March of the MMR charlatan

Published by The Mail on Sunday (22nd July, 2018)

With its long sweep of beautiful sandy beaches, shady parks filled with picnicking families and swanky clubs for the party crowd, Rimini is firmly established as one of the favourite Italian destinations for British holidaymakers.

As the summer season shifted into full swing, bronzed tourists sprawled on lines of sun loungers before hitting the bars and trattorias as dusk fell over the country’s biggest Adriatic resort.

But few of the holidaymakers thronging packed piazzas last week realised this friendly town, with its Roman ruins and Renaissance cathedral, stands at the centre of growing concerns over the world’s most infectious disease.

For Rimini is the stronghold of a populist revolt against vaccinations that is seeing measles – a deadly disease that should have been consigned to history in wealthy nations – surge across both Italy and Europe.

Cases quadrupled on the Continent last year, with a spike in Italy making it the fifth worst place for measles worldwide. The number of European incidents will soon surpass the total for the whole of 2017.

In England there have been three times as many cases already this year than were confirmed for all of last year – with several clusters sparked by infected people returning from trips to countries such as Italy before symptoms become apparent.

Last week, health authorities in London and Rome issued a joint plea for travellers to be aware of the risks, saying measles ‘can cause severe complications including encephalitis, pneumonia and even death’.

Behind the fears, the fatalities and the misery for families struck by measles lies the frighteningly influential figure of a disgraced British doctor spreading damaging and widely debunked theories.

Andrew Wakefield is a former London specialist who was sacked and struck off for ‘dishonest and irresponsible’ conduct after linking the measles, mumps and rubella (MMR) vaccine to autism. Yet after decamping to the United States with his credibility shredded, Wakefield’s cause was adopted by Hollywood stars, promoted by online conspiracy theorists and picked up by populist politicians.

His powerful supporters include Donald Trump, whose inauguration ball Wakefield attended, while leaders of two populist parties in Italy exploited his claims to win an election earlier this year. Now, to cap his astonishing resurgence, it has emerged that Wakefield – a divorced father of four – has landed a supermodel girlfriend in Elle ‘The Body’ Macpherson.

This is, bear in a mind, a man vilified across the medical world.

Last year I visited Minnesota after he was blamed for a measles epidemic and branded Public Health Enemy No 1 in a nation that had declared the disease wiped out in 2000. Now he is seen as primary cause of the crisis across Europe.

‘He’s a crook and the worst possible enemy of ethical healthcare,’ said Walter Ricciardi, president of Italy’s National Health Institute. ‘It’s incredible he is still around – just disgraceful.’

Professor Ricciardi’s group joined Public Health England to warn travellers to check their vaccinations, revealing seven measles cases had been carried from Italy to the UK since start of last year. A 33-year-old woman from London also ended up in a Rome hospital six weeks ago after contracting the disease.

‘Measles associated with travel is a major problem because it is so infectious,’ said Mary Ramsay, PHE head of immunisation. ‘Studies have shown you can get it even going into a room after someone infected has left.’

Yet Wakefield heads a global movement fighting enforced childhood inoculations. These jabs tackle diseases that once killed, maimed and infected vast numbers – yet his fanatical followers believe a massive conspiracy is covering up their risks.

Nowhere demonstrates the dangers more than Italy, which also highlights how this corrosive issue feeds into populist political discourse with its distrust of expertise by playing on parental fears over the safety of their children.

Last year Italy had more than 5,000 confirmed cases of measles, according to the World Health Organisation (WHO). There were another 1,716 cases in the first five months of this year – more than half in the holiday hotspot of Sicily – with four deaths. They include a six-year-old boy with leukaemia, who died last month in Monza after catching measles from unvaccinated siblings; a ten-month-old boy in Catania whose mother was not vaccinated; and a 25-year-old unvaccinated mother, also in Sicily.

The WHO recommends 95 per cent of a region’s population should be inoculated for ‘herd immunity’, ensuring sufficient protection against epidemics. But in parts of Sicily the numbers have dropped below 80 per cent.

Similar levels have been seen in Rimini, the heartland of Italy’s ‘anti-vax’ movement since Comilva, a national campaign group, was launched there 25 years ago.

Originally they voiced general concerns over vaccinations. But their cause exploded in 2012 after a court in the city awarded compensation to the family of an autistic child on the grounds the condition had probably been caused by the MMR injection.

This official endorsement of Wakefield’s discredited research – which the British Medical Journal disclosed was fraudulent with data manipulated – was thrown out on appeal three years later. But the damage was done.

‘Before this only a few Italians knew the Wakefield story,’ said Andrea Grignolio, a medicine historian at Rome’s La Sapienza University in Rome. ‘After this case appeared, a lot of Italians saw there were claims of a relationship between MMR and autism.’

Wakefield was a gastroenterologist at a North London hospital in 1998 when he raised issues over the safety of MMR vaccine. This was based on work – looking at just 12 cases – published in The Lancet, which suggested a link through a bowel disorder with autism and was later retracted as ‘utterly false’ by the journal.

Comilva insists it just wants to warn parents about vaccination risks, calling on the government to hold an investigation of Wakefield’s claims. Two prominent Italian doctors supporting its cause have been struck off recently.

Claudio Simion, the group’s president, said Wakefield should not be condemned, especially as incidence of autism rises. ‘I see him as a researcher who raised an important question: is MMR the right choice to immunise against measles?’

The shamed doctor even visited the region two years ago to promote his views and a self-aggrandising film he directed called Vaxxed. His cause was fanned by two anti-establishment parties – Five Star Movement, founded by comedian Beppe Grillo, and the hard-right League. They used to be on the fringe but now these populists run a coalition government.

Grillo has even claimed vaccines can carry risks as severe as the diseases they protect against, while three years ago his party proposed a law against them, pointing to supposed links with cancer, autism and allergies.

League leader Matteo Salvini, the deputy premier and anti-migration hardliner seen as Italy’s most powerful politician, claimed in May that making children have a barrage of jabs was ‘useless, and in many cases dangerous, if not harmful’.

Both parties are focusing on a law introduced last year forcing children to have official certification of ten vaccines before being allowed to enrol in state schools. It came as Germany and France also cracked down on non-compliant parents.

They have already proposed self-certification. And I understand two leading figures – one from each party – plan to introduce a bill to parliament overturning a measure credited with instantly lifting vaccination levels.

They insist it is a matter of personal freedom. ‘We are not against vaccines,’ said Five Star’s Raffaella Sensoli, a Rimini MP who was cradling her baby son when we met. ‘But I have followed this closely and they should not be obligatory.’

She said medical experts could advise but politicians had to decide what was best for citizens. ‘Many parents have doubts and if you oblige them to vaccinate their children then you are putting petrol on the fire of these doubts.’

This is the extraordinary legacy of Wakefield’s discredited research after 20 years, with fearful parents and the resurgence in rich nations of a disease that killed 2.6 million people annually before these vaccines were introduced in 1963.

Most measles cases in countries such as Italy and the UK are people who have not been inoculated. British vaccination rates crashed below 80 per cent after the Wakefield furore – a generation that is now heading off alone on holidays.

‘This is a big problem if children grow up without vaccinations, since they are susceptible to serious diseases,’ said Roberto Burioni, a professor of virology in Milan. ‘It is not just measles but polio and diphtheria.

‘We are in danger of seeing diseases return that we have not seen in our countries for many years. It is an emergency.’

Professor Burioni became active online debunking conspiracy theories from anti-vaccination fanatics, which led to death threats. One Facebook page even organised ‘measles parties’ to infect children so they had natural immunity.

Alice Pignatti, a graphic designer from near Rimini who started a group posting information to counter false claims, has also suffered abuse and attempts to destroy her reputation.

One doctor told Mrs Pignatti the climate had become so hostile that parents were terrified of getting children vaccinated. ‘He said they felt like they were sending their children to Iraq since the risks were so high,’ she told me.

Yet thousands of miles away across the Atlantic, the defiant doctor who fostered such fear hangs out with celebrities, presidents and now one of the world’s most famous models – despite being drummed out of his profession in ignominy.

He is hailed by fans as a martyr hounded by the medical establishment. Hollywood stars including Robert de Niro, Jim Carrey and Jenny McCarthy have backed the anti-vaccination cause, leaving a third of Americans with concerns.

Perhaps they should remember the words of author Roald Dahl, whose daughter Olivia died aged seven from inflammation of the brain caused by measles. He dedicated The BFG to her memory.

‘In an hour, she was unconscious. In 12 hours, she was dead. There was nothing the doctors could do to save her,’ he wrote later.

In 1962 there was no reliable measles vaccine to protect children. Today there is – but thanks to this disgraced doctor, aided by the advent of social media, angry activists and foolish politicians, many parents in places such as Rimini choose instead to flirt with the deadly disease.

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