After the MMR scare comes the inevitable measles scare: there’s now a big outbreak in Swansea, Wales.
What Wakefield et al sowed is now being reaped. No reports yet of deaths or serious disability, but unfortunately the odds of getting through the outbreak without them are poor.
Why Swansea? It has been suggested that an anti-MMR campaign spearheaded by the local rag in the 1990s may, in part, be responsible for lower MMR uptake in the region and loss of herd immunity.
Now, I heard/read about this somewhere in the media in the last couple of days, so it’s not as if there’s a big conspiracy to keep it quiet. But in other circumstances, if the actions of a named individual, organisation (eg hospital), or even another professional group (eg doctors) could be deemed even part-responsible for an outbreak of potentially serious harm to a large group of people, I’d expect to hear a lot more about it in the news. But maybe the fact that the media aren’t saying much about their own failings shouldn’t be a big surprise.
Anyway, here’s a pretty good account of it on “the home of UK regional journalism and jobs”.
Just to be clear: the primary responsibility for this shocking debacle actually lies with a medical person, Andrew Wakefield. And both the UK government, and collectively, the entire medical profession, have also come under justified criticism for poor communication and arrogance— in failing to recognise the ethical dilemma that mothers of unvaccinated young children faced in the wake of the MMR scare, and in failing to properly explain (rather than just declaim) the rationale and evidence behind MMR vaccination.
That said, if we’d had a more ‘responsible’ media (yes, I realise media responsibility is difficult to define— and even difficulter/dangerouser to mandate) both then, and now, I suspect the MMR dissenters would have been much fewer in number. The way herd immunity works, populations can tolerate a certain number of refuseniks— those who have a deep distrust of modern medicine, with fixed views unassailable by rational argument and evidence. The health of their un-immunised children will remain protected by the immunity of their schoolmates. Most people do respond to rational arguments, however, and without the MMR controversy it seems likely that nearly 95% of children would have been immunised, meeting the crucial threshold for herd immunity.
Previously I’ve highlighted Hans Rosling’s death/news ratios as a way of highlighting how poorly the impact of a health problem or disaster, in terms of actual mortality, is reflected in the amount of media coverage. There is no linear relationship between actual health impact and the amount of media coverage. For several reasons, news/death ratios are not really applicable in this discussion of post-MMR scare measles outbreaks, but there’s a similar principle at play.
The potential impact of MMR— on an individual child’s health, or overall population health— was never accurately reflected in either the scale or the tone of the original MMR controversy media coverage. The intensity of the reporting went way, way beyond any conceivable health impact from the jab. At best, it featured the same misleading, manufactured ‘false balance’ that was (and still is) often seen in global warming debates, and at worst it was characterised by highly partisan ‘campaigns’ with a strong bias towards the anti-vaccination viewpoint. All this succeeded in frightening a sufficient number of parents away from the MMR jab to ultimately cause the herd immunity effect to fail— parents who, in the absence of a media frenzy, would otherwise have been in the majority ‘rational’ camp. In time, this allowed a measles outbreak- a non-linear explosion in measles cases above the expected baseline incidence (which in a properly immunised population, of course, should be close to zero).
So— an irresponsible media is a source of instability in society. It magnifies responses to small stimuli— such as poorly designed and dubiously implemented case series studies of minimal scientific merit— non-linearly, and in a way that is highly dependent on initial conditions (such as the configuration of existing ‘news environment’, and receptiveness of sections of the public to beguiling conspiracy theories). However, much of the way it operates is predictable and deterministic— launch a local campaign against MMR vaccination, for example, and less children in the area will get vaccinated. Effect follows cause.
All this makes me think that the media (as currently constituted) pushes society towards behaving like a chaotic system. Perhaps this isn’t always a bad thing— it’s just the way things are— but in cases where it clearly is, such as the reporting on MMR, a more widespread understanding of this insight (if it’s true) might help avoid future cock-ups.