View source for Social:MMR vaccine and autism

{{Short description|False claims of a link between the MMR vaccine and autism}}
{{Alternative medicine sidebar|conspiracy}}

Claims of a link between the '''[[Medicine:MMR vaccine|MMR vaccine]] and [[Medicine:Autism|autism]]''' have been extensively investigated and found to be false.<ref name="Cochrane2020">{{cite journal|last1=Di Pietrantonj |first1=C |last2=Rivetti |first2=A |last3=Marchione |first3=P |last4=Debalini |first4=MG |last5=Demicheli |first5=V|date=2021-11-22 |title=Vaccines for measles, mumps, rubella, and varicella in children.|journal=Cochrane Database of Systematic Reviews |volume=2021 |issue=11 |pages=CD004407 |doi=10.1002/14651858.CD004407.pub5 |pmc=8607336 |pmid=34806766 }}</ref> The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 [[Unsolved:Lancet MMR autism fraud|''Lancet'' MMR autism fraud]], characterised as "perhaps the most damaging medical hoax of the last 100 years".<ref>{{cite journal |last=Flaherty |first=Dennis K. |date=October 2011 |title=The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science |journal=The Annals of Pharmacotherapy |volume=45 |issue=10 |pages=1302–1304 |doi=10.1345/aph.1Q318 |issn=1542-6270 |pmid=21917556 |s2cid=39479569}}</ref> The fraudulent research paper authored by [[Biography:Andrew Wakefield|Andrew Wakefield]] and published in ''The Lancet'' falsely claimed the vaccine was linked to [[Medicine:Colitis|colitis]] and [[Medicine:Autism spectrum|autism spectrum]] disorders. The paper was retracted in 2010<ref>{{cite journal |last=Dyer |first=Clare |date=2 February 2010 |title=''Lancet'' retracts Wakefield's MMR paper |url=https://www.bmj.com/content/340/bmj.c696 |journal=BMJ |volume=340 |pages=c696 |doi=10.1136/bmj.c696 |issn=0959-8138 |pmid=20124366 |s2cid=43465004 }}</ref> but is still cited by [[Unsolved:Anti-vaccine activism|anti-vaxxers]].<ref>{{cite web |url=https://sites.psu.edu/kyraschwartztechwriting/2015/10/15/public-health-education/ |title=Public Health Education |publisher=KYRA SCHWARTZ TECHNICAL WRITING SAMPLES |access-date=3 February 2019}}</ref>

The claims in the paper were widely reported,<ref name="Goldacre-2008">{{cite news |title=The MMR hoax |last=Goldacre |first=B. |work=The Guardian |location=London |date=30 August 2008 |access-date=30 August 2008 |url=https://www.theguardian.com/society/2008/aug/30/mmr.health.media |archive-url=https://web.archive.org/web/20150206073230/http://www.theguardian.com/society/2008/aug/30/mmr.health.media |archive-date=6 February 2015}} [http://www.badscience.net/2008/08/the-medias-mmr-hoax/ Alt URL]</ref> leading to a sharp drop in vaccination rates in the UK and Ireland. Promotion of the claimed link, which continues in anti-vaccination propaganda despite being refuted,<ref>{{cite journal |last1=Hussain |first1=Azhar |last2=Ali |first2=Syed |last3=Ahmed |first3=Madiha |last4=Hussain |first4=Sheharyar |title=The Anti-vaccination Movement: A Regression in Modern Medicine |journal=Cureus |volume=10 |issue=7 |pages=e2919 |doi=10.7759/cureus.2919 |issn=2168-8184 |pmc=6122668 |pmid=30186724 |year=2018|doi-access=free }}</ref><ref>{{cite journal |last=Gross |first=Liza |date=26 May 2009 |title=A Broken Trust: Lessons from the Vaccine–Autism Wars |journal=PLOS Biology |volume=7 |issue=5 |pages=e1000114 |doi=10.1371/journal.pbio.1000114 |issn=1544-9173 |pmc=2682483 |pmid=19478850 |doi-access=free }}</ref> has led to an increase in the incidence of [[Medicine:Measles|measles]] and [[Medicine:Mumps|mumps]], resulting in deaths and serious permanent injuries.<ref name="McIntyre" /><ref name="Pepys" /> Following the initial claims in 1998, multiple large epidemiological studies were undertaken. Reviews of the evidence by the Centers for Disease Control and Prevention,<ref name="CDC-MMR-autism">{{cite web |url=http://cdc.gov/vaccinesafety/concerns/mmr_autism_factsheet.htm |title=Measles, mumps, and rubella (MMR) vaccine |date=22 August 2008 |access-date=21 December 2008 |publisher=Centers for Disease Control and Prevention |archive-url=https://web.archive.org/web/20080407015528/http://www.cdc.gov/vaccinesafety/concerns/mmr_autism_factsheet.htm |archive-date=7 April 2008}}</ref> the American Academy of Pediatrics, the Institute of Medicine of the US National Academy of Sciences,<ref name="IOM">{{cite book |last=Institute of Medicine (US) Immunization Safety Review Committee |date=17 May 2004 |pmid=20669467 |url=http://www.iom.edu/Reports/2004/Immunization-Safety-Review-Vaccines-and-Autism.aspx |title=Immunization Safety Review: Vaccines and Autism |publisher=Institute of Medicine of the National Academy of Sciences |access-date=13 June 2007 |url-status=dead |archive-url=https://web.archive.org/web/20091026043205/http://www.iom.edu/reports/2004/immunization-safety-review-vaccines-and-autism.aspx |archive-date=26 October 2009 |doi=10.17226/10997 |isbn=978-0-309-09237-1}}</ref> the UK National Health Service,<ref name="MMRthefacts">{{cite web |url=http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002972 |access-date=19 September 2007 |year=2004 |title=MMR The facts |publisher=NHS Immunisation Information |archive-url=http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002972 |archive-date=7 January 2013}}</ref> and the [[Cochrane Library]]<ref name="Cochrane2020" /><ref name=":0">{{cite journal |last1=Di Pietrantonj |first1=Carlo |last2=Rivetti |first2=Alessandro |last3=Marchione |first3=Pasquale |last4=Debalini |first4=Maria Grazia |last5=Demicheli |first5=Vittorio |date=20 April 2020 |title=Vaccines for measles, mumps, rubella, and varicella in children |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD004407 |doi=10.1002/14651858.CD004407.pub4 |issn=1469-493X |pmc=7169657 |pmid=32309885}}</ref> all found no link between the MMR vaccine and autism.<ref name="Klaherty">{{cite journal |last1=Flaherty |first1=Dennis K |title=The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science |journal=Annals of Pharmacotherapy |volume=45 |issue=10 |pages=1302–4 |date=October 2011 |pmid=21917556 |doi=10.1345/aph.1Q318 |s2cid=39479569 }}</ref> Physicians, medical journals, and editors<ref name="BMJLiftsCurtain">{{cite web |url=http://www.medpagetoday.com/Pediatrics/Autism/24203 |title=BMJ Lifts Curtain on MMR-Autism Fraud |last1=Gever |first1=John |website=MedPage Today |date=5 January 2011 |access-date=8 January 2011 }}</ref><ref name="GodleeEditorial">{{cite journal |url=http://www.bmj.com/content/342/bmj.d22.full |title=The fraud behind the MMR scare |last1=Godlee |first1=F |journal=The BMJ |date=January 2011 |pages=d22 |issue=jan06 1 |volume=342 |doi=10.1136/bmj.d22 |s2cid=73020733}}</ref><ref name="BMJBlogDeer">{{cite web |url=http://blogs.bmj.com/bmj/2011/01/06/brian-deer-piltdown-medicine-the-missing-link-between-mmr-and-autism/ |title=Brian Deer: Piltdown medicine: The missing link between MMR and autism |date=6 January 2011 |publisher=BMJ Group Blogs |last1=Deer |first1=Brian |access-date=8 January 2011}}</ref><ref name="IBTimes">{{cite news |url=http://www.ibtimes.com/articles/98531/20110107/link-between-mmr-vaccines-and-autism-conclusively-broken.htm |title=Link between MMR Vaccines and Autism conclusively broken |newspaper=IB Times |date=7 January 2011 |access-date=8 January 2011}}</ref><ref name="WebMDBroyd">{{cite web |url=http://www.webmd.com/brain/autism/news/20110106/bmj-declares-vaccine-autism-study-fraud |title=BMJ Declares Vaccine-Autism Study 'an Elaborate Fraud', 1998 Lancet Study Not Bad Science but Deliberate Fraud, Claims Journal |last1=Broyd |first1=Nicky |publisher=[[Company:WebMD|WebMD]] Health News |date=6 January 2011 |access-date=8 January 2011}}</ref> have described Wakefield's actions as fraudulent and tied them to epidemics and deaths.<ref name="AgeOld" /><ref name="Jasek">{{cite news |last1=Jasek |first1=Marissa |url=http://www.wwaytv3.com/healthwatch-disputed-autism-study-sparks-debate-about-vaccines/01/2011 |title=Healthwatch: Disputed autism study sparks debate about vaccines |publisher=WWAY Newschannel 3 |date=6 January 2011 |access-date=7 January 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110724093057/http://www.wwaytv3.com/healthwatch-disputed-autism-study-sparks-debate-about-vaccines/01/2011 |archive-date=24 July 2011 }}</ref>

An investigation by journalist Brian Deer found that Wakefield, the author of the original research paper linking the vaccine to autism, had multiple undeclared conflicts of interest,<ref name="Deer04a">''The Sunday Times'' 2004:
* {{cite news |last1=Deer |first1=Brian |title=Revealed: MMR research scandal |work=The Sunday Times |date=22 February 2004 |url=http://www.timesonline.co.uk/tol/news/uk/health/article1027603.ece |access-date=23 September 2007 |location=London}}
* {{cite web |last1=Deer |first1=Brian |title=The Lancet scandal |url=http://briandeer.com/mmr-lancet.htm |year=2007 |access-date=23 September 2007}}</ref><ref name="Patent-and-test-results">2004 BBC documentary:
* {{cite web |last1=Deer |first1=Brian |title=The Wakefield factor |year=2007 |url=http://briandeer.com/wakefield-deer.htm |access-date=23 September 2007}}
* {{cite journal |last1=Deer |first1=Brian |journal=The BMJ |year=2004 |volume=329 |issue=7477 |page=1293 |title=Dispatches. MMR: What They Didn't Tell You |doi=10.1136/bmj.329.7477.1293 |pmc=534460}}</ref> had manipulated evidence,<ref name="Deer2009">{{cite news |url=http://www.thesundaytimes.co.uk/sto/public/news/article148992.ece |archive-url=https://web.archive.org/web/20140227222152/http://www.thesundaytimes.co.uk/sto/public/news/article148992.ece |url-status=dead |archive-date=27 February 2014 |title=MMR doctor Andrew Wakefield fixed data on autism |last1=Deer |first1=Brian |work=The Sunday Times |date=8 February 2009 |access-date=9 February 2009 |location=London }}</ref> and had broken other ethical codes.{{Which|date=May 2021}} The ''Lancet'' paper was partially retracted in 2004 and fully retracted in 2010, when ''Lancet''{{'}}s editor-in-chief Richard Horton described it as "utterly false" and said that the journal had been deceived.<ref name="Boseley, Sarah">{{cite news |url=https://www.theguardian.com/society/2010/feb/02/lancet-retracts-mmr-paper |title=Lancet retracts 'utterly false' MMR paper |newspaper=The Guardian |date=2 February 2010 |access-date=14 January 2015 |location=London |last1=Boseley |first1=Sarah }}</ref> Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010 and was struck off the Medical Register, meaning he could no longer practise as a physician in the UK.<ref name="Triggle, Nick">{{cite news |url=http://news.bbc.co.uk/1/hi/health/8695267.stm |title=MMR doctor struck off register |last1=Triggle |first1=Nick |date=24 May 2010 |work=BBC News |access-date=24 May 2010}}</ref> In January 2011, Deer published a series of reports in the ''British Medical Journal'',<ref name="Deer fixed">{{cite journal | title=How the case against the MMR vaccine was fixed| author=Deer B| journal=The BMJ| year=2011| volume=342 | issue=jan05 1| pages=c5347| url=http://www.bmj.com/content/342/bmj.c5347.full |doi= 10.1136/bmj.c5347 | pmid=21209059| doi-access=free}}</ref><ref name=HowMakeMoney>{{cite journal |journal= The BMJ |date= 11 January 2011 |pages= c5258 |issue= jan11 4 |volume=  342|doi= 10.1136/bmj.c5258 |title= How the vaccine crisis was meant to make money |author=Deer B |url= http://www.bmj.com/content/342/bmj.c5258.full |pmid=21224310|s2cid= 37724643 }}</ref><ref>{{cite news| url=https://www.bmj.com/content/342/bmj.c7001 | work=The BMJ)| title=The Lancet's two days to bury bad news | author = Deer B | date=18 January 2011 | access-date=2021-08-05}}</ref> which in a signed editorial stated of the journalist, "It has taken the diligent scepticism of one man, standing outside medicine and science, to show that the paper was in fact an elaborate fraud."<ref name="WakefieldarticleBMJ">{{cite journal |vauthors=Godlee F, Smith J, Marcovitch H |title=Wakefield's article linking MMR vaccine and autism was fraudulent |journal=[[Medicine:The BMJ|The BMJ]] |volume=342 |pages=c7452 |year=2011 |pmid=21209060 |url=http://www.bmj.com/content/342/bmj.c7452.full |doi=10.1136/bmj.c7452 |s2cid=43640126}}</ref><ref name="DeerarticleBMJ">{{cite journal |last1=Deer |first1=Brian |title=Wakefield's article linking MMR vaccine and autism was fraudulent |journal=[[Medicine:The BMJ|The BMJ]] |volume=342 |pages=c5347 |year=2011 |pmid=21209059 |url=http://www.bmj.com/content/342/bmj.c5347.full |doi=10.1136/bmj.c5347 |doi-access=free }}</ref> The [[Philosophy:Scientific consensus|scientific consensus]] is that there is no link between the MMR vaccine and autism and that the vaccine's benefits greatly outweigh its potential risks.<!-- See the Research section for supporting references. -->

== Background ==

=== Revaccination campaign ===
In the wake of the measles outbreaks, which occurred in England in 1992, and on the basis of analyses of seroepidemiological data combined with mathematical modeling, British Health authorities predicted a major resurgence of measles in school-age children. Two strategies were then examined: either to target vaccination at all children without a history of prior measles vaccination or to immunize all children irrespective of vaccination history.<ref>{{cite journal |doi=10.1017/S0950268800058969 |vauthors=Calvert N, Cutts F, Irving R, Brown D, Marsh J, Miller E |title=Measles immunity and response to revaccination among secondary school children in Cumbria |journal=Epidemiology & Infection |volume=116 |issue=1 |pages=65–70 |date=February 1996 |pmid=8626005 |pmc=2271248}}</ref> In November 1994, the latter option was chosen and a national measles and rubella vaccination campaign, described as "one of the most ambitious vaccination initiatives that Britain has undertaken" was commenced:<ref>{{cite journal |last1=Miller |first1=E |title=The new measles campaign |journal=The BMJ |volume=309 |issue=6962 |pages=1102–3 |date=October 1994 |pmid=7987096 |pmc=2541903 |doi=10.1136/bmj.309.6962.1102}}</ref> within one month, 92% of the 7.1&nbsp;million schoolchildren in England aged 5–16 years received measles and rubella (MR) vaccine.<ref>{{cite journal |last1=Cutts |first1=FT |title=Revaccination against measles and rubella |journal=The BMJ |volume=312 |issue=7031 |pages=589–90 |date=March 1996 |pmid=8595319 |pmc=2350416 |doi=10.1136/bmj.312.7031.589}}</ref>

=== MMR litigation starts ===
In April 1994, Richard Barr,<ref>{{cite web |url=http://www.richardbarr.org/#/mmr/4511615194 |title=Richard Barr original writing site |website=www.richardbarr.org |access-date=27 May 2010 |archive-date=7 July 2018 |archive-url=https://web.archive.org/web/20180707205739/http://www.richardbarr.org/#/mmr/4511615194 |url-status=dead }}</ref> a solicitor, succeeded in winning legal aid for the pursuit of a class action lawsuit against the manufacturers of MMR vaccines under the UK Consumer Protection Act 1987. The class action case was aimed at Aventis Pasteur, SmithKline Beecham, and Merck, manufacturers respectively of Immravax, Pluserix-MMR and MMR II.<ref>{{cite web |last=Fitzpatrick |first=Michael |url=http://www.spiked-online.com/articles/00000006E019.htm |title=spiked-health {{pipe}} Medicine on trial |publisher=Spiked-online.com |access-date=8 January 2011 |archive-url=https://web.archive.org/web/20160625005008/http://www.spiked-online.com/Articles/00000006E019.htm |archive-date=25 June 2016 |url-status=dead }}</ref><ref>{{cite journal|url=https://printeger.eu/wp-content/uploads/2018/08/UK-Case-Study-1_MMR.pdf|title=Case study: Wakefield and MMR|journal=Promoting Integrity as an Integral Dimension of Excellence in Research|date=22 September 2017|first=Mari-Rose|last=Kennedy|issue=D III.3.2}}</ref> This suit, based on a claim that MMR is a defective product and should not have been used, was the first big class action lawsuit funded by the Legal Aid Board (which became the Legal Services Commission, which in turn was replaced by the Legal Aid Agency) after its formation in 1988. Noticing two publications from Andrew Wakefield that explored the role of measles virus in [[Medicine:Crohn's disease|Crohn's disease]] and [[Medicine:Inflammatory bowel disease|inflammatory bowel disease]],<ref>{{cite journal |vauthors=Wakefield AJ, Pittilo RM, Sim R, etal |year=1993 |title=Evidence of Persistent Measles Virus in Crohn's Disease |journal=Journal of Medical Virology |volume=39 |issue=4 |pages=345–53 |doi=10.1002/jmv.1890390415 |pmid=8492105 |s2cid=29899812 }}</ref><ref>{{cite journal |year=1995 |title=Is Measles Vaccine a Risk for Inflammatory Bowel Disease? |doi=10.1016/s0140-6736(95)90816-1 |pmid=7715338 |journal=The Lancet |volume=345 |issue=8957 |pages=1071–74 |last1=Thompson |first1=N.P |last2=Pounder |first2=R.E |last3=Wakefield |first3=A.J |last4=Montgomery |first4=S.M |s2cid=30683685 }}</ref> Barr contacted Wakefield for his expertise. According to Wakefield supporters, the two men first met on 6 January 1996.<ref>{{cite web |url=http://www.wesupportandywakefield.com/documents/AutismFile_US31_Wakefield.pdf |title=On Second Looking Into the Case of Dr. Andrew J. Wakefield |access-date=19 May 2010 |url-status=dead |archive-url=https://web.archive.org/web/20100525081504/http://www.wesupportandywakefield.com/documents/AutismFile_US31_Wakefield.pdf |archive-date=25 May 2010 }}</ref> The Legal Services Commission halted proceedings in September 2003, citing a high probability of failure based on the medical evidence, bringing an end to the first case of research funding by the LSC.<ref name="Fitz2004">{{cite book |last1=Fitzpatrick |first1=M |title=MMR and Autism: What Parents Need to Know |publisher=Routledge |year=2004 |access-date=2 February 2011 |url=https://books.google.com/books?id=XMWuvsJ1WY4C |isbn=978-0-415-32179-2 }}</ref>

== 1998 ''The Lancet'' paper ==
{{main|Unsolved:Lancet MMR autism fraud}}

Wakefield's paper "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children" was published in ''The Lancet'' on 28 February 1998. An investigation by journalist Brian Deer found that Wakefield had multiple undeclared conflicts of interest,<ref name="Deer04a" /><ref name="Patent-and-test-results" /> had manipulated evidence,<ref name="Deer2009" /> and had broken other ethical codes.{{Which|date=June 2021}} Based on Deer's findings, Peter N. Steinmetz summarizes six fabrications and falsifications in the paper itself and in Wakefield's response in the areas of findings of non-specific colitis; behavioral symptoms; findings of regressive autism; ethics consent statement; conflict of interest statement; and methods of patient referral.<ref>{{cite magazine |last=Steinmetz |first=Peter N. |date=November–December 2020 |title=The Scientific Frauds Underlying the False MMR Vaccine–Autism Link |url=https://skepticalinquirer.org/2020/11/the-scientific-frauds-underlying-the-false-mmr-vaccine-autism-link/ |url-status= |magazine=[[Unsolved:Skeptical Inquirer|Skeptical Inquirer]] |location=Amherst, New York |publisher=[[Organization:Center for Inquiry|Center for Inquiry]] |archive-url=https://web.archive.org/web/20210808144442/https://skepticalinquirer.org/2020/11/the-scientific-frauds-underlying-the-false-mmr-vaccine-autism-link/ |archive-date=8 August 2021 |access-date=8 August 2021}}</ref> The ''Lancet'' paper was partially retracted in 2004 and fully retracted in 2010, when ''The Lancet''{{'}}s editor-in-chief Richard Horton described it as "utterly false" and said that the journal had been deceived.<ref name="Boseley, Sarah" /> Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010 and was struck off the Medical Register, meaning he could no longer practise as a doctor in the UK.<ref name="Triggle, Nick" /> In 2011, Deer provided further information on Wakefield's improper research practices to the ''British Medical Journal'', which in a signed editorial described the original paper as fraudulent.<ref name="WakefieldarticleBMJ" /><ref name="DeerarticleBMJ" />

The [[Philosophy:Scientific consensus|scientific consensus]] is that there is no link between the MMR vaccine and autism and that the vaccine's benefits greatly outweigh its risks.<!-- See the Research section for supporting references. --> However, by the time that scientists had shown the narrative to be false, it had become part of the lay understanding of autism.<ref name="Moore 2006">{{cite journal |last1=Moore|first1=Alfred |last2=Stilgoe|first2=Jack |title=Experts and Anecdotes|journal=Science, Technology, & Human Values |volume=34|issue=5 |year=2009 |pages=654–677 |issn=0162-2439|doi=10.1177/0162243908329382|s2cid=142993062}}</ref><ref>{{cite journal |last1=Taylor|first1=B. |s2cid=26423046 |title=Vaccines and the changing epidemiology of autism|journal=Child: Care, Health and Development |volume=32|issue=5 |year=2006 |pages=511–519|issn=0305-1862|doi=10.1111/j.1365-2214.2006.00655.x|pmid=16919130}}</ref> The narrative was easy to understand and apparently consistent with anecdotal evidence of children receiving autism diagnoses shortly after having been vaccinated.<ref>{{cite news|url=http://news.bbc.co.uk/2/hi/health/5118166.stm|title= Doctors issue plea over MMR jab|work=BBC News|access-date=2009-02-04 | date=26 June 2006}}</ref>

By the time it was retracted, all authors other than Wakefield had requested their names be removed from the publication.<ref>{{cite web |url=https://sciencebasedmedicine.org/lancet-retracts-wakefield-article/ |title=The Lancet retracts Andrew Wakefield's article |date=3 February 2010 |website=Science-Based Medicine |access-date=3 February 2019 }}</ref>

Fiona Godlee, editor of ''The BMJ'', said in January 2011:<ref name="GodleeEditorial" />

{{blockquote|The original paper has received so much media attention, with such potential to damage public health, that it is hard to find a parallel in the history of medical science. Many other medical frauds have been exposed but usually more quickly after publication and on less important health issues.}}

== Media role ==
Observers{{Who|date=May 2021}} have criticized the involvement of mass media in the controversy, what is known as '[[Unsolved:Science by press conference|science by press conference]]',<ref name="EMBOreports">{{cite journal |last1=Moore |first1=Andrew |year=2006 |title=Bad science in the headlines: Who takes responsibility when science is distorted in the mass media? |journal=[[Biology:EMBO Reports|EMBO Reports]] |volume=7 |issue=12 |pages=1193–1196 |doi=10.1038/sj.embor.7400862 |pmid=17139292 |pmc=1794697}}</ref> alleging that the media provided Wakefield's study with more credibility than it deserved. A March 2007 paper in ''BMC Public Health'' by Shona Hilton, Mark Petticrew, and Kate Hunt postulated that media reports on Wakefield's study had "created the misleading impression that the evidence for the link with autism was as substantial as the evidence against" through an attempt to create "balanced reporting".<ref name="hilton">{{cite journal |last1=Hilton |first1=S |last2=Petticrew |first2=M |last3=Hunt |first3=K |year=2007 |title=Parents' champions vs. vested interests: Who do parents believe about MMR? A qualitative study |journal=BMC Public Health |volume=7 |page=42 |pmc=1851707 |pmid=17391507 |doi=10.1186/1471-2458-7-42 |doi-access=free }}</ref> Earlier papers in ''Communication in Medicine'' and ''British Medical Journal'' concluded that media reports provided a misleading picture of the level of support for Wakefield's hypothesis.<ref name="Speers">{{cite journal |last1=Speers |first1=T |last2=Justin |first2=L |title=Journalists and jabs: media coverage of the MMR vaccine |journal=Communication and Medicine |volume=1 |issue=2 |pages=171–181 |doi=10.1515/come.2004.1.2.171 |pmid=16808699 |date=September 2004 |s2cid=29969819}}</ref><ref>{{cite journal |last1=Jackson |first1=T |year=2003 |title=MMR: more scrutiny, please |journal=[[Medicine:The BMJ|The BMJ]] |volume=326 |issue=7401 |page=1272 |doi=10.1136/bmj.326.7401.1272 |pmc=1126154 }}</ref><ref name="Dobson">{{cite journal |last=Dobson |first=Roger |date=May 2003 |title=Media misled the public over the MMR vaccine, study says |journal=The BMJ |volume=326 |issue=7399 |page=1107 |doi=10.1136/bmj.326.7399.1107-a |pmc=1150987 |pmid=12763972 }}</ref>

A 2007 editorial in ''Australian Doctor'' complained that some journalists had continued to defend Wakefield's study even after ''The Lancet'' had published the retraction by 10 of the study's 12 original authors, but noted that it was an investigative journalist, Brian Deer, who had played a leading role in exposing weaknesses in the study.<ref name="Katelaris">{{cite journal |last1=Katelaris |first1=A |url=http://www.australiandoctor.com.au/news/bf/0c04f2bf.asp |title=Wakefield saga a study in integrity |journal=Australian Doctor |date=17 August 2007 |page=20 |archive-url=https://web.archive.org/web/20070908211909/http://www.australiandoctor.com.au/news/bf/0c04f2bf.asp |archive-date=8 September 2007}}</ref> ''PRWeek'' noted that after Wakefield was removed from the general medical register for misconduct in May 2010, 62% of respondents to a poll regarding the MMR controversy stated they did not feel that the media conducted responsible reporting on health issues.<ref name="PRWeek">[http://www.prweek.com/uk/news/1007378/Reputation-survey-MMR-panic-subsides "Reputation Survey: MMR panic subsides"]. ''PR Week'', 2 June 2010: 24.</ref>

A ''New England Journal of Medicine'' article examining the history of antivaccinationists said that opposition to vaccines has existed since the 19th century, but "now the antivaccinationists' media of choice are typically television and the Internet, including its social media outlets, which are used to sway public opinion and distract attention from scientific evidence".<ref name="AgeOld">{{Cite journal|vauthors=Poland GA, Jacobson RM|date=13 January 2011|title=The age-old struggle against the antivaccinationists|journal=The New England Journal of Medicine|volume=364|issue=2|pages=97–99|doi=10.1056/NEJMp1010594|pmid=21226573|s2cid=39229852}}</ref> The editorial characterized anti-vaccinationists as people who "tend toward complete mistrust of government and manufacturers, conspiratorial thinking, denialism, low cognitive complexity in thinking patterns, reasoning flaws, and a habit of substituting emotional anecdotes for data", including people who range from those "unable to understand and incorporate concepts of risk and probability into science-grounded decision making" and those "who use deliberate mistruths, intimidation, falsified data, and threats of violence".<ref name="AgeOld" />

In a January 2011 editorial in ''The American Spectator'', Robert M. Goldberg contended that evidence from the scientific community of issues with Wakefield's research "were undermined because the media allowed Wakefield and his followers to discredit the findings just by saying so".<ref>Goldberg, Robert M., [http://spectator.org/archives/2011/01/07/andrew-wakefields-lethal-legac "Andrew Wakefield's Lethal Legacy"] {{webarchive|url=https://web.archive.org/web/20110110035155/http://spectator.org/archives/2011/01/07/andrew-wakefields-lethal-legac |date=10 January 2011 }}, ''The American Spectator'', 7 January 2011. Retrieved 11 January 2011.</ref>

Seth Mnookin, author of ''The Panic Virus'', also partly blames the media for presenting a [[False balance|false balance]] between scientific evidence and people's personal experiences: "Reporting fell into this 'on the one hand, on the other hand' fallacy, this notion that if you have two sides that are disagreeing, that means that you should present both of them with equal weight."<ref>{{cite web |title=Vaccines: An Unhealthy Skepticism |url=http://www.retroreport.org/video/vaccines-an-unhealthy-skepticism/ |date=1 February 2015 |website=Retro Report |access-date=31 July 2015 }}</ref>

Concerns have also been raised over the journal peer review system, which largely relies on trust among researchers,<ref name="BMJLiftsCurtain" /> and the role of journalists reporting on scientific theories that they "are hardly in a position to question and comprehend".<ref name="IBTimes" /> Neil Cameron, a historian who specializes in the history of science, writing for the ''Montreal Gazette'', labeled the controversy a "failure of journalism" that resulted in unnecessary deaths, saying that: 1) ''The Lancet'' should not have published a study based on "statistically meaningless results" from only 12 cases; 2) the anti-vaccination crusade was continued by the satirical ''Private Eye'' magazine; and 3) a grapevine of worried parents and "nincompoop" celebrities fueled the widespread fears.<ref name="FailureJournalism">{{cite news |url=https://montrealgazette.com/health/Autism+study+represents+failure+journalism/4095111/story.html |title=Autism 'study' represents a failure of journalism |last1=Cameron |first1=Neil |date=12 January 2011 |work=The Montreal Gazette |access-date=12 January 2011}}{{dead link|date=June 2016|bot=medic}}{{cbignore|bot=medic}}</ref> The ''Gazette'' also reported that:<ref name="FalseStudy">{{cite news |url=https://montrealgazette.com/health/False+autism+study+done+untold+harm/4086366/story.html |title=False autism study has done untold harm |work=The Montreal Gazette |date=10 January 2011 |access-date=12 January 2011}}{{dead link|date=June 2016|bot=medic}}{{cbignore|bot=medic}}</ref>

{{blockquote|There is no guarantee that debunking the original study is going to sway all parents. Medical experts are going to have to work hard to try to undo the damage inflicted by what is apparently a rogue medical researcher whose work was inadequately vetted by a top-ranked international journal.}}

=== Folk epidemiology {{anchor|Folk epidemiology}}<!-- The redirect [[Social:Folk epidemiology of autism|Folk epidemiology of autism]] points to this anchor. If the information in this section is moved, please move the anchor with it. If this information is deleted, please consider pointing the redirect to another article, possibly [[Medicine:Epidemiology of autism|epidemiology of autism]] or [[Social:Causes of autism|causes of autism]]. --> ===
Folk epidemiology of autism refers to the popular beliefs about the [[Social:Causes of autism|origin of autism]].<ref name="Moore 2006" /> Without direct informed knowledge of autism, a complex disorder, members of the public are easily influenced by rumors and misinformation presented in the [[Social:Mass media|mass media]] and repeated on [[Social:Social media|social media]] and the [[Internet|internet]].<ref name="Moore 2006"/><ref name="LewandowskyEcker2012">{{cite journal |last1=Lewandowsky|first1=Stephan|last2=Ecker|first2=Ullrich K. H.|last3=Seifert|first3=Colleen M.|last4=Schwarz|first4=Norbert|last5=Cook|first5=John|s2cid=42633|title=Misinformation and Its Correction|journal=Psychological Science in the Public Interest |volume=13|issue=3 |year=2012 |pages=106–131 |issn=1529-1006 |doi=10.1177/1529100612451018 |pmid=26173286|doi-access=free}}</ref>

These misinformed beliefs persist even when contradicted by [[Scientific evidence|scientific evidence]].<ref name="LewandowskyEcker2012"/><ref name="Sharts-Hopko 2009">{{cite journal|last1=Sharts-Hopko|first1=Nancy C.|title=Issues in Pediatric Immunization|journal=MCN: The American Journal of Maternal/Child Nursing |volume=34|issue=2 |year=2009 |pages=80–88 |issn=0361-929X|doi=10.1097/01.NMC.0000347300.39714.19 |pmid=19262260 |s2cid=22635524}}</ref> Folk epidemiology persists because people seek, receive, and preferentially believe information that is consistent with their existing views;<ref name="LewandowskyEcker2012"/> misjudge the reliability of their sources of information, and are misled by [[Anecdotal evidence|anecdotal evidence]];<ref name="Moore 2006"/><ref name="Sharts-Hopko 2009"/> and tend not to revise their opinions even when their original sources of information are shown to be wrong.<ref name="LewandowskyEcker2012"/>

== Litigation ==
During the 1980s and 1990s, a number of lawsuits were brought against manufacturers of vaccines, alleging the vaccines had caused physical and mental disorders in children. While these lawsuits were unsuccessful, they did lead to a large jump in the costs of the MMR vaccine, and pharmaceutical companies sought legislative protections. In 1993, Merck KGaA became the only company willing to sell MMR vaccines in the United States and the United Kingdom.{{citation needed|date=March 2019}}

=== Italy ===
In June 2012, a local court in Rimini, Italy, ruled that the MMR vaccination had caused autism in a 15-month-old boy. The court relied heavily on the discredited ''Lancet'' paper and largely ignored the scientific evidence presented to it. The decision was appealed.<ref>{{cite news |url=https://www.forbes.com/sites/emilywillingham/2013/08/09/court-rulings-dont-confirm-autism-vaccine-link/ |title=Court Rulings Don't Confirm Autism-Vaccine Link |work={{wipe|Forbes}} |last1=Willingham |first1=E |date=8 August 2013 |access-date=13 August 2013}}</ref> On 13 February 2015, the decision was overturned by a Court of Appeals in Bologna.<ref name="Bocci">{{cite news |last=Bocci |first=Michele |date=1 March 2015 |title=Autismo, i giudici assolvono il vaccino ("Autism, the judges acquit the vaccine") |newspaper=La Repubblica |url=http://www.repubblica.it/salute/medicina/2015/03/01/news/autismo_i_giudici_assolvono_il_vaccino-108441541/ |access-date=4 March 2015 |language=it}}</ref>

=== Japan ===
The MMR scare caused a low percentage of mumps vaccination (less than 30%), which resulted in outbreaks in Japan.<ref name="naoko">{{cite journal |journal=Vaccine |vauthors=Yoshida N, Fujino M, Ota Y, etal |title=Simple differentiation method of mumps Hoshino vaccine strain from wild strains by reverse transcription loop-mediated isothermal amplification (RT-LAMP) |volume=25 |issue=7 |pages=1281–1286 |date=26 January 2007 |pmid=17097200 |doi=10.1016/j.vaccine.2006.09.093}}</ref> There were up to 2002 measles-caused deaths in Japan while there were none in the UK, but the extra deaths were attributed to Japan's application of the vaccine at a later age. A spokesman for the Ministry of Health said that the discontinuation had no effect in measles, but also mentioning that there were more deaths by measles while MMR was being used.<ref name="whyjapan">{{cite news |title=Why Japan stopped using MMR |work=BBC News |date=8 February 2002 |url=http://news.bbc.co.uk/2/hi/asia-pacific/1808316.stm}}</ref> In 1994 the government dropped the vaccination requirement for measles and rubella due to the 1993 MMR scare.<ref name="norrie" />{{rp|2}} It has been called a "measles exporter" by the US Centers for Disease Control and Prevention.<ref name="norrie">{{cite news |title=Japanese measles epidemic brings campuses to standstill |work=The Sydney Morning Herald |last1=Norrie |first1=Justin |date=27 May 2007 |url=http://www.smh.com.au/news/world/japanese-measles-epidemic-brings-campuses-to-standstill/2007/05/27/1180205052602.html}}</ref> As another consequence of the scare, in 2003, 7 million schoolchildren had not been vaccinated against rubella.<ref name="kakuchi" />

Autism rates continued to rise in Japan after the discontinuation of the MMR vaccine, which disproves any large-scale effect of vaccination,<ref name="andy">{{cite news |work=New Scientist |title=Autism rises despite MMR ban in Japan |last1=Coghlan |first1=Andy |date=3 March 2005 |url=https://www.newscientist.com/article/dn7076-autism-rises-despite-mmr-ban-in-japan.html}}</ref> and means that the withdrawal of MMR in other countries is unlikely to cause a reduction in autism cases.<ref name="honda">{{cite journal |doi=10.1111/j.1469-7610.2005.01425.x |journal=Journal of Child Psychology and Psychiatry |volume=46 |issue=6 |pmid=15877763 |pages=572–579 |title=No effect of MMR withdrawal on the incidence of autism: a total population study |last1=Honda |first1=Hideo |last2=Shimizu |first2=Yasuo |last3=Rutter |first3=Michael |date=18 February 2005 |doi-access=free }}</ref> The Japanese government does not recognize any link between MMR and autism.<ref name="whyjapan" /> By 2003 it was still trying to find a combined vaccine to replace MMR.<ref>{{cite journal |journal=Nature Medicine |volume=9 |issue=11 |page=1337 |year=2003 |pmid=14595415 |doi=10.1038/nm1103-1337b |title=Japanese scientists plan MMR alternative |last1=Chou |first1=I-han |s2cid=45255392 |doi-access=free }}</ref>

It was later discovered that some of the vaccines were administered after their expiry date and that the MMR compulsory vaccination was only retracted after the death of three children and more than 2000 reports of adverse effects.<ref name="kakuchi" /> By 1993 the Japanese government had paid $160,000 in compensation to the families of each of the three dead children.<ref name="kakuchi">{{cite news |work=Consumercide.com |agency=Global Information Network |location=New York |date=25 February 2003 |last1=Kakuchi |first1=Suvendrini |title=Health-Japan: Vaccine Manufacturer Sued over deaths |url=http://consumercide.com/health/japan-mmr.html |url-status=dead |archive-url=https://web.archive.org/web/20111112045809/http://consumercide.com/health/japan-mmr.html |archive-date=12 November 2011 }}</ref> Other parents received no compensation because the government said that it was unproven that the MMR vaccine had been the cause; they decided to sue the manufacturer instead of the government.<ref name="kakuchi" /> The Osaka district court ruled on 13 March 2003 that the death of two children (among numerous other serious conditions) had been indeed caused by Japan's strain of Urabe MMR.<ref name="foiacentre.com">{{cite web |url=http://www.foiacentre.com/news-MMR-comment.html |title=comments on MMR vaccine |publisher=FOIA Centre |access-date=8 January 2011}}</ref><ref>{{cite news |url=http://www.japantimes.co.jp/news/2003/03/14/national/families-win-lawsuit-over-mmr-vaccine/ |title=Families win lawsuit over MMR vaccine |newspaper=The Japan Times |date=14 March 2003 |access-date=8 January 2011}}</ref> In 2006, the Osaka High Court stated in another ruling that the state was responsible for failing to properly supervise a manufacturer of the measles-mumps-rubella vaccine, which caused severe side effects in children.<ref>{{cite news |url=http://www.tmcnet.com/usubmit/2006/04/20/1589848.htm |title=High court rules state responsible for vaccine side effects |publisher=TMCnet News |agency=Japan Economic Newswire |date=20 April 2006 |location=Kyodo |access-date=8 January 2011 }}</ref>

=== United Kingdom ===
Commenced before the Civil Procedure Rules were promulgated, the MMR Litigation had its status as group litigation achieved by the then Lord Chief Justice's practice direction of 8 July 1999. On 8 June 2007, the High Court judge, Justice Keith, put an end to the group litigation because the withdrawal of legal aid by the legal services commission had made the pursuit of most of the claimants impossible. He ruled that all but two claims against pharmaceutical companies must be discontinued.<ref>{{cite web |url=http://briandeer.com/wakefield/keith-judgment.doc |title=Approved Judgment |website=briandeer.com |date=23 May 2007 |access-date=28 April 2018 }}</ref> The judge stressed that his ruling did not amount to a rejection of any of the claims that MMR had seriously damaged the children concerned.<ref>{{cite web |url=http://www.foiacentre.com/news-MMR-070608.html |title=FOIA Centre news: MMR group legal claim collapses in high court |work=FOIA Centre |access-date=8 January 2011 }}</ref>

A pressure group, JABS (Justice, Awareness and Basic Support), was established to represent families with children who, their parents said, were "vaccine-damaged". £15&nbsp;million in public legal aid funding was spent on the litigation, of which £9.7&nbsp;million went to solicitors and [[Social:Barrister|barrister]]s, and £4.3&nbsp;million to expert witnesses.<ref name="Fitzpatrick07">{{cite news |work=spiked |date=4 July 2007 |title='The MMR–autism theory? There's nothing in it' |last1=Fitzpatrick |first1=M |url=http://spiked-online.com/index.php?/site/article/3562/ |access-date=22 January 2008 }}</ref>

=== United States ===
{{main|Medicine:Vaccine court|Medicine:Omnibus Autism Proceeding}}

The omnibus autism proceeding (OAP)<ref>{{cite web |url=http://www.uscfc.uscourts.gov/omnibus-autism-proceeding |title=Omnibus Autism Proceeding {{pipe}} US Court of Federal Claims |publisher=Uscfc.uscourts.gov |access-date=8 January 2011}}</ref> is a coordinated proceeding before the Office of Special Masters of the U.S. Court of Federal Claims—commonly called the [[Medicine:Vaccine court|vaccine court]].{{Citation needed|date=May 2021}} It is structured to facilitate the handling of nearly 5000 vaccine petitions involving claims that children who have received certain vaccinations have developed autism. The Petitioners' Steering Committee have claimed that MMR vaccines can cause autism, possibly in combination with [[Chemistry:Thiomersal controversy|thiomersal-containing vaccines]].<ref>{{cite news |url=https://www.nytimes.com/2009/02/13/opinion/13fri2.html |title=Editorial: Vaccines Exonerated on Autism |work={{wipe|The New York Times}} |date=12 February 2009 |access-date=1 November 2013}}</ref> In 2007 three test cases were presented to test the claims about the combination; these cases failed. The vaccine court ruled against the plaintiffs in all three cases, stating that the evidence presented did not validate their claims that vaccinations caused autism in these specific patients or in general.<ref name="Cedillo-v-HHS">''[ftp://autism.uscfc.uscourts.gov/autism/vaccine/Hastings-Cedillo.pdf Cedillo v. HHS]{{dead link|date=May 2017 |bot=InternetArchiveBot |fix-attempted=yes }}'' (PDF), U.S. Court of Federal Claims, Office of Special Masters, No. 98-916V (12 February 2009). Retrieved 25 March 2009.</ref>

In some cases, the plaintiffs' attorneys opted out of the Omnibus Autism Proceedings, which were concerned solely with autism, and issues concerned with bowel disorders; they argued their cases in the regular vaccine court.

On 30 July 2007, the family of Bailey Banks, a child with pervasive developmental delay, won its case versus the Department of Health and Human Services.<ref>{{cite web |url=http://www.uscfc.uscourts.gov/sites/default/files/Abell.BANKS.02-0738V.pdf |title=Entitlement Ruling |access-date=23 May 2010 |url-status=dead |archive-url=https://web.archive.org/web/20090514063807/http://www.uscfc.uscourts.gov/sites/default/files/Abell.BANKS.02-0738V.pdf |archive-date=14 May 2009}}</ref> In a case listed as relating to "non-autistic developmental delay", Special Master Richard B. Abell ruled that the Banks had successfully demonstrated, "the MMR vaccine at issue actually caused the conditions from which Bailey suffered and continues to suffer." In his conclusion, he ruled that he was satisfied that MMR had caused a brain inflammation called acute disseminated encephalomyelitis (ADEM). He reached this conclusion because of two vaccine cases in 1994 and 2001, which had concluded, "ADEM can be caused by natural measles, mumps, and rubella infections, as well as by measles, mumps, and rubella vaccines."<ref>[http://www.thedailybeast.com/newsweek/blogs/lab-notes/2009/02/25/vaccines-and-autism-the-unending-story.html Vaccines and Autism: The Unending Story] {{Webarchive|url=https://web.archive.org/web/20160121164405/http://www.thedailybeast.com/newsweek/blogs/lab-notes/2009/02/25/vaccines-and-autism-the-unending-story.html |date=21 January 2016 }}, thedailybeast.com</ref>

In other cases, attorneys did not claim that vaccines caused autism; they sought compensation for encephalopathy, encephalitis, or seizure disorders.<ref>{{cite news |url=http://www.huffingtonpost.com/robert-f-kennedy-jr-and-david-kirby/vaccine-court-autism-deba_b_169673.html |title=Robert F. Kennedy, Jr. and David Kirby: Vaccine Court: Autism Debate Continues |work=HuffPost |access-date=8 January 2011}}</ref>

== Research ==
The number of reported cases of autism increased dramatically in the 1990s and early 2000s. This increase is largely attributable to changes in diagnostic practices;<!-- ref name="Rutter"/ --> it is not known how much, if any, growth came from real changes in autism's [[Prevalence|prevalence]], and no causal connection to the MMR vaccine has been demonstrated.<ref name="Rutter">{{cite journal |last1=Rutter |first1=M |title=Incidence of autism spectrum disorders: changes over time and their meaning |journal=Acta Paediatrica |volume=94 |issue=1 |year=2005 |pages=2–15 |pmid=15858952 |doi=10.1111/j.1651-2227.2005.tb01779.x |s2cid=79259285 |}}</ref>

In 2004, a meta review financed by the [[Social:European Union|European Union]] assessed the evidence given in 120 other studies and considered unintended effects of the MMR vaccine, concluding that although the vaccine is associated with positive and negative side effects, a connection between MMR and autism was "unlikely".<ref>{{cite journal |vauthors=Jefferson T, Price D, Demicheli V, Bianco E |title=Unintended events following immunization with MMR: a systematic review |journal=Vaccine |year=2003 |pages=3954–60 |volume=21 |issue=25–26 |pmid=12922131 |doi=10.1016/S0264-410X(03)00271-8}}</ref> Also in 2004, a review article was published that concluded, "The evidence now is convincing that the measles–mumps–rubella vaccine does not cause autism or any particular subtypes of autistic spectrum disorder."<ref>{{cite journal |last1=DeStefano |first1=F |last2=Thompson |first2=WW |title=MMR vaccine and autism: an update of the scientific evidence. |journal=Expert Review of Vaccines |date=February 2004 |volume=3 |issue=1 |pages=19–22 |doi=10.1586/14760584.3.1.19 |pmid=14761240 |s2cid=36898414}}</ref> A 2006 review of the literature regarding vaccines and autism found "[t]he bulk of the evidence suggests no causal relationship between the MMR vaccine and autism."<ref>{{cite journal |last1=Doja |first1=A |last2=Roberts |first2=W |title=Immunizations and autism: a review of the literature |journal=Canadian Journal of Neurological Sciences |volume=33 |issue=4 |pages=341–6 |date=November 2006 |pmid=17168158 |doi=10.1017/s031716710000528x |doi-access=free}}</ref> A 2007 case study used the figure in Wakefield's 1999 letter to ''The Lancet'' alleging a temporal association between MMR vaccination and autism<ref name="Original">{{cite journal |journal=The Lancet |year=1999 |volume=354 |issue=9182 |pages=949–50 |title=MMR vaccination and autism |last1=Wakefield |first1=Andrew Jeremy |pmid=10489978 |pmc=56739 |doi=10.1016/S0140-6736(05)75696-8}}</ref> to illustrate how a graph can misrepresent its data, and gave advice to authors and publishers to avoid similar misrepresentations in the future.<ref>{{cite journal |journal=Drug Safety |year=2007 |volume=30 |issue=10 |pages=831–6 |title=A case study of a graphical misrepresentation: drawing the wrong conclusions about the measles, mumps and rubella virus vaccine |last1=Cox |first1=AR |last2=Kirkham |first2=H |pmid=17867721 |doi=10.2165/00002018-200730100-00002 |s2cid=24702919}}</ref> A 2007 review of independent studies performed after the publication of Wakefield ''et al.''{{'}}s original report found that the studies provided compelling evidence against the hypothesis that MMR is associated with autism.<ref>{{cite journal |journal=Clinical Pharmacology & Therapeutics |year=2007 |volume=82 |issue=6 |pages=756–9 |title=Vaccines and autism: evidence does not support a causal association |last1=DeStefano |first1=F |doi=10.1038/sj.clpt.6100407 |pmid=17928818|s2cid=12872702 }}</ref> A review of the work conducted in 2004 for UK court proceedings but not revealed until 2007 found that the [[Biology:Polymerase chain reaction|polymerase chain reaction]] analysis essential to the Wakefield ''et al.'' results was fatally flawed due to contamination, and that it could not have possibly detected the measles that it was supposed to have detected.<ref name="Fitzpatrick07" /> A 2009 review of studies on links between vaccines and autism discussed the MMR [[Medicine:Vaccine controversies|vaccine controversy]] as one of three main hypotheses that epidemiological and biological studies failed to support.<ref>{{cite journal |last1=Gerber |first1=JS |last2=Offit |first2=PA |title=Vaccines and autism: a tale of shifting hypotheses |journal=Clinical Infectious Diseases |volume=48 |issue=4 |pages=456–61 |year=2009 |pmid=19128068 |pmc=2908388 |doi=10.1086/596476}} See  [http://www.idsociety.org/Content.aspx?id=13336 IDSA lay summary] {{Webarchive|url=https://web.archive.org/web/20110812162028/http://www.idsociety.org/Content.aspx?id=13336 |date=12 August 2011 }}, 2009-01-30.</ref>

In 2012, the [[Cochrane Library]] published a review of dozens of scientific studies involving about 14,700,000 children, which found no credible evidence of an involvement of MMR with either autism or [[Medicine:Crohn's disease|Crohn's disease]]. The article was updated in 2020<ref name=":0" /> and again in 2021,<ref name="Cochrane2020" /> with the authors stating, "We have observed an improvement in the quality of the design and reporting of safety outcomes in MMR and MMRV in recent years both pre- and post-marketing."<ref name=":0" /> A June 2014 [[Meta-analysis|meta-analysis]] involving more than 1.25&nbsp;million children found "vaccinations are not associated with the development of autism or autism spectrum disorder. Furthermore, the components of the vaccines (thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder."<ref name="Taylor2014">{{cite journal |vauthors=Taylor LE, Swerdfeger AL, Eslick GD |title=Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies |journal=Vaccine |volume=32 |issue=29 |pages=3623–9 |date=June 2014 |pmid=24814559 |doi=10.1016/j.vaccine.2014.04.085}}</ref> In July 2014, a [[Systematic review|systematic review]] found "strong evidence that MMR vaccine is not associated with autism",<ref>{{cite journal |vauthors=Maglione MA, Das L, Raaen L, etal |title=Safety of vaccines used for routine immunization of U.S. children: a systematic review |journal=Pediatrics |volume=134 |issue=2 |pages=325–37 |date=August 2014 |pmid=25086160 |doi=10.1542/peds.2014-1079 |s2cid=514220 |url=https://cloudfront.escholarship.org/dist/prd/content/qt2f93s53t/qt2f93s53t.pdf |doi-access=free}}</ref> and in March 2019, a large-scale study conducted by Statens Serum Institut following over 650,000 children for over 10 years found no link between the vaccine and autism, even among children with autistic siblings.<ref>{{cite web |url=https://en.ssi.dk/news/news/2019/no-association-between-mmr-vaccine-and-autism |title=No Association between MMR Vaccine and Autism |date=4 March 2019}}</ref><ref name="annals.orgSSI">{{cite journal |url=https://annals.org/aim/article-abstract/2727726/measles-mumps-rubella-vaccination-autism-nationwide-cohort-study |title=Measles, Mumps, Rubella Vaccination and Autism |publisher=Annals of Internal Medicine / American College of Physicians |date=5 March 2019 |doi=10.7326/M18-2101 |access-date=7 March 2019 |quote=The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination|last1=Hviid |first1=Anders |last2=Hansen |first2=Jørgen Vinsløv |last3=Frisch |first3=Morten |last4=Melbye |first4=Mads |journal=Annals of Internal Medicine |volume=170 |issue=8 |pages=513–520 |pmid=30831578 |s2cid=73474920 }}</ref>

== Disease outbreaks ==
<!-- Image commented out pending modification: [[File:Measles incidence and vaccination England & Wales 1991-2007.png|thumb|Measles incidence (lower curve) and vaccination rates (upper curve) in England and Wales, 1991–2007.]]-->
After the controversy began, the MMR vaccination compliance dropped sharply in the United Kingdom, from 92% in 1996 to 84% in 2002. In some parts of London, it was as low as 61% in 2003, far below the rate needed to avoid an epidemic of measles.<ref>{{cite journal |journal=The Lancet |year=2003 |volume=362 |issue=9394 |pages=1498–9 |title=Separating inflammation from speculation in autism |last1=Murch |first1=S |doi=10.1016/S0140-6736(03)14699-5 |pmid=14602448 |s2cid=40071957}}</ref> By 2006 coverage for MMR in the UK at 24 months was 85%, lower than the about 94% coverage for other vaccines.<ref name="McIntyre">{{cite journal |last1=McIntyre |first1=P |last2=Leask |first2=J |title=Improving uptake of MMR vaccine |journal=The BMJ |volume=336 |issue=7647 |pages=729–30 |year=2008 |pmid=18309963 |pmc=2287215 |doi=10.1136/bmj.39503.508484.80 }}</ref>

After vaccination rates dropped, the incidence of two of the three diseases increased greatly in the UK. In 1998 there were 56 confirmed cases of measles in the UK; in 2006 there were 449 in the first five months of the year, with the first death since 1992; cases occurred in inadequately vaccinated children.<ref>{{cite journal |journal=The BMJ |year=2006 |volume=333 |issue=7574 |pages=890–5 |title=Measles in the United Kingdom: can we eradicate it by 2010? |last1=Asaria |first1=P |last2=MacMahon |first2=E |doi=10.1136/bmj.38989.445845.7C |pmid=17068034 |pmc=1626346}}</ref> Mumps cases began rising in 1999 after years of very few cases, and by 2005 the United Kingdom was in a mumps epidemic with almost 5000 notifications in the first month of 2005 alone.<ref>{{cite journal |journal=The BMJ |year=2005 |volume=330 |issue=7500 |pages=1132–5 |title=Mumps and the UK epidemic 2005 |vauthors=Gupta RK, Best J, MacMahon E |pmid=15891229 |doi=10.1136/bmj.330.7500.1132 |pmc=557899}}</ref> The age group affected was too old to have received the routine MMR immunisations around the time the paper by Wakefield ''et al.'' was published, and too young to have contracted natural mumps as a child, and thus to achieve a [[Medicine:Herd immunity|herd immunity]] effect. With the decline in mumps that followed the introduction of the MMR vaccine, these individuals had not been exposed to the disease, but still had no immunity, either natural or vaccine induced. Therefore, as immunisation rates declined following the controversy and the disease re-emerged, they were susceptible to infection.<ref>{{cite news |url=http://www.nzherald.co.nz/index.cfm?c_id=2&ObjectID=10125382 |title=England and Wales in grip of mumps epidemic |work=N Z Herald |date=13 May 2005 |access-date=10 July 2008 |archive-date=10 April 2005 |archive-url=https://web.archive.org/web/20050410142531/http://www.nzherald.co.nz/index.cfm?c_id=2 |url-status=dead }}</ref><ref>{{cite web |url=http://www.hpa.org.uk/infections/topics_az/mumps/gen_info.htm |title=Mumps |publisher=Health Protection Agency |access-date=10 July 2008 |url-status=dead |archive-url=https://web.archive.org/web/20070502002924/http://www.hpa.org.uk/infections/topics_az/mumps/gen_info.htm |archive-date=2 May 2007}}</ref> Measles and mumps cases continued in 2006, at incidence rates 13 and 37 times greater than respective 1998 levels.<ref>{{cite web |title=Confirmed cases of measles, mumps & rubella |publisher=Health Protection Agency |date=22 March 2007 |url=http://www.hpa.org.uk/infections/topics_az/measles/data_mmr_confirmed.htm |access-date=5 September 2007}}</ref> Two children who underwent [[Medicine:Kidney transplantation|kidney transplantation]] in London were severely and permanently injured by measles encephalitis.<ref name="Pepys" />

Disease outbreaks also caused casualties in nearby countries. Three deaths and 1,500 cases were reported in the Irish outbreak of 2000, which occurred as a direct result of decreased vaccination rates following the MMR scare.<ref name="Pepys">{{Cite journal |vauthors=Pepys MB |date=December 2007 |title=Science and serendipity |journal=Clinical Medicine |volume=7 |issue=6 |pages=562–78 |doi=10.7861/clinmedicine.7-6-562 |pmc=4954362 |pmid=18193704}}</ref>

In 2008, for the first time in 14 years, measles was declared [[Medicine:Endemic (epidemiology)|endemic]] in the UK, meaning that the disease was sustained within the population; this was caused by the preceding decade's low MMR vaccination rates, which created a population of susceptible children who could spread the disease.<ref name="Eurosurveillance">{{cite journal |journal=Eurosurveillance |year=2008 |author1=European Centre for Disease Prevention and Control (ECDC) – Surveillance and Communication Unit |volume=13 |issue=27 |page=18919 |title=Measles once again endemic in the United Kingdom |url=http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18919 |pmid=18761933}}</ref> MMR vaccination rates for English children were unchanged in 2007–08 from the year before, at too low a level to prevent serious measles outbreaks.<ref>{{cite news |url=http://news.bbc.co.uk/1/hi/health/7633115.stm |date=24 September 2008 |access-date=24 September 2008 |title=MMR vaccine uptake rise 'stalls' |work=BBC News}}</ref> In May 2008, a British 17-year-old with an underlying immunodeficiency died of measles. In 2008 Europe also faced a measles epidemic, including large outbreaks in Austria, Italy, and Switzerland.<ref name="Eurosurveillance" />

Following the January 2011 ''BMJ'' statements about Wakefield's fraud, Paul Offit, a pediatrician at Children's Hospital of Philadelphia and a "long-time critic of the dangers of the anti-vaccine movement", said, "that paper killed children",<ref name="Time">{{cite news |url=http://healthland.time.com/2011/01/06/study-linking-vaccines-to-autism-is-fraudulent/ |title=Study linking vaccines to autism is 'fraudulent' |magazine={{wipe|Time (magazine)}} |date=6 January 2011 |access-date=7 January 2011}}</ref><ref name="KilledChildrenCBS">{{cite news |url=http://www.cbsnews.com/stories/2011/01/06/eveningnews/main7220709.shtml |last1=Gupta |first1=Sanjay |date=6 January 2011 |title=Dr. Sanjay Gupta Confronts Autism Study Doctor |work=CBS Evening News |access-date=8 January 2011 |quote='Four children died from measles,' says Offit. 'Three died in Ireland, one died in England, died from a disease that was perfectly and safely prevented by a vaccine, died because of that paper. That paper killed four children.'}}</ref><ref>{{cite journal |vauthors=McBrien J, Murphy J, Gill D, Cronin M, O'Donovan C, Cafferkey MT |title=Measles outbreak in Dublin, 2000 |journal=The Pediatric Infectious Disease Journal |volume=22 |issue=7 |pages=580–4 |date=July 2003 |pmid=12867830 |doi=10.1097/00006454-200307000-00002}}</ref> and Michael Smith of the [[Organization:University of Louisville|University of Louisville]], an "infectious diseases expert who has studied the autism controversy's effect on immunization rates", said "clearly, the results of this (Wakefield) study have had repercussions."<ref name="APVaccineBooster">{{cite news |url=http://usatoday30.usatoday.com/yourlife/health/medical/2011-01-07-boost-vaccines_N.htm |date=7 January 2011 |title=Will autism fraud report be a vaccine booster? |agency=Associated Press |access-date=8 January 2011}}</ref><ref>{{cite journal |vauthors=Smith MJ, Ellenberg SS, Bell LM, Rubin DM |title=Media coverage of the measles-mumps-rubella vaccine and autism controversy and its relationship to MMR immunization rates in the United States |journal=Pediatrics |volume=121 |issue=4 |pages=e836–43 |date=April 2008 |pmid=18381512 |doi=10.1542/peds.2007-1760 |url=http://pediatrics.aappublications.org/cgi/content/full/121/4/e836 |citeseerx=10.1.1.317.3211 |s2cid=1448617}}</ref> In 2014, Laurie Garrett, senior fellow at the [[Organization:Council on Foreign Relations|Council on Foreign Relations]], blamed "Wakefieldism" for an increase in the number of unvaccinated children in countries such as Australia and New Zealand, saying, "Our data suggests that where Wakefield's message has caught on, measles follows."<ref>{{cite news |url=http://www.theaustralian.com.au/news/world/measles-map-exposes-global-fallout-of-an-autism-scare-campaign/story-fnb64oi6-1226828830190 |title=Measles map exposes global fallout of an autism scare campaign |work=The Australian |date=17 February 2014 |access-date=18 February 2014 |last1=Harlow |first1=John}}</ref>

=== Impact on society ===
The ''New England Journal of Medicine'' said that antivaccinationist activities resulted in a high cost to society, "including damage to individual and community well-being from outbreaks of previously controlled diseases, withdrawal of vaccine manufacturers from the market, compromising of national security (in the case of anthrax and smallpox vaccines), and lost productivity".<ref name="AgeOld" />

Costs to society from declining vaccination rates (in US dollars) were estimated by AOL's DailyFinance in 2011:<ref name="CostlyLie">{{cite news |url=http://www.dailyfinance.com/story/autism-vaccine-fraud-wakefield-cost-money-deaths/19793484/ |title=The Autism Vaccine Fraud: Dr. Wakefield's Costly Lie to Society |last1=Alazraki |first1=Molly |date=12 January 2011 |publisher=AOL Money and Finance: DailyFinance |access-date=13 January 2011 |archive-url=https://web.archive.org/web/20110115040538/http://www.dailyfinance.com/story/autism-vaccine-fraud-wakefield-cost-money-deaths/19793484/ |archive-date=15 January 2011 |via=[[Wayback Machine]]}}</ref>

* A 2002–2003 outbreak of measles in Italy, "which led to the hospitalizations of more than 5,000 people, had a combined estimated cost between 17.6 million euros and 22.0 million euros".
* A 2004 outbreak of measles from "an unvaccinated student return[ing] from India in 2004 to Iowa was $142,452".
* A 2006 outbreak of mumps in Chicago, "caused by poorly immunized employees, cost the institution $262,788, or $29,199 per mumps case".
* A 2007 outbreak of mumps in Nova Scotia cost $3,511 per case.
* A 2008 outbreak of measles in San Diego, California cost $177,000, or $10,376 per case.

In the United States, Jenny McCarthy blamed vaccinations for her son Evan's disorders and leveraged her celebrity status to warn parents of a link between vaccines and autism. Evan's disorder began with seizures and his improvement occurred after the seizures were treated, symptoms experts have noted are more consistent with [[Medicine:Landau–Kleffner syndrome|Landau–Kleffner syndrome]], often misdiagnosed as autism.<ref name="Greenfeld">{{cite news |last1=Greenfeld |first1=KT |url=http://www.time.com/time/nation/article/0,8599,1967796-1,00.html |title=The autism debate: who's afraid of Jenny McCarthy? |magazine={{wipe|Time (magazine)}} |date=25 February 2010 |archive-url=https://web.archive.org/web/20110805041329/http://www.time.com/time/magazine/article/0%2C9171%2C1968100%2C00.html |archive-date=5 August 2011 |url-status=dead }}</ref> After the ''Lancet'' article was discredited, McCarthy continued to defend Wakefield.<ref name="ParentsBelieve">{{cite news |url=http://www.huffingtonpost.com/jenny-mccarthy/vaccine-autism-debate_b_806857.html |last1=McCarthy |first1=Jenny |title=Jenny McCarthy: In the Vaccine-Autism Debate, What Can Parents Believe? |date=10 January 2011 |work=The Huffington Post |access-date=22 September 2013}}</ref> An article in Salon.com called McCarthy "a menace" for her continued position that vaccines are dangerous.<ref name="SalonMcCarthy">{{cite news |url=http://www.salon.com/life/feature/2011/01/06/jenny_mccarthy_autism_debate/ |last=Williams |first=Mary Elizabeth |title=Jenny McCarthy's autism fight grows more misguided |work=Salon |date=6 January 2011 |access-date=22 September 2013 }}</ref>

[[Biography:Bill Gates|Bill Gates]] has reacted strongly to Wakefield and the work of anti-vaccination groups:<ref name="Finnegan_3/18/2011">{{cite web |last=Finnegan |first=Gary |title=Bill Gates: Anti-vaccine myths 'kill children' |website=VaccinesToday |date=18 March 2011 |url=https://www.vaccinestoday.eu/stories/bill-gates-anti-vaccine-myths-kill-children/ |access-date=7 January 2018}}</ref>

{{blockquote|Dr. [Andrew] Wakefield has been shown to have used absolutely fraudulent data. He had a financial interest in some lawsuits, he created a fake paper, the journal allowed it to run. All the other studies were done, showed no connection whatsoever again and again and again. So it's an absolute lie that has killed thousands of kids. Because the mothers who heard that lie, many of them didn't have their kids take either pertussis or measles vaccine, and their children are dead today. And so the people who go and engage in those anti-vaccine efforts—you know, they, they kill children. It's a very sad thing, because these vaccines are important.}}

The proportion of children in England receiving the vaccine by the age of two fell to 91.2% in 2017–18, from 91.6% the year before. Only 87.2% of five-year-olds had received both MMR vaccines.<ref>{{cite news |title=Take-up of MMR vaccine falls for fourth year in a row in England |url=https://www.theguardian.com/society/2018/sep/18/take-up-mmr-vaccine-falls-fourth-year-in-a-row-england-measles |access-date=31 October 2018 |newspaper=The Guardian |date=18 September 2018}}</ref>

With the onset of a large number of measles outbreaks in the United States in 2019, there is fear that parents who have not had their children vaccinated will help to spread infectious diseases in schools and universities where there are already other outbreaks.<ref>{{cite web |url=https://www.latimes.com/local/lanow/la-me-ln-measles-outbreaks-los-angeles-colleges-20190423-story.html |title=Measles' next target in Los Angeles: Unvaccinated college students |first=Soumya |last=Karlamangla |date=23 April 2019 |access-date=24 April 2019 |work={{wipe|Los Angeles Times}}}}</ref>

== See also ==
* Autism rights movement
* ''[[Medicine:Autism's False Prophets|Autism's False Prophets]]''
* [[Unsolved:Controversies in autism|Controversies in autism]]
* [[Medicine:Epidemiology of autism|Epidemiology of autism]]
* Measles resurgence in the United States
* [[Biology:Vaccine shedding|Vaccine shedding]]

== References ==
{{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite news |url=https://www.pbs.org/wgbh/pages/frontline/vaccines/ |title=The Vaccine War |publisher=PBS |work=Frontline |date=27 April 2010 |access-date=28 December 2013}}
* {{cite web |last1=Willingham |first1=Emily |last2=Helft |first2=Laura |title=The Autism-Vaccine Myth with Timeline |url=http://www.pbs.org/wgbh/nova/body/autism-vaccine-myth.html |publisher=PBS NOVA |date=5 September 2014}}
* {{cite web |url=http://www.webmd.com/brain/autism/news/20110105/bmj-wakefield-autism-faq?print=true |title=Autism/MMR Vaccine Study Faked: FAQ |last1=DeNoon |first1=Daniel J |publisher=WebMD Health News |date=6 January 2011 |access-date=27 December 2013}}
* {{cite news |url=http://news.bbc.co.uk/2/hi/health/1808956.stm |title=MMR research timeline |work=BBC News |date=4 February 2008 |access-date=27 December 2013}}
* Deer, Brian (2020) "''The Doctor Who Fooled the World''", Johns Hopkins University Press, {{ISBN|978-1421438009}}
{{refend}}

{{Vaccines}}
{{Pervasive developmental disorders}}

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[[Category:Autism pseudoscience]]
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[[Category:Academic scandals]]
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{{Sourceattribution|MMR vaccine and autism}}