Last month, the Maryland Department of Health and Mental Hygiene reported the first case of measles in the state since 2009.
This development demonstrates that even Maryland, which has one of the highest vaccination rates in the U.S., is not immune to a larger trend facing the nation. This past year, the U.S. has seen the largest increase in measles cases in almost two decades, according to the U.S. Centers for Disease Control and Prevention. The rise in measles cases over the first half of this year is double the rate typically seen compared with previous years.
Most of those diagnosed with the disease did not receive the measles, mumps, and rubella (MMR) vaccine.
In the U.S., most children receive the MMR vaccine series by age 2. Of those patients diagnosed with measles, most survive; however, fatal brain and lung complications can occur.
A survey released earlier this month by the CDC showed almost 80 percent of parents are uncomfortable with the concept of childhood vaccination. Among the reasons provided, roughly 30 percent cited the potential for learning disabilities, such as autism, for their hesitation to vaccinate.
Some of the fear of vaccination is driven by disease-driven litigation tied to junk science.
The landmark research linking the MMR vaccine to autism was initially published in 1998 by Dr. Andrew Wakefield in the Lancet, a respected British medical journal. Other researchers' inability to replicate his findings spawned further investigation. Subsequent inquiry into Dr. Wakefield's research demonstrated that his subjects were recruited by a plaintiff's lawyer preparing a lawsuit against vaccine manufacturers.
Additionally, not only had Dr. Wakefield received payment from these attorneys two years prior to initiating his research study, but he also had a patent application for a rival measles vaccine. In addition to the numerous conflicts of interest, Dr. Wakefield's research was also found laden with altered data. Finally, the Lancet took the unprecedented step of retracting the original published peer-reviewed article.
The best medical research suggests no link between vaccination and autism. Nonetheless, the absence of data has not stopped families from pursuing their claims of disability through available legal channels.
Lawyers intent on creating a mini-industry out of lawsuits against vaccine makers have threatened the supply of vaccines to the American public. Many drug companies in the U.S. were pushed out of the vaccine business in the 1980s from large settlements related to whooping cough-tetanus-diphtheria (DTP) vaccine reaction lawsuits. In response, Congress in 1986 created an alternate legal system of "vaccine courts," compensating patients financially based on known vaccine-related side effects. Payments on the judgments of these tribunals are funded by a tax levied on each vaccine.
Despite the lack of solid research confirming a causal link between vaccines and autism, there are petitions from more than 5,000 families pending before the courts, arguing otherwise. However, as per the common scientific axiom, the plural of "anecdote" is not "data."
In February, the Supreme Court heard a challenge to the legality of the federal law that created this no fault, nonjuried tribunal system, which shields drug companies from product liability lawsuits. In a 6-2 decision, the court reaffirmed the success of these vaccine courts, whose judgments are based on known science rather than fickle juries, which are often swayed by personal stories of hardship.
Writing in the majority opinion, Justice Antonin Scalia found the law "reflects a sensible choice to leave complex epidemiological judgments about vaccine design to the [Food and Drug Administration] and the National Vaccine Program rather than juries."
While scientifically baseless claims of disability have no weight in these courts, they have had a monumental effect on the lay public.
The response following Dr. Wakefield's initial study in the United Kingdom was palpable. MMR vaccination rates in Britain dropped from 92 percent in 1996 to 84 percent by 2002. Measles and mumps cases subsequently grew at rates tenfold to thirtyfold compared with periods prior to the study. A decade of suboptimal levels of vaccination in the U.K. has now compromised herd immunity to measles, (that is, the immunity gained by an individual susceptible to a disease through the critical mass of the surrounding immunized community).
According to the UK Health Protection Agency, their equivalent to the CDC, the U.K. now faces endemic levels of measles within its population, allowing for the continuous spread of the disease.
In a viral age, the persistence and prevalence of vaccine misinformation among the public may take some time to correct. However, regaining the health protection afforded by effective vaccination programs will take longer.
Dr. Sandeep Rao is a fellow at Johns Hopkins Hospital. His email is firstname.lastname@example.org.