America’s public health enemy No 1

Published by The Mail on Sunday (1st October, 2017)

When Patsy Stinchfield was a young nurse practitioner three decades ago, her home town in the US Midwest was hit by a measles epidemic. She remembers seeing sick children, fearful families and tragic fatalities on the wards of her own hospital.

Watching those children die in a rich nation from an epidemic that was easily preventable changed the course of her career. Today she runs infection prevention services at a major children’s hospital and serves on government advisory boards.

Yet once again she has found herself fighting a measles outbreak in her home state of Minnesota. Once again, she has seen panic on faces of parents as they admit sons and daughters with a disease that can kill, damage or disable.

And once again, she knows this would not be happening if young children were being given a cheap and simple vaccination. Yet she is not only fighting a deadly disease. She is also up against a disgraced British doctor who has been declared Public Health Enemy No 1 in the US for spreading damaging and widely debunked theories.

Andrew Wakefield is a former London specialist sacked on ethical grounds after linking the measles, mumps and rubella (MMR) vaccine to autism. Now he leads a lucrative movement campaigning against childhood inoculations.

These jabs have led to huge improvements in health and life expectancy around the world – yet Wakefield’s fanatical followers accuse governments, doctors, drug firms and scientists of colluding in a giant global conspiracy to cover up risks.

And they are growing in strength, their bogus claims inflamed by the US President who backs their anti-establishment stance and has personally endorsed the reviled ex-doctor. Wakefield was even at Donald Trump’s inauguration ball earlier this year.

Yet if immunisation levels drop below critical levels, dangers of these highly contagious diseases grow – as seen in several countries across Europe, where there have been 35 deaths from measles over the past year.

Last week the World Health Organisation revealed that measles has been eliminated in Britain. This is a major advance. In 1967, before the vaccine arrived, there were 460,000 cases and 99 deaths. But the US outbreak is a warning about the frailty of such success – for the illness was declared eliminated there in 2000 and across all the Americas last year.

Minnesota shows the dangers posed by the anti-vaccination movement, especially since critics suggest Wakefield played a part by holding secret meetings there.

‘I know measles takes lives because I have seen it,’ says Stinchfield, senior director of infection control at Children’s Minnesota hospital.

This outbreak emerged in early April among a Somali-American community that arrived in the state after civil war erupted in their own nation at start of the 1990s.

Measles used to be the biggest killer of children aged under five in Africa – and with 10,000 deaths a year in Somalia, the migrants knew all too well the dangers of the disease. So by turn of the century the community in Minnesota had the highest vaccination rates in the state.

But over the subsequent decade, immunisation rates suddenly began to slide – from 92 per cent of this population in 2004 to just 42 per cent by 2014. ‘Clinicians would call me and ask what was going on,’ recalls Stinchfield. ‘Why are they not having MMR when they are getting all their other vaccines?’

The reason soon emerged: fear of autism, a condition that does not have a specific name in the Somali language. ‘I had never even heard of it although I come from a medical family,’ says Anab Gulaid, a Somali-American health researcher.

The number of children being diagnosed on the autistic spectrum is rising rapidly in the West – and the condition often becomes evident around the age that they have their first MMR injection.

The 25,000-strong Somali community feared it was being struck by a Western affliction. ‘We did not know of autism before,’ says Mariam, a mother of four. ‘Many families stopped giving their children MMR.’

They had stumbled upon Wakefield’s discredited claims, which were being fuelled online by alarmed parents of autistic children, alternative practitioners and conspiracy theorists. ‘They were mentioning him by name,’ says Stinchfield. ‘They were even saying their parents back in Somalia were telling them not to have the triple MMR jab in the United States because your child will get autism.’

Wakefield was a gastroenterologist at the Royal Free Hospital in Hampstead, North London, when he raised concerns in 1998 over the safety of the MMR vaccine, based on his report – looking at just 12 cases – in the medical journal The Lancet. The report, suggesting a link through a bowel disorder with autism, was later retracted as ‘utterly false’ by the journal.

The General Medical Council revoked Wakefield’s medical licence in 2010, ruling his conduct ‘dishonest and irresponsible’. And the British Medical Journal concluded his work was fraudulent with data manipulated.

But Wakefield had moved to Texas. A populist movement was taking off in the US that heralded him as a martyr being hounded by the mainstream medical establishment. Hollywood stars including Robert De Niro and Jim Carrey have joined the anti-vaccine cause. One public health expert has estimated that one in three North American parents now has concerns.

So when the Somali community in Minnesota grew alarmed over autism, local anti-vaccination campaigners fanned their fears by inviting the charismatic Wakefield to visit them at least three times in 2010 and 2011.  At least one of the meetings was held in Safari, a well-known Somali restaurant. A state public health official attempted to attend but claimed she was prevented from entering the room by a guard armed with a gun.

‘It was an easy sell for Wakefield,’ says Gulaid. ‘He came because the parents were concerned about their children’s development, then hid behind closed doors from people who care about things such as data and ethics.’

MMR inoculation rates are now higher in Somalia than among these Somali migrants in Minnesota. The result was inevitable: a measles outbreak, the state’s biggest for almost three decades, that saw 79 cases, 22 people admitted to hospital and 8,800 people exposed.

Among those who listened to warnings against MMR was Suaado Salah, despite her own sister dying from measles in Somalia before her fifth birthday. ‘I thought, “I’m in America, in a safe place and my kids will never get sick with that disease,” ’ she says.

Both her children contracted measles, with her 18-month-old daughter so feverish that she ended up in hospital for four nights.

State authorities responded with an unprecedented public health collaboration between clinicians, officials and community leaders, including imams, urging families to protect their children.

Some 600 children were excluded from mixing with others for the 21-day infection period. There were no deaths, fortunately, and the state has declared the four-month outbreak over, at a cost of millions.

Yet this localised epidemic shows with clarity the potentially lethal impact of the anti-vaccination movement, which feeds into the current climate of mistrust against experts and is inflamed by fanatics on internet echo chambers.

‘This is all down to Andrew Wakefield,’ says Professor Michael Osterholm, director of the Center for Infectious Disease Research and Policy. ‘He is taking advantage of the underlying mood of distrust of science and authority. ’

This has proved lucrative for Wakefield, who lives in a large house in Austin, and has been involved in several non-profit groups. One spent more than 40 per cent of donations on his salary, handing him more than $300,000 (£225,000) over five years.

A Minnesota source told me he had been paid $10,000 for a single appearance in the state – although Wakefield denied this to friends. One said that he gets ‘perhaps $1,000 maximum’ for his talks.

It is worth noting that among the ethical violations leading to his ban on practising medicine was mishandling of funds and failure to disclose conflicts of interest.

Certainly this medical pariah has done well enough, according to a close source, to hand $50,000 to Donald Trump for his presidential campaign. Trump has tweeted on several occasions about ‘doctor-inflicted autism’, raised the issues during one presidential debate, and spent 45 minutes talking about the issue with Wakefield and other leading vaccination sceptics last summer.

Jennifer Larson, the chief executive of a Minnesota autism clinic who was at this meeting, later wrote that Trump was ‘extremely educated on our issues’. Wakefield also gave Trump a copy of Vaxxed, his film alleging that vaccines cause autism and claiming that the US Government is covering up data to prove his case. De Niro, whose son is autistic, has defended the movie.

Wakefield is parading his martyrdom in a new documentary about his life called Pathological Optimist, released last week in the US. So on the same day Minnesota celebrated the end of its measles outbreak, some 40 mothers, fathers and children clustered around his business partner Polly Tommey after she pulled up in the Vaxxed campaign bus in a Minneapolis park.

Tommey is the British mother of an autistic son and is convinced the MMR injection caused his condition. ‘Vaccines are one of the biggest lies ever perpetuated,’ she insists. When I asked about so much scientific evidence disproving their case, she replied: ‘B******s. I used to believe in science but it is so corrupt. It has been bought by the pharmaceutical companies.’

No child ended up dead in the Minnesota outbreak but it shows starkly the risks of not vaccinating children. And thanks to a discredited British doctor, his fanatical followers and their fan in the White House, the dangers are growing daily.

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