Deciding whether or not to vaccinate your child can be one of the hardest decisions for one to make as a parent. It is for this reason that physicians must understand the critical roles they fulfill as informants and experts in the medical field to aid parents and caregivers in the decision-making process. The case of Dr. Andrew Wakefield, though a rather unfortunate one, has had a profound impact on solidifying the importance of delivering accurate medical knowledge to establish a trusting relationship between parent and provider in the context of healthcare. In his article published in The Lancet, Wakefield asserts that the developmental/behavioral dysfunctions observed in conjunction with the gastrointestinal disorders diagnosed in his specified population may have implications in the presentation of Autism as a result of receiving the MMR vaccine. While subsequent research efforts continuously refute this claim, there is much to be said about the strength of this research design and the ethical nature of this case.
The Claim
As previously suggested, Wakefield’s basis for providing evidence of the potential relationship between Autism and the MMR vaccine lies in a relatively small sample size of 12 pediatric patients, all of whom present with gastrointestinal symptoms and behavioral abnormalities. With that said, the validity of Wakefield’s claims immediately comes into question, given that the sample size is too small to be generalizable to the population at large. The work of other researchers in the field have proven the lack of validity within Wakefield’s research design, as described in a literature review of Immunizations and Autism. In this review, several researchers such as Madsen et al, who concluded that the risk of developing Autism is constant in vaccinated and unvaccinated populations of children, and Kaye et al, who observed an increase in the incidence of Autism despite a constant rate of MMR vaccinations, contributes to the body of literature that refutes Wakefield’s claims. In many of the studies discussed in the review, the populations examined were significantly larger and more diverse than the population studied by Wakefield, which further indicates a lack of strength in Wakefield’s study design. However, not only does this review provide further evidence of the disconnect between Autism and the MMR vaccine, but it also speaks to Wakefield’s motives for publishing his article. This arouses an ethical concern. According to the review, Wakefield was offered financial compensation for assisting the participants initially involved in his study with a lawsuit against vaccine manufacturer’s, which could signify an ulterior motive. Nonetheless, his assertions undoubtedly continue to influence the general public’s perceptions of vaccinations and contribute to the skepticism among many parents in regards to immunization safety.
Global Skepticism
Immunization safety, however, is a global concern that may be contributing to the resurgence of diseases that were once almost eradicated. Given data on the global immunization profile provided by the World Health Organization, it can be determined that a global increase in the number of reported cases of measles, mumps, and rubella has been observed in recent years. This may be due, in part, to the relatively constant vaccination rates observed over the same time period, despite the fact that the global population has grown significantly. By this theory, the number of unvaccinated individuals is continuing to rise, which increases the risk of susceptibility to infection among individuals and thus, the population. A variety of factors must be considered when trying to explain various vaccination patterns worldwide. As suggested by an article that describes several demographics, accessibility and affordability are critical factors to assess when trying to improve vaccination rates worldwide. However, as previously mentioned, the level of trust that caregivers have in their providers is also playing a critical role in the observed pattern of behaviors internationally. The article also suggests that countries that have lower levels of trust in their provider also have higher reported rates of strongly disagreeing with the idea that vaccines are effective.
The Solution
It has become clear that finding a solution to stabilize the trends in high vaccination rates against deadly diseases worldwide is a necessity. This stability must start with healthcare professionals who are responsible for disseminating accurate knowledge about vaccines to the general public in order to ensure an effective approach is being taken to eradicate disease. This stability continues with the support of the individuals in the population to protect not just themselves and their children, but the lives of those around them as well.
Marvelous Microogranisms 