Why ‘Vaxxed’ gets a hearing (and why the defence of vaccination can’t be left to doctors)

I watched the movie Vaxxed – from Cover-up to Catastrophe recently. It has been generating a great deal of excitement ­and controversy ­as it does the rounds in New Zealand.

Vaxxed is directed by Andrew Wakefield, the former UK doctor who was struck off the medical register after he was found to have falsified data in a study he published in the medical journal, The Lancet. (The Lancet retracted the article in 2010.) Wakefield’s study claimed to show a link between the MMR (measles, mumps and rubella) vaccine and autism.

Poster for the movie Vaxxed – from cover-up to catastrophe

The movie Vaxxed features extensive interviews with Wakefield, who continues to promote his hoax from the US. The central idea in the movie is this same one Wakefield put forward in his discredited study – that there is a link between the MMR vaccine and autism. It alleges that the medical establishment is conspiring to cover up this link.

Andrew Wakefield

Some 400 people turned up to the first screening in Auckland in early April, where the organisers kept the location of the venue secret until a few hours before it was scheduled, supposedly in order to thwart expected protests. Press commentaries have debated the merits of the movie, but until recently there had been no public protests at the screenings.

Lance O’Sullivan. Photo: Reagen Butler

When the organisers set up a screening in Kaitaia, in the far north of New Zealand, well-known rural doctor Lance O’Sullivan, who had been invited to the screening, stepped onto the stage and delivered a speech against the movie.  O’Sullivan denounced the anti-vaccination movement, saying that children will die because of the false ideas and misinformation in the movie. In interviews following his protest, O’Sullivan criticized health professionals employed by the District Health Board (DHB) who were in the audience, saying that their presence was incompatible with their professional roles. At the end of his speech, he performed a haka. Given O’Sullivan’s high profile in the community (he was named New Zealander of the year in 2014 for his work in promoting access to health care in an impoverished community) this action touched off a renewed round of heated debate in the press and on social media.

I commend O’Sullivan for his protest. I was not present in Kaitaia, but as far as I can tell from videos of his speech that have been shown in the news media, it was courteous and respectful. He urged people not to watch the movie, and warned of the dangers of the ideas promoted in it, but – other than by these means of persuasion – he did not try to prevent anyone from seeing it. The accusations by the organisers of the event that his demeanour was bullying and threatening were clearly unfounded. I wish there were more such direct, public challenges to this movie.

In making its case for Wakefield’s discredited ideas, Vaxxed substitutes dramatic presentation and appeals to emotion in place of scientific evidence. The emotional core of the movie is a series of interviews with parents of children who seemed to be developing normally at a young age, then soon after receiving the MMR vaccine, their child regressed, lost the ability to walk they had had earlier, lost the words of speech they had previously acquired, and were later diagnosed with autism.

One can only sympathise with the acute distress of these parents, and with their desperate need for an explanation for what had happened to their child. Their stories of callous treatment from the health authorities they turned to for help will ring true for many people. The parents interviewed are convinced that Wakefield’s explanation – that the MMR vaccine was the cause of their child’s developing autism – is correct.

Cases of such ‘regressive autism’ – where children who seem to be following a normal path of neural development later develop the characteristics of autism, and ‘regress’ – are relatively rare, but not unknown. At this point, scientific knowledge cannot answer the question of the causes of autism, except to say that there appears to be a substantial genetic component. (Siblings of children diagnosed with autism are far more likely to develop autism than others, for example, even after correcting for environmental factors shared by siblings.) The causes of autistic regression are even less understood.

Science can, however, answer the question of whether the MMR vaccine causes autism to a high degree of certainty. The answer is: no, it does not. In the years following Wakefield’s bogus study, statistical studies involving hundreds of thousands of children have been carried out, investigating a possible link between the MMR vaccine and autism. Two multiple-study reviews have examined the data from more than ten million children in each case.

If the MMR vaccine was a cause of autism, even it were one cause among many, some evidence of that would have to show up in these data. No such evidence was found in any of these studies or reviews. (Vaxxed several times shows a graph which purports to show evidence of a temporal link between time the vaccine was administered and the onset of autistic symptoms. This is the closest it gets to presenting scientific evidence beyond the anecdotal evidence of the interviews, but the graph is shown very briefly on each occasion, and the sources of the data are not given, so no judgment can be made from this.)

Wakefield’s article in The Lancet was retracted in 2010

The article in which Wakefield originally put forward his claims of a possible link was based on a study of only 12 cases. Some of the families involved in Wakefield’s study were already pursuing court action against the vaccine manufacturers, and Wakefield failed to disclose his association with that court case to The Lancet. He went so far as to falsify the data to fit his ‘case’, such as by suppressing evidence that some of the children had shown symptoms of autism prior to receiving the MMR vaccine. Details of his manipulation of the evidence can be found here in an article in the British Medical Journal.

Vaxxed bolsters these anecdotal interviews with some highly dubious ‘facts’. One of these is that in the period since the widespread use of the MMR vaccine there has been a rapid increase in the frequency of cases of autism. This idea is repeated many times over in various forms, including a graph with a ‘hockey-stick’-shaped trend curve superimposed, and some wild panic-laden extrapolations concerning the future incidence of autism, such as a prediction that 80% of male children will develop autism by 2032.

Diagnoses of autism have been increasing in recent years, although not at ‘hockey-stick’ rates. Whether the actual incidence of the condition is becoming more common is unclear. It may be. It is entirely possible that there are environmental factors contributing to autism, although as far as I am aware, although several have been investigated, none has been conclusively proved. It is also quite possible that the increased rates of diagnosis are due to nothing more than increased awareness of and interest in the condition, together with changing methods and criteria of diagnosis.

The final ingredient in the anti-scientific concoction is conspiracy: Vaxxed makes dramatic use of telephone conversations with a ‘whistle-blower’ working at the US Centre for Disease Control and Prevention (CDC), supposedly recorded without his knowledge. The whistle-blower hints that the CDC has evidence of the link between MMR and autism, which they are covering up to protect the profits of the drug companies which manufacture the MMR and other vaccines. Such hearsay adds absolutely nothing to the scientific evidence one way or the other; the dark talk of conspiracy and cover-up at the highest levels merely serves to spice it up.

That, in short, is the case made by Vaxxed for Andrew Wakefield’s MMR hoax. Lance O’Sullivan is entirely correct in saying that the movie constitutes dangerous misinformation. Although its supporters routinely claim that the movie is not ‘anti-vaccination’ in its intent, Vaxxed spreads unsubstantiated fears about the MMR vaccine, and so discouraging vaccination is precisely the effect it has. In the years following the publication of Wakefield’s bogus study, there was a measurable decline in vaccination rates in the both the US and the UK. There have since been outbreaks of measles in Auckland, whooping cough and other illnesses in the developed world, epidemics that could have been prevented by higher vaccination rates, with their toll of deaths, blindness, deafness, and other permanent consequences of these diseases.¹ We can expect a corresponding decline in vaccination rates, with similar appalling consequences, to the degree that this movie influences people.

Unfortunately, the defence of scientific evidence-based medicine put forward by Lance O’Sullivan and most of the medical establishment has many weaknesses, and leaves openings for the fraudsters and conspiracists of the Wakefield type to gain a hearing for their reactionary scare campaign.

“You have to have a certain amount of trust in the people who are in the area of health and know what we’re talking about,” O’Sullivan says in an interview. And for those who are unconvinced of this, O’Sullivan favours various coercive and punitive measures to encourage high vaccination rates: in 2015 O’Sullivan spoke in support of an Australian policy change which resulted in working people who received a social welfare benefit having those benefits cut if they refuse or neglect to have their children vaccinated.

Australian Prime Minister Malcolm Turnbull wants unvaccinated children banned from childcare centres

Australian Prime Minister Malcolm Turnbull goes even further down this road. He has proposed that children who are not vaccinated should be banned from child-care centres. This fits neatly with Turnbull’s drive to exclude many other categories of workers from access to social services, such as migrants, people with New Zealand passports, and so on.

The argument frequently put forward in support of such high-handed measures is the one of ‘herd immunity’. Unvaccinated individuals endanger not only their own health but also, by becoming vectors of the contagion, the health of people who for various reasons cannot be vaccinated, such as children who are too young. A population where 95% or more have immunity to a disease effectively protects these people as well as the vaccinated ones, since there are so few possible hosts who could spread the disease to them. This effect is called ‘herd immunity,’ and it is severely weakened by those who choose not to vaccinate.

Herd immunity is a real thing. Contrary to the appeal by by opponents of vaccination to the right of individual choice whether or not to vaccinate, vaccination is in the first instance not an individual question, but a social one. This is a problem we have to resolve collectively.

There can arise exceptional situations, epidemics and similar health emergencies, where the interests of public health might justify drastic temporary violations of civil liberties, such as compulsory vaccinations and treatments, quarantines and restrictions on the right to travel, even compulsory isolation of infected individuals. The recent Ebola crisis in West Africa was such a situation.

The MMR situation is not one of these, however, and to resort to coercive measures when they are not justified can only be counter-productive. It drives many people unnecessarily into the arms of the conspiracists and hoaxers.

The anti-vaccination campaign does not unfold in a vacuum, but in the context of a deep-going crisis in the provision of health care. In the United States, first Obamacare and then Trumpcare ‘reforms’ have left millions without access to affordable health and dental care, and many millions more in a situation of extreme insecurity. These same ‘reforms’ have delivered a profit bonanza to medical insurance companies, pharmaceutical companies and others in the ‘industry.’ In the UK, the government is pushing towards privatising the National Health Service, which promises a similar disaster for working people. In New Zealand, a deep crisis in mental health care drags on unresolved month after month, and assistance for parents of children with autism, already woefully inadequate, gets cut further.

One need not doubt the sincerity of doctors like Lance O’Sullivan to see why many people are unwilling to trust that the medical profession ‘know what they’re talking about.’ The crisis in health care is part of a broader social crisis of capitalism, and to one degree or another, many health professionals get drawn into it and compromised by it. We should not forget that Andrew Wakefield was a member of this profession when he committed his fraud.

There is a rare moment where Vaxxed accidentally hits on a truth. “These people,” says one of the talking heads, referring to the individuals responsible for ensuring the safety of vaccines, drugs and pharmaceuticals prescribed in the US health system, “they bounce around, from government, to the CDC and other regulatory bodies, to industry [by which he means, of course, executive positions in pharmaceutical businesses, not actually working in the industry!], to government again.” ² He gives an example of a member of the CDC who, soon after approving a drug, gets appointed to a lucrative position in the very same drug company.

This is exactly how regulation of capitalist industry by a capitalist government works, and not just in the medical-pharmaceutical ‘industry.’ It requires no high-level conspiracy: this is business as usual, and it’s legal. The domination of big business corrupts every aspect of health care, including its drug-testing regime. For example, as science writer Ben Goldacre points out, the drug companies spend twice as much on marketing and advertising as they do on research and development of new drugs. Goldacre reminds us that the goal of advertising is to reduce the influence of the scientific evidence on doctors’ prescription practices. Most drugs research is carried out by the drug companies themselves, and 85% of industry-sponsored trials are positive, compared to 50% of government-sponsored trials. Negative results are simply not published. ³ There is a strong scientific basis for the popular suspicion towards drug companies.

The broader crisis in health care, of which falling vaccination rates are a part, will only be resolved through the political intervention of the working class, mobilising to demand free, state-funded health care for all, and the nationalisation of the pharmaceutical industry. It was working class political action of this kind in the 1930s to 1950s that created the system of free public hospitals in New Zealand, and successfully defended them in the 1990s against the attempts to start charging patients for stays in hospital. This system exists to this day, albeit in an impoverished and weakened form.

O’Sullivan’s proposed solutions to the problem of low vaccination rates, on the other hand, bear the hallmarks of the middle-class professional’s disdain for the working class. This view sees workers as gullible and dim-witted, having to be coaxed and managed to do the right thing by a system of rewards and punishments, under the benevolent leadership of the educated middle class themselves.

Coaxed, managed, and shielded from bad influences: the same outlook motivates those who seek to obstruct the screenings of Vaxxed. Grant Jacobs, writing on Sciblogs 7 April, expresses dismay that the University of Otago has permitted a screening of Vaxxed on that campus. (The university, in response to criticism, defended hosting the movie on free-speech grounds, while condemning the film itself, saying in a statement “We believe the makers and distributors of this movie are scaremongering, and behaving in an anti-child manner, showing no regard for the health and wellbeing of children.”)

Jacobs writes, “free speech is about that I am able to express my views, even if others may not agree or may even object strongly. It is not about venues being obliged to host everything that comes their way. Venues should be able to decline if the topic or style of presentation does not suit them or what they represent.”

But ‘venues’ are concrete and timber constructions, without the capacity to accept or decline anything. What this actually means is that the owners of the venues get the right to ‘decline if the topic does not suit them’. And with a tiny handful of exceptions, the owners of all venues are either the capitalist state (city councils, universities, public libraries and the like) or capitalist-run institutions and clubs. Conceding the ‘venue’s right to decline’ in the case of Vaxxed would set a very dangerous precedent for the political rights of working people.

And in my opinion, workers should go and see Vaxxed – not because there is anything of value in its arguments, but rather for the opposite reason: workers need to learn to recognise the smooth-talking, educated face of scientific fraud when they see it.

In order to resolve the health care crisis, it is not trust in the medical profession that the working class needs. It is trust in scientific evidence (including the evidence assembled by medical professionals), trust in their own judgment, and above all, trust in their own power to effect changes in society. When the working class gains such self-confidence and begins to act independently of the bourgeoisie and its professional appendages, it will find that many medical workers and professionals are fighting by its side.

Footnotes

1. However, in many countries in Africa where vaccination rates have historically been much lower, huge inroads against these diseases have been achieved recently by making vaccination more accessible.
2. I quote this from memory, and while I am confident that the gist of the comment is correct, the detail may be inaccurate. The website where I was watching the movie appeared to infect my computer with a virus, so I was reluctant to go back and check it.
3. Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, by Ben Goldacre, 2012, page 5.