Measles-Rubella Vaccine: Is it Safe? Explore the Evidence!

Introduction

Uganda government (Ministry of Health) in partnership with World Health Organization, Global Alliance for Vaccines, and United Nations Children’s Fund (UNICEF) have recently launched a massive immunization campaign against Measles, Rubella and Polio.

According to the Ministry of Health and UNICEF, in Uganda, there has been Measles and Rubella outbreak since 2016 with more than 109 districts affected. Concerning Polio, reports say, we have refugees entering from heavily affected areas, for example, DRC, implying a direct risk to Ugandans. The immunization campaign which started on 16^th October and ended on Tuesday 22^nd October 2019 was targeting more than 18 million children between 9 months and 15 years for Measles-Rubella (MR) vaccine and, additionally, polio vaccine for those of 5 and below years.

Surprisingly, far from the normal, many parents including educated ones did not respond well to the campaign, with some dragging the ministry to court. Government was being accused of immunizing children in schools without parents’ consent, hiding information regarding side-effects of the vaccines, especially to children with HIV and other special conditions and not explaining well the advantages of the campaign.

In response, partly, the ministry threatened those boycotting the campaign with imprisonment or fine, a move that many saw as a weakness. In other endeavors, the sensitization went on.

Despite the government’s assurances regarding the safety of the vaccines, social media users kept posting sparse evidences of possible dangerous side-effects. Daily Monitor of 16^th October highlighted the famous ‘peophet’, Mugisha Elvis Mbonye who, on his Facebook account, posted that:

“There’s a reason that every doctor or scientist who has ever spoken out publicly against vaccines has been branded a quack, regardless of their unblemished reputation up to that point conscious campaign to maintain the myth of vaccine safety, effectiveness and necessity. We need a transparent national discussion of vaccine safety and effectiveness”

Besides Mugisha, so many other Ugandans, including the famous Frank Gashuma had negative sentiments regarding the exercise. Below are few screenshots of social media users’ arguments:

On the other hand, the famous musician, Bebe Cool promoted the campaign:

Bad past experience with immunization!

Concerning vaccination in Uganda, you may not need to be quick to blame people and their skeptics; we have had a bad experience! One or two years ago, Uganda health care system was infiltrated with fake hepatitis vaccines. An investigation into the matter confirmed the rumors though the ministry later said that the fake vaccines did not cause any negative side effects to the victims. And we aren’t the only ones; there have been immunization conspiracies around the world, accusing the west of terrible intentions, for example, children sterilization accusations in Pakistan or unethical testing of drugs on African children (Jegede, 2007), Nigeria.

According to his detailed study, Jegede (2007) asserts that every immunization boycott doesn’t happen out of blue; there is always a context. For Nigeria’s 2003 boycott, the country’s political campaign on family planning made the public suspicious, connecting immunization to reducing number of people. He (Jegede) recommends that enough information should be provided to the public in respect of local politics and culture.

In 2015, in Kenya, Catholic Bishops called on the public to boycott polio vaccination. In the accusations, they asserted that it is possible to spread cancer, HIV and other diseases to children. Additional accusations included the possible link between vaccines and HIV and or autism. Always, as earlier highlighted by Mugisha in his Facebook post, these anxieties and accusations are usually referred to as ‘anti-immunization rumors’, a demeaning term if the health care system is to produce constructive results while engaging with ‘anti-vaccinals’. In other words, argues (Jegede, 2007), health workers should always pay attention to those complaints and treat them with respect and answer them with evidence-based information.

In the documentary, Vaccination: the hidden truth, practicing independent doctors and researchers assert that vaccination is actually not helpful. With some scholarly evidence, the guys argue that the ‘historical’ eradication or reduction of some diseases isn’t or wasn’t necessarily about immunization but socio-economic improvements. Instead of boosting our immunity, the documentary reveals, vaccination takes away our ability to build strong immunity, making us dependent on artificial drugs, the vaccines!

Measles-Rubella Vaccine: Is it Safe?

For now, aside from the accusations and everything else, the question on every parent’s mind is or was: is the vaccine safe or it is some sort of ‘drug testing scheme’ on our children? To answer this question we have peeped into some peer-reviewed publications, case control studies and official reports to help you out. This review is not extensive but it can be helpful.

MMR and autism and IBS

In 1998, Andrew Wakefield with about 11 coauthors linked MMR to autism and inflammatory bowel disease. The guy published a paper entitled ‘Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children’ in Lancet, one of the oldest (since 1823) and most respected peer reviewed medical journal and clearly accused immunization! In his or their words, the paper authors reported:

‘Onset of behavioral symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another’ (Wakefield et al., 1998, p. 1)

As always, I peeped into that original work myself and here is how it is marked (a download from Lancet):

In 1999, following various complaints and scientific ‘rumors’, including the above Wakefield’s report regarding possible associations between vaccines and harmful side effects or dangerous diseases, the World Health Organization set up a committee that should concentrate on studying vaccines and reported side effects. This committee is called the ‘Global Advisory Committee on Vaccine Safety’ (GACVS). According to WHO, this committee is independent of everyone, including WHO and responds to critics and reported side-effects with scientific enquiry!

This committee gave a report concerning the relationship between autism and or inflammatory bowel disease and measles-rubella and mumps combined vaccine (MMR) in 2003. In that report, which I personally have read, the committee reported no association. According to the report, 11 epidemiological studies (ecological, case-control, case cross-over, and cohort) were reviewed and no association was reported between measles-rubella-mumps vaccine and autism or any other diseases. In the report’s words:

‘The review concluded that existing studies do not show evidence of an association between the risk of autism or autistic disorders and MMR vaccine’ (WHO, 2003, p. 2).

However, in consideration of the laboratory studies (only 3 of them and which, according to World Health Organization, had severe limitations) that ‘alleged’ persistence of measles vaccine virus in the gut of children with autism and inflammatory bowel disease, the organization asked for further studies. In the report’s words:

‘It was concluded that the alleged persistence of measles vaccine virus in the gastrointestinal tract of children with autism and inflammatory bowel disease requires further investigation through independent studies before the laboratory findings of the published studies, which have serious limitations, can be considered confirmed’ (WHO, 2003, p. 2).

The review ended with a direct support for continued use of immunization against measles, rubella and mumps and not in isolation with single vaccines (emphasis) but using the combined MMR. Read the report’s conclusion:

‘Based on the extensive review presented, GACVS concluded that no evidence exists of a causal association between MMR vaccine and autism or autistic disorders. The Committee believes the matter is likely to be clarified by a better understanding of the causes of autism. GACVS also concluded that there is no evidence to support the routine use of monovalent measles, mumps and rubella vaccines over the combined vaccine, a strategy that would put children at increased risk of incomplete immunization. Thus, GACVS recommends that there should be no change in current vaccination practices with MMR’ (WHO, 2003, p. 2).

Concerning the Wakefield’s report, it was later found out that it was all a lie! First, two 2002 studies by other researchers (Madsen et al., 2002 and Black et al., 2002) failed to reproduce the guy’s results. For those familiar with research, one way to validate your results is if they can be replicated by other researchers.

Secondly, an investigation into his allegations by a British investigative journalist, Brian Deer (this is a biography you shouldn’t miss; the guy is an investigator!), reported that Wakefield had a hidden agenda and many unclear conflicts of interest (Deer, 2011). To understand how the guy cooked his study results, drown yourself into this short article.

Following Deer’s investigations, UK’s General Medical Council (GMC) did an even deeper inquiry and found out that Wakefield was or is ‘dishonest, unethical and callous’. He was later cancelled off the UK medical register. His article which Lancet had partially retracted (Feb. 2004) on Deer’s accord was fully retracted on full GMC’s accord (Feb. 2010).

It is said that the MMR controversy (sometimes termed as (‘the lancet MMR autism fraud) by Wakefield is the most damaging medical hoax of the 20^th century (Flaherty, 2011).

A detailed 2002 review of MMR and possible connections with autism and gut disorders reported no association (Roberts and Harrford, 2002).

MMR and mercury poisoning

Concerning other allegation of possible mercury poisoning as most vaccines are thought to be preserved using mercury (Thimerosall), the report said, the preservative isn’t used anymore in all vaccines (for UK) except in hepatitis B vaccine in some provinces. Besides, the preservative is usually in very low recommended dose and is of a type of mercury (ethylmercury) that is easily and quickly cleared from the body, posing no harm to the child!

In United States, in 1999, FDA called for removal of thimerosal from all vaccines as precautionary measure except for hepatitis B vaccine that had no free-thimerosal version out until August 1999. By 2001, all vaccines that children below six years received were thimerosal-free in United States (CDC, 2001). Yet, again, United States’ Immunization Safety Review Committee emphasizes that the removal of it (thimerosal) from vaccines wasn’t because it was dangerous. In the committee’s words:

‘These actions (removing thimerosal from vaccines) do not, however, reduce the importance of trying to resolve whether the past presence of thimerosal in some vaccines could have caused neurodevelopmental problems in some children. Moreover, thimerosal remains in use in many other countries, which continue to depend on multi-dose supplies of vaccine that must be protected from microbial contamination’ (Stratton et al., 2001, p.17).

In that deep review of both published and unpublished work, the committee clearly reported that thimerosal usually used in vaccines doesn’t have any associations with autism or mercury poisoning or any other neurological diseases of children. Like we earlier highlighted, the reasons are: the dose used is very low; gets cleared easily and quickly from the body. Instead, CDC (2001) emphasizes the use of thimerosal in vaccines:

‘Thimerosal is added to vials of vaccine that contain more than one dose (multi-dose vials) to prevent growth of germs, like bacteria and fungi. Introduction of bacteria and fungi has the potential to occur when a syringe needle enters a vial as a vaccine is being prepared for administration. Contamination by germs in a vaccine could cause severe local reactions, serious illness or death. In some vaccines, preservatives, including thimerosal, are added during the manufacturing process to prevent germ growth’ (Stratton et al., 2001, p. 35).

In Uganda, in response to some of the critics by Mugisha Mbonye, Ministry of Health asserted that thimerosal is usually used for vaccine preservation here in Uganda, though no specifications regarding which vaccines do contain the preservative were stated. Additionally, emphasized the ministry, research shows no association with any neurological side-effects, including autism. CDC states that some vaccines, for example, MMR, have never been preserved or manufactured with thimerosal. Does this mean that wherever you find MMR (just like the one of yesterday) expect no such a preservative? I don’t know.

On the good side of it all, two vaccines (pneumococcal Conjugate Vaccine and Inactivated Polio Vaccine) that were famously know to contain thimerosal were replaced with thimerosal free types since 2018, an added layer of ‘feeling safe’ for Ugandans!

Despite hundreds of studies showing no connection between thimerosal and neurological diseases, why are people still worried about it? CNN recorded Dr. Paul Offit (an American pediatrician specializing in vaccines and immunology) on this: “Something that has the word ‘mercury’ in it is never going to sound good to some people,”

Summary and Conclusions

Vaccines are very helpful in preventing diseases, especially among children. However, these benefits sometimes come with side-effects, side-effects which are usually minor and not trouble-some at all. Over the years, ‘anti-vaccine’ activists together with few studies have alleged that vaccines, especially Measles-Rubella and Mumps combined vaccine were linked to serious neurological disorders, including autism and inflammatory bowel syndrome. However, clear epidemiological studies of all types have found no evidence supporting these claims. Vaccine safety review committees in various nations, including USA, UK and the WHO’s committee on safety of vaccines have, through scientific studies and deeper literature review re-affirmed that these vaccines pose no harm to children. Substances like thimerosal which have been used as preservatives since 1930s have also been proven to be safe and helpful in ensuring the safety and potency of these vaccines.

In Uganda, it looks, the Ministry of Health and government have really taken great steps in ensuring that our children are safe. Where exceptions have happened (for example, the fake hepatitis vaccine saga), the ministry has openly apologized and, after investigations, re-emphasized that the problem wasn’t harmful at all. It is thus very helpful and safe to trust and treasure the immunization programs within Uganda and fulfill our children’s rights by ensuring they get immunized as recommended.

God Bless You

SOME REFERENCES

Black, C., Kaye, J. A., & Jick, H. (2002). Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database. Bmj, 325(7361), 419-421.

Flaherty, D. K. (2011). The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science. Annals of Pharmacotherapy, 45(10), 1302-1304.

Jegede, A. S. (2007). What led to the Nigerian boycott of the polio vaccination campaign? PLoS medicine, 4(3), e73.

Madsen, K. M., Hviid, A., Vestergaard, M., Schendel, D., Wohlfahrt, J., Thorsen, P., … & Melbye, M. (2002). A population-based study of measles, mumps, and rubella vaccination and autism. New England Journal of Medicine, 347(19), 1477-1482.

Stratton, K., Gable, A., McCormick, M. C., & Institute of Medicine (US) Immunization Safety Review Committee. (2001). Thimerosal-containing vaccines and neurodevelopmental disorders. In Immunization Safety Review: Thimerosal-Containing Vaccines and Neurodevelopmental Disorders. National Academies Press (US).

Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., … & Valentine, A. (1998). RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.

WHO (2003). MMR and autism. https://www.who.int/vaccine_safety/committee/topics/mmr/Dec_2002, accessed on 21/10/2019