The measles outbreak in South Wales is the largest in a decade and over 800 children are affected. Public health officials are warning that this childhood disease can be life-threatening with complications including pneumonia and long term damage to the nervous system. The public health response has been rapid and involves ‘every health board in Wales’. Anxious parents can consult the NHS Wales website. To counteract the further spread of the disease a number of drop-in immunisation clinics have been set up. But from the very start of this health crisis the part played by the media has been questioned.
The most recent challenge to the role of the media in the MMR ‘controversy’ followed the decision by the Independent on Sunday to feature the views of Andrew Wakefield, whose flawed research sparked the original MMR controversy in 1998. Questions were raised about whether a ‘quality’ publication should have awarded the spotlight to Wakefield when the Lancet had retracted his original research paper and he had been struck off by the GMC for bringing “the medical profession into disrepute” .
Wakefield’s argument was that the current measles outbreak was the fault of the UK Government who had preserved their immunisation programme rather than children’s lives. Many argued the story should not have run at all. The New Statesman described it as “lunacy”, whilst the Telegraph stated that ‘The Independent should be ashamed of itself’. Ben Goldacre engaged in a testy argument with the Independent’s medical correspondent. In answering Goldacre’s critique, Jeremy Laurance pleaded that he had clearly critiqued Wakefield’s case point by point and that his article should be read in full.
This controversy and the crisis in South Wales speak to wider debates about differences in lay and scientific perceptions of risk and ethics in public health. It also raises important questions about science communication in the media. The outbreak is presented as the legacy of publicity given to the (discredited) Wakefield study of 1998 linking MMR to autism. Media reporting of the original Wakefield case is believed to have played a significant part in fuelling parental fears. Indeed Fiona Fox, Head of the Science Media Centre, has spoken about how this marked a watershed in science reporting:
As it happens I think things have already changed because of MMR – especially in the media. I have been in rooms when editors admitted they called it wrong on MMR and claimed that they defer to their specialist science and health reporters more because of the fallout from that story. It’s also the case that one of the reasons MMR comes up so often in every discussion about science in the media is that there are no more recent examples with quite the same wide-reaching impact. The fact that a scare story that broke 13 years ago is still being discussed suggests that to some extent, all of us are doing things differently. I would certainly like to think that the presence of the Science Media Centre now means that the scientific community engages more effectively and more swiftly when extraordinary claims are made on weak evidence.
There has been talk of compulsory vaccination. David Salisbury, Director of Immunisation at the UK Department of Health argues that vaccination coverage can be increased by improving immunisation services – but he argues that, even after the MMR scare, compulsory vaccination “was never considered” and “would probably have made matters much worse.” This is clearly an area riven with some ethical complexity.
But where do the public feature in this debate? The decision to immunise appears straightforward to medical professionals but clearly causes considerable anxiety for some parents. Measures to counteract this need to extend beyond simple arguments about ‘improving immunisation services’. I conducted a study of orthodox Jewish mothers in London to explore the assumption that poor access to immunisation services was the main reason for low uptake of childhood vaccinations. With very large families, often of 9 or more children, it seemed reasonable that it might be difficult to take children to health clinics and that staff at those clinics might lack cultural sensitivity – i.e. that reasons for low rates of immunisation would not be related to mainstream media debates. Members of this community maintained distinct boundaries with outsiders. Unlike the wider population, orthodox Jewish mothers were assumed to be relatively insulated from direct media influence. However many of the mothers I spoke to were just as concerned about the risks of vaccination. As one said,
This [child] hasn’t had the MMR yet, because of all the scares. The other two [children] had everything”.
I’m hearing so many different things about [the MMR] that I just don’t know…there’s so much about autism and all these horrible things and measles, mumps and rubella aren’t really deathly [sic] diseases. I’m kind of leaning towards not doing it.
In this community social networks were an important source of rumours circulating of adverse reactions to vaccinations. The origins of these rumours were media scares and they were transmitted easily throughout the community regardless of physical proximity. Social networks have an important role to play in creating a culture in which it is ‘normal’ to immunise. The media and specialist health and science correspondents in particular have been blamed for fuelling the 1998 MMR crisis but we know that media can play an equally powerful role in modifying health related behaviour in positive ways. US prime time drama has tackled the topic of immunisation through prosocial storylines. In detective series Law and Order a two year old child is found to have died from encephalitis after she contracts measles from a boy who was not immunised. Producer and paediatrician, Neal Baer explained, “[the story] raised this really interesting question about not only what is your responsibility to your own child but to the community of children. It made the show more complex than ‘I know what’s best for my child’.
Surely the current situation in South Wales could have been predicted and a strategy developed to counteract this ‘legacy’ of misinformation? Perhaps a health communications campaign that addresses wider societal values such as the impact of our actions on a ‘community of children’ rather than emphasising individual choice would be more effective in persuading parents to vaccinate despite their fears.