Webb-Gurley 1

Tamryn Webb-Gurley

Professor McGriff

ENC 1102

08 December 2019

WC 2358

Vaccines and Autism: Truth or Conspiracy?

Five, that is the number of males that have autism in my close family. According to the CDC

and the Department of Education’s special education counts, in the year 2000, children

diagnosed with autism was 1 in 1,000; today they report the numbers to be 1 in 56 (Autism Data

Visualization Tool). One thing these children have in common is vaccinations. While

mainstream vaccination advocates continue to argue there is no correlation between autism-like

disorders and vaccinations, conversely, there are others that posit multiple hypotheses

encompassing measles, mumps, rubella (MMR) vaccines, thimerosal-containing vaccines

(TCVs), and an ever-growing hurried number of immunizations on the recommended

vaccination schedule. It has become common today to dismiss the vaccination debate as nothing

more than a conspiracy theory, however, evidence continues to mount as to the validity of

vaccine safety as a potential root cause of autism and its related disorders and though I agree that

vaccinations have saved an untold amount of children’s lives, I tend to subscribe to that theory.

At the beginning of the vaccine controversy is a man named Andrew Wakefield, a British

gastroenterologist, that did research for the Royal Free Hospital School of Medicine in the

United Kingdom. In 1998, Wakefield released a case series of his observations over a 3-year

period. The Lancet, a prestigious medical journal in Great Britain published the study. Since the
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journal was so well known the media, the medical community, and parents took notice. The

paper entitled, ​Illeal-Lympho-Nodular-Hyperplasia, Non-Specific Colitis, and Pervasive

Developmental Disorder in Children,​ reported on care that was rendered by the gastroenterology

clinic to 12 autistic children that presented with colitis-type symptoms. Of all of the children

included in the study, all but one reportedly developed regressive disorders after the combined

MMR vaccine was administered. Later, the parents of the one remaining child admittedly

reported that they would not make the correlation between the occurrence of their child’s autistic

symptoms being connected to the MMR vaccine due to previous encounters with the medical

community where they had been refused care for their son because of this claim (Wakefield,

Callous Disregard​ 10). This study began the firestorm and ultimately caused over half of the

parents in the United Kingdom to refuse the MMR vaccine for their children (Barford).

Professor Trisha Greenhalgh, who was well-known and had written specifically about

analyzing medical studies, wrote an analysis criticizing Wakefield’s study. Among her concerns

were that the paper contained no clear research hypothesis and conclusions that did not have

supporting data. The controversy exploded when the United Kingdom’s Department of Health’s

website directed those concerned about Wakefield’s study, to Greenhalgh’s analysis (Wakefield,

Callous Disregard ​11).

First, Greenhalgh’s critique of Wakefield’s findings firmly asserted that there was no clearly

defined hypothesis within the study: ​ ​“The administration of MMR vaccine to infants increases

their risk of developing (a) a particular pattern of inflammatory damage in the gastrointestinal

tract and (b) autism or an autism-like syndrome” ​(Greenhalgh, ​Analysis of Wakefield Study)​ .​ In

other words, Greenhalgh rendered a hypothesis where one was not given by Wakefield, nor was
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one intended to be given as part of the study. Just by the insertion of her own hypothesis,

Greenhalgh changed the entire tone of the study. One of the final assertions declared by

Greenhalgh was the presumption that there was no data that supported the claim of association

between autism-related disorders and the MMR. According to Wakefield:

Contemporaneously, parents of 9 children associated onset of symptoms with measles,

mumps, and rubella (MMR) vaccine exposure, 8 of whom were reported on in the

original paper . . . parents started contacting me with the story that their normally

developing child had regressed into autism or an autism-like state, with onset in the

majority of cases soon after the MMR vaccine. (Wakefield, ​Callous Disregard​ 9)

There does seem to be some evidence of a connection due to the timing of the MMR vaccine of

9 of 12 children and the onset of symptoms. Clearly, a correlation exists. However, Wakefield

drew no conclusion as he considered this a case-series of 12 children that had symptoms that

were deeply concerning and one absolute commonality was the MMR ​(11).

Wakefield contends that the analysis Greenhalgh provided is erroneous on several counts.

First, by the fact that Greenhalgh inserted her own hypothesis. Second, she demanded that the

study should have followed the parameters of a more extensive, research study. Consequently,

her analysis made the Royal Free Hospital’s study appear crucially flawed in content and

process. The discrepancy between Greenhalgh and Wakefield was clearly due to Greenhalgh’s

demands that the case-series, which Wakefield clearly presented as such, be treated and work

within the parameters of a case-controlled study (12). Admittedly, in an unrelated article, she

opined:
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Clinical situations in which a case report or case series is an appropriate type of study

include the following: a doctor notices that two babies born in his hospital have absent

limbs (phocomelia). Both mothers had taken a new drug (thalidomide) in early

pregnancy. The doctor wishes to alert his colleagues worldwide to the possibility of

drug-related damage as quickly as possible (McBride, in The Lancet 1961). Anyone who

thinks ‘quick and dirty’ case reports are never scientifically justified should remember

this example (Greenhalgh, ​How to Read a Paper​).

Greenhalgh was justifying her analysis by providing her own hypothesis, yet, in her own

book, she alluded to the fact that sometimes it is necessary to do a hasty report to get the

information into the hands of those responsible for the care of patients. This was a definite

standard she did not extend to Wakefield and his colleagues when they were presented with an

issue.

Although Greenhalgh’s analysis of Wakefield’s paper may seem trivial, it is in fact, crucial in

terms of the debate over how the original study lost credibility. Unfortunately, this one, short

analysis made laypeople and professionals alike ultimately view the study as fraudulent and it

overshadowed the concerns that Wakefield, his colleagues, and concerned parents had about an

MMR vaccine and autism association. This was to be the beginning of very diverse viewpoints.

While Wakefield initiated the debate within the general public, other hypotheses began to surface

hinting at a relation between vaccines and autism.

Another point of contention within the vaccination debate was that of thimerosal, an organic

mercury-based preservative that had been used in vaccines since 1931. In a preservative

capacity, thimerosal slows the replication of microorganisms that may invade vaccine ampules.
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Data purportedly existed on the safety of thimerosal prior to its introduction to vaccines. (Center

for Biologics Education and Research).

In the 1990s, the general public became keenly aware of the dangers of mercury toxicity in

humans from environmental contamination. In an effort to reduce public exposure to the

substance, the Modernization Act of 1997, created by the FDA, caused a sweeping overhaul of

product ingredients sold within the United States. This new law caused the agency to call for

data on drug mercury levels and the timeframe within which they had to be removed if they

exceeded Environmental Protection Agency guidelines. Vaccine manufacturers fell under this

mandate.

As results came in and mercury levels fell under scrutiny, it became the recommendation of

the American Academy of Pediatrics, and the Public Health Service to request the FDA

authorize the removal of thimerosal-containing vaccines from the market. There was a consensus

that the majority of vaccines in the United States should be thimerosal-free.

The debate of thimerosal-containing vaccines reached a fever-pitch as the public became

aware that vaccines contained mercury. Parents and advocacy groups called for clarification but

not before panic set in and questions began to surge about the possibility of

thimerosal-containing vaccines being the causality of autism. According to one group of

concerned physicians:

Exposure to mercury can cause immune, sensory, neurological, motor, and behavioral

dysfunctions similar to traits defining or associated with autism, and the similarities

extend to neuroanatomy, neurotransmitters, and biochemistry (Bernard et al.).

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Bernard and colleagues felt there was a definite link between what appeared as autistic

symptoms and actual mercury poisoning. Mercury was a known neurotoxin and its poisoning

effects mimicked autism to a degree as noted by dysfunctions often exhibited by autistic

children. The FDA felt, however, that what the public failed to realize was that thimerosal

metabolized into ethyl-mercury, not the more dangerous methyl-mercury found in fish. Studies

seemed to prove that ethyl-mercury had a shorter half-life and only stayed in a subject’s blood

for 7 days, as compared to methyl-mercury remaining almost 15 days. Additionally, researchers

found that there was no build-up of ethyl-mercury causing mercury toxicity (Center for Biologics

Evaluation and Research). By this time, the damage was done, fear and more unanswered

questions remained.

With not enough scientific evidence to go on, parents of children on the autistic spectrum

found what they believed to be another reason for the connection between vaccines and autism.

Certainly, this was the key that would unlock the floodgate. There was no strong scientific

evidence that showed ethyl-mercury to be an acceptably safe vaccine ingredient. Though the

federal government felt it prudent to cite one study that they viewed as proving the safety and

efficacy of thimerosal, all it left was questions.

In 1931, Eli Lilly investigators, Jamieson and Powell, briefly studied thimerosal’s effects. It

was their conclusion, through their own animal studies, that high doses of the neurotoxic

thimerosal were well tolerated in animals. What they failed to mention is that within less than 30

days, most animals that received the injection had died. However, they looked at this as a success

since immediate death did not occur. Further, Jamieson and Powell used data from another

doctor, K.C. Smithburn, from Indianapolis who during a meningitis outbreak gave thimerosal to
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21 ill patients. All 21 patients died, 7 within 24 hours of administration (Kennedy 5, 7-9). This

study is still cited today as proof of thimerosal’s safety on the Food and Drug Administration’s

website. Although I grant that vaccines need to be protected from harmful microorganisms, I still

maintain that safe ingredients are paramount. A known neurotoxin is not what I would consider a

safe ingredient. As autism rates rose, answers were still sought.

The next argument in line for debate was an ever-increasing number of vaccinations on the

recommended vaccination schedule. In the 1980s, there were 7 vaccines given to children,

however, never more than one at a time. Today, children are administered vaccines for a total of

16 different diseases. Children start receiving these vaccines within the first 24 hours of their life

when the hepatitis B vaccine is given. The next batch of vaccines comes when the child is at

least 2 months of age, a total of six vaccines are given to the child at this time. By the time a

child is the age of 6, they may receive up to 36 doses of vaccines.

One particular set of adverse reactions that came on the heels of vaccination was the death of

nearly 50 infants in Japan shortly after a strong series of vaccinations. According to one

case-series:

One cannot determine which vaccination affected the body adversely or in what way

because the infants had received many vaccinations. This study found that the most

frequent vaccine used before death was Hib . . . In Japan, fatal incidents occurred after

combined immunization with Hib and ​S. pneumonia​ vaccines in 2011 . . . this activation

and expression lead to hypersecretion of proinflammatory cytokines, so-called cytokine

storm, which might create unfavorable immunological conditions in infants who are

affected by inflammation (Osawa et al.).

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Inflammation, exactly what Andrew Wakefield first spoke of in his now-retracted paper and the

same thing many parents of autistic children speak of as being problematic in their children’s

daily lives. In their assessment of the situation, Osawa and colleagues noted inflammation caused

by cytokines. Questions continued in regard to a possible connection with autism, and the

exorbitant number of vaccinations now administered. In spite of the concerns, it is generally

frowned upon to contemplate changing a child’s vaccination schedule as most feel the risks are

worth the benefits.

Advocacy groups, parents, and academics all want to ascertain whether the current schedule

contributes to autism or autism-like symptoms. According to a 2013 Institute of Medicine

meeting with stakeholders:

The evidence of an association between autism and the overall immunization schedule is

limited both in quantity and in quality and does not suggest a causal association . . .

forty-one papers concerning a relationship among immunizations, immunization

schedule, or vaccines and learning disorders, communication disorders, and

neurodevelopmental disorders, were identified via an Ovid MEDLINE database

search...after an initial review, five of the papers were believed to focus on some aspect

of the immunization schedule and were selected for more in-depth review.

In other words, no answers, more research to be done but still, no answers. Interesting,

correlation, yet no causal relationship once again with vaccines and autism. Vaccines can cause

adverse effects like death but not autism. They found five papers that they felt needed more

review but never any resolution to the problem. They only passed it to the next meeting.
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​Ultimately, what is at stake here is the safety of our children. Stakeholders in the fight present

three major claims, with competing evidence presented as answers. The one thing that children

with autism do have in common is vaccinations. Whether the answers be found in combined

strains of viruses, mercury, or too many vaccines within such a small amount of time, all efforts

should be made, and all sides should be listened to. To characterize a concerned party as

conspiratorial, anti-vaccine, and at fault for disease reemergence is inherently flawed and

counterproductive. What is vital to the cause of keeping our children safe is to determine through

unbiased testing if there are any differences in the rate of autism between vaccinated and

unvaccinated children. Those responsible for our national health reject those ideas due to ethics

concerns. So, for now, we have come no further in the fight for answers. At the same time that I

believe vaccinations are vital to maintaining our national health, I also believe that 1 in 56 is far

too many to ignore.

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Works Cited

“Autism Data Visualization Tool.” ​Centers for Disease Control and Prevention​, Centers for

Disease Control and Prevention, 27 Aug. 2019,

www.cdc.gov/ncbddd/autism/data/index.html.

Barford, Vanessa. “MMR: How Parents Feel Now about Avoiding Jabs.” ​BBC News​, BBC, 2

May 2013, www.bbc.com/news/magazine-22354895.

Bernard, S., Enayati A., Redwood, L., Roger, H., Binstock, T. “Autism: a Novel Form of

Mercury Poisoning.” ​Medical Hypotheses​, U.S. National Library of Medicine, Apr. 2001,

www.ncbi.nlm.nih.gov/pubmed/11339848.

Center for Biologics Evaluation and Research. “Thimerosal and Vaccines.” ​U.S. Food and Drug

Administration​, FDA, 1 Feb. 2018,

www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/thimerosal-and-vacci

nes.

Committee on the Assessment of Studies of Health Outcomes Related to the Recommended

Childhood Immunization Schedule, et al. ​The Childhood Immunization Schedule and

Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies.​ National

Academies Press (US), 27 Mar. 2013, www.ncbi.nlm.nih.gov/pubmed/24901198.

Greenhalgh, Trisha. “Analysis of Wakefield MMR Study Asks Why Flaws Weren't Spotted by

Lancet Editors.” ​Vaccine Casualty Blogspot​, 2010,

vaccinecasualty.blogspot.com/2010/03/analysis-of-wakefield-mmr-study-asks.html.

---. ​How to Read a Paper: The Basics of Evidence-Based Medicine​. BMJ Publishing Group,

2001.
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Kennedy, Robert F. ​Thimerosal: Let the Science Speak: The Evidence Supporting the Immediate

Removal of Mercury - a Known Neurotoxin - from Vaccines.​ Skyhorse Publishing, 2015.

Osawa, Motoki, et al. “Sudden Infant Death After Vaccination.” ​The American Journal of

Forensic Medicine and Pathology,​ vol. 40, no. 3, 2019, pp. 232–237.,

DOI:10.1097/paf.0000000000000494.

Wakefield, Andrew J., “RETRACTED: Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific

Colitis, and Pervasive Developmental Disorder in Children.” ​The Lancet,​ Elsevier, 17

Apr. 1998, www.sciencedirect.com/science/article/pii/S0140673697110960.

---. ​Callous Disregard: Autism and Vaccines -- the Truth behind a Tragedy.​ Skyhorse

Publishing, 2017.