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Skip to 0 minutes and 3 seconds Hi, my name is Andy Williams, and I work at the School of Journalism in Cardiff University, where I do research about health and science in the news media. I’m going to tell you about a notorious case study in health communication. It’s all to do with how the news media in the UK reported supposed health risks about the measles, mumps, and rubella vaccine, or MMR, for short. It’s about how a small group of people with little or no evidence to back up their claims were able to generate a media health scare, which led lots of people in the UK to believe that if they vaccinated their kids with the MMR jab, they were at greater risk of getting autism.

Skip to 0 minutes and 51 seconds Now, autism is an as yet incurable brain disorder. It’s normally diagnosed in young childhood. Nobody knows what causes it. And it can be incredibly distressing and difficult for parents and their families to live with. The condition can be more or less extreme in its symptoms, and it affects millions of people worldwide. And it can mean that people have difficulty forming relationships, communicating with others, using language, and dealing with abstract concepts. So, when a scientist suggests that they’d found the cause, and it’s something as common as a vaccine like MMR that’s given to all children, this is a really big deal. The problem was that the scientists who made the claims did not have the scientific evidence to back them up.

Skip to 1 minute and 38 seconds And the news media who reported these claims did not scrutinise them enough and ended up lending credence to bad science. Lots of people ended up not vaccinating their children because of all the media hype around MMR, which led to another problem. Measles, mumps, and rubella, also known as German measles, are all very nasty illnesses. Measles can lead to blindness and death in some cases. Mumps is very unpleasant in itself, but it’s also linked to meningitis and pancreatitis. And rubella can be very damaging to unborn babies if it’s contracted by a woman who’s pregnant.

Skip to 2 minutes and 16 seconds Because of the way the science was communicated by the scientists involved in this MMR research, and because of the way it was reported by the national news media, there were lots of problems that arose out of this case study. First of all, though, I want to give you some context. How did this science become the centre of such a national controversy? So, in 1988 the MMR-combined vaccine was introduced in the UK. Initially a very high uptake, there was no public resistance. In 1996 the UK introduces a second booster MMR jab to increase protection against measles, specifically. It just worked better with a second jab. 1988 to 1997, immunisation levels remained high.

Skip to 3 minutes and 3 seconds But 1998, gastroenterologist Andrew Wakefield from London’s Royal Free hospital, claimed to have found a link between autism and measles in a paper in the Lancet medical journal, a very prestigious medical journal. This paper claims no link between the vaccine and autism. In fact, it explicitly states there’s no association between these two things. But in the press conference, where he and his colleagues launch the research, he claimed that MMR could be a factor in getting autism. Now this was a really big claim, but it was made without having the proper peer-reviewed evidence to back it up. It wasn’t in the journal paper.

Skip to 3 minutes and 46 seconds The fact that when he made these claims Wakefield’s co-authors started to distance themselves from him should’ve sent alarm bells ringing with the sceptical journalists who were covering this. But it didn’t. The fact that claims were made in the public relations material and not in the peer-reviewed, quality-controlled, scientific paper should also have sent alarm bells ringing. But it didn’t. So between 1998 and 2003, after this research was first talked about in public, initially the UK news media was pretty low key and measured in its coverage. It was pretty descriptive. But the new stories became increasingly alarmist as Wakefield continued to claim a link between the jab and autism.

Skip to 4 minutes and 31 seconds MMR immunisation levels fell year on year to a low of just over 80%, much lower in some local areas, especially in London. All of this meant that herd immunity, the proportion of immunised children needed to make the vaccine effective for everyone, was affected. The way that herd immunity works is that if enough parents decide not to vaccinate their children, even the kids who’ve had the vaccine will be put at risk. And it’ll become less effective as fewer people are vaccinated. Now I want to look a little bit more closely at the science. Much of the media scare coverage of MMR referred to a now totally discredited study published by Wakefield in the highly prestigious Lancet medical journal.

Skip to 5 minutes and 19 seconds Even if the study had been well conducted, which we now know it wasn’t, it was actually a case control study with just 12 children. Because of the kind of study it is, it could never have justified the claim that MMR causes autism. Because it just didn’t have enough participants, and because the study like this, a case control study is generally exploratory and can’t really be used to determine cause and effect like this. The media should have checked it much more scrupulously. They should have stopped reporting about it when they realised there was no proof for these claims. But again, it gets worse. The Lancet article actually admits it didn’t find evidence for a link between MMR, the vaccine, and autism.

Skip to 5 minutes and 58 seconds Now I’m not a scientist but these words from Wakefield’s scientific journal are very clear. We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. And Wakefield makes these claims about the supposed health risks of the vaccine in his PR statements, his public relations statements, in his interviews with journalists and sympathetic media outlets. This kind of science by press release should have been checked much more against this peer-reviewed evidence and what it actually showed. But not enough reporters did that. So the news media are in large part responsible for inaccurate and sensationalist coverage, because they didn’t check their facts properly. They didn’t get accurate facts in the news that they were reporting.

Skip to 6 minutes and 40 seconds But in a rare piece of good news for journalism in this story, it was actually down to a tenacious and rigorous investigative reporter, Brian Deer, that the full picture of Dr. Wakefield’s malpractice actually emerged. And you can check out his full MMR coverage at BrianDeer.com which is his website. Really, really excellent. Very, very well worth reading through. Let’s look a little bit now at the media coverage. On the left side of this slide, we’ve got a very small selection of headlines that appeared in the spring of the year 2000. You can see how different papers reported the developing story in pretty alarmist ways.

Skip to 7 minutes and 23 seconds It wasn’t until 2002 that the health scare really reached its peak, though, and the majority of stories started to focus on the risks associated with MMR. Now some coverage, as you can see from those headlines, suggested that the job is linked to autism. Some were claiming it’s safe. Some papers even ran contradictory stories. So if you look at the Independent’s headlines, you’ll see that they ran stories claiming MMR was safe one week and followed up the next week with another story saying it is linked to autism. So some of these outlets like the Daily Mail actively backed Andrew Wakefield.

Skip to 7 minutes and 56 seconds They campaigned for a ban on MMR in favour of single vaccines, single vaccines for measles, for mumps, and for rubella instead of the combined triple vaccine. Others tended to report the government and public health authorities more prominently. These people, the government, the public health experts, they were all arguing that the jab was safe, and they had the evidence and the facts on their side. But overall their perspectives were quoted less often, less prominently in the news media than the anti-vaccination spokespeople. Almost eight out of 10 stories mentioned the risk of autism. Only four out of 10 mentioned the fact that the vaccine is actually safe, and that there’s loads of proof for that.

Skip to 8 minutes and 38 seconds So even though there was no reliable evidence to suggest MMR caused autism, these claims got much more coverage than the truth essentially. This was very confusing for news audiences. If you’re a parent of a young child due for its MMR jab, you saw all of this negative coverage. Imagine how you might act. Lots of us, most of us, I’d say, don’t have the knowledge, don’t have the expertise, to be able to sceptically read the news all the time seeking out this kind of evidence at source. So this kind of news media coverage, can have a really, really important and negative effect. But I’m getting ahead of myself when I assume that the media scare coverage caused vaccination rates to drop.

Skip to 9 minutes and 23 seconds Now this course, in part, is teaching you to be sceptical of claims like this, that the media coverage caused the vaccine uptake to drop. People like me with letters after my name, claiming to know the score, well as any statistician will tell you, a correlation does not imply a causation. Just because two things happened at the same time, like sensationalist media coverage overlapping with sharp drops in vaccination rates, this doesn’t prove that one caused the other. How can I be so sure that the news media played a role in this public health problem?

Skip to 9 minutes and 59 seconds Well, in this case, researchers did a number of things which even though they don’t prove a direct link, do give us lots of indications about the importance of news coverage in all of this. And one indication is found when you look at how global this scare was. A good indicator of whether a health scare is real, whether it’s founded in fact, is whether it crosses international borders. If journalists and media systems across the world are reporting a health risk, it’s fairly likely to be real. On the other hand, if a media scare story is restricted to just one country, then that’s an indication the evidence behind it might be not so strong. Let’s look at these two graphs.

Skip to 10 minutes and 39 seconds The first graph on the left shows that in the UK, as the inaccurate news media coverage of MMR increased, the number of parents vaccinating their children drops sharply. So the line graph maps the rise and fall in media coverage. The bar graph shows you the number of people immunised with the MMR jab every year. But if you compare the UK data with the equivalent figures from the USA, there’s no media scare about MMR in the USA. You see very little media coverage and relatively stable rates of vaccination. Further evidence of media responsibility for this drop off in vaccination rates can be found in audience research that was done.

Skip to 11 minutes and 22 seconds So for instance, researchers at Cardiff University in the journalism school where I work carried out a nationally representative survey and found that almost 70% of people were aware of Wakefield’s claims. So this was very widely known about in the UK. And they then carried out a series of focus groups, in depth interviews with groups of people, to find out where the public got this knowledge from. And they found that the people overwhelmingly picked up on this issue from the news coverage. They also found that when given the full facts and told that Wakefield’s science wasn’t credible, they were angry and confused about why the news media would have reported the subject so badly, so inaccurately.

Skip to 12 minutes and 8 seconds And I think that these people have a right to be angry and they’ve got a point when they criticise the way the news media failed to inform the public properly about the risks associated with the MMR vaccine. That’s the end of this presentation. Thank you very much for listening.

The MMR vaccine scare and the media

Andy Williams explores the health scare around the MMR vaccine in the UK and asks: were the media irresponsible in their reporting?

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Making Sense of Health Evidence: The Informed Consumer

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