not exist once a proper analysis of the children in the study was performed. The data are available on the CDC website for analysis by interested parties.
Autism is a lifelong developmental disability that affects how children communicate, relate and interact with the people and world around them. Autism cannot be cured, and autistic children grow up into autistic adults. The cause of autism is still being investigated, however genetic factors are thought to play a significant role. There is absolutely no link between the MMR vaccine and autism, a fact that has been clearly expressed by the National Autistic Society in the UK. We take care of children and grown-ups with autism and work very hard to ensure they are included in society. Calling children with autism ‘anguished zombies’, as Ms. Borg does, is distasteful.
Immunisation is one of the most effective public health interventions available for protecting people from vaccine-preventable diseases. Before a vaccine is recommended, it passes through a lengthy, rigorous process of development and testing over several years. Vaccines are not marketed unless medical regulatory authorities are certain that they are safe. In addition, once a new vaccine is introduced in a country, medical regulatory authorities remain on the lookout for any safety concerns. Doctors report any rare side effects that occur around the time of vaccination to health authorities, who then apply rigorous scientific methods to assess whether side effects are really a result of vaccination or occurred purely by chance. If there are any concerns, health authorities immediately retract the vaccine. Such robust measures are there to protect everyone. Vaccine sceptics tend to reject the scientific approach by ignoring, neglecting, selectively skewing and suppressing scientific evidence to justify their behaviour. They typically selectively refer to isolated papers that are poorly conducted or grossly misinterpreted to challenge the scientific consensus, and denigrate established experts in the field. Ms. Borg’s article contained all these elements, suggesting that a single interview in a film directed by a discredited individual with a financial interest in the film’s success ‘demolishes’ the conclusions of rigorous scientific studies that prove beyond any doubt that the MMR vaccine is safe.
The right to free speech should never be confused with the primacy of ensuring that news articles have a factual basis. Ms. Borg’s blatant promotion of the film is of great concern, since such emotionally manipulative articles may lead to parents refusing to have their children immunised with the MMR vaccine. This may result in outbreaks of measles in unvaccinated children, as has happened recently in Europe, including Italy and Romania earlier this year. We still hear of children who die or remained permanently disabled as a result of contracting measles. While laudable, the SToM’s retraction of the article in question states that “Next Sunday the paper will publish a comprehensive article presenting an expert medical view on the issue, ensuring readers get both sides of the story.” We object to this statement: there is no other side of the story. Publishing poorly researched articles on a reputable media platform like the SToM lends apparent credibility and legitimacy to these myths in the eyes of the general public, as is evident from browsing through the comments section of certain social media platforms.
Most of us barely remember what measles and other potentially fatal infectious diseases feel and look like – the vaccines work so well that the memory of these diseases has mostly faded in Malta. Let us all ensure that it stays this way.
Malta Association of Public Health Medicine (MAPHM)
Malta College of Family Doctors (MCFD)
Malta Paediatric Association (MPA)
Maltese Advisory Committee on Immunisation Policy (ACIP)
Primary Health Care Directorate
Full Letter available Letter to the Editor – Sunday Times of Malta
Press Release by the Superintendent of Public Health(Malta) – Press Release – PR170975
 Measles Fact Sheet (WHO, 2017) http://www.who.int/mediacentre/factsheets/fs286/en/
 Godlee Fiona, Smith Jane, Marcovitch Harvey. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 2011; 342 :c7452
 How the case against the MMR vaccine was fixed. BMJ 2011;342:c5347
 CDC Statement Regarding 2004 Pediatrics Article, “Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-matched Control Subjects: A Population-Based Study in Metropolitan Atlanta” (2015) Accessed from: https://www.cdc.gov/vaccinesafety/concerns/autism/cdc2004pediatrics.html