Interview: Dr Andrew Wakefield,
research team leader,
Royal Free Hospital School of Medicine
INTERVIEWER: Dr Wakefield, what exactly have you found?
DR ANDREW WAKEFIELD: Well this work started just over a year ago when we were contacted by a group of mothers who complained that their children had been developing perfectly normally until they had encountered an environmental insult, in many cases they claimed it was the measles, mumps and rubella vaccine, and then had lost their … all their acquired skills, such as speech, language, developmental milestones. And at the time we were not sure of the implications of that. But what was interesting is that those children had also suffered gastrointestinal symptoms, diarrhoea, alternating constipation and diarrhoea, sometimes blood loss. And it became evident to us that after five calls in two days we had to look at this very seriously to (investigate) these gastrointestinal side effects in particular. Now one of the questions that had been raised before … the claims had been rather put to one side of gastrointestinal disturbances, these were just a function of the behavioural problems, but we felt they merited taking a little more seriously and so that we investigated them. Interestingly, we set out a study, ten children, we thought we might find inflammation perhaps in one or two based upon the history -- we’ve now looked at 40 children and 39 of those have exactly the same findings. And that’s been intriguing. The children have a patchy inflammation of the colon, rather like colitis as we recognise it historically. And they also have great big swollen lymph glands in the terminal ileum, that is the end of the small intestine. And that combination, as we call it ‘ileo hyperplasia’, follicular hyperplasia of the terminal ileum and colitis, is the, is the core of the gastrointestinal syndrome. Interestingly, they also have all undergone developmental regression after a period of normal development.
INTERVIEWER: There has been concern recently over any long term effects as a result of the MMR vaccine, are you saying now then that there does appear to be a proven link between the vaccine and the side effects?
DR ANDREW WAKEFIELD: No, the work certainly raises a question mark over MMR vaccine, but it is, there is no proven link as such and we are seeking to establish whether there is a genuine causal association between the MMR and this syndrome or not. It is our suspicion that there may well be but that is far from being a causal association that is proven beyond doubt.
INTERVIEWER: But if you say there’s at least a question mark over it now, should the vaccine continue to be administered while you’re investigating?
DR ANDREW WAKEFIELD: I think if you asked members of the team that have investigated this they would give you different answers. And I have to say that there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines, that is continued use of the individual measles, mumps and rubella components.
INTERVIEWER: Because that begs the question that you know, are the … do the advantages of continuing with the vaccines outweigh the disadvantages of a problem developing if you, if you continue to have them?
DR ANDREW WAKEFIELD: Well I think it’s a very complex question. Certainly if you continue, as I would recommend to use the single vaccine, you do not incur a greater risk of those diseases in the children, so that you do not lose the benefits of vaccination if you space them over time.
INTERVIEWER: (CUTS) So even measles?
DR ANDREW WAKEFIELD: Well as yet we don’t know, but there is no doubt that if you give three viruses together, three live viruses, then you potentially increase the risk of an adverse event occurring, particularly when one of those viruses influences the immune system in the way that measles does. And it may be, and studies will show this or not, that giving the measles on its own reduces the risk of this particular syndrome developing.
INTERVIEWER: So you’re saying that a parent should still ensure that their child is inoculated but perhaps not with the MMR combined vaccine?
DR ANDREW WAKEFIELD: Again, this was very contentious and you would not get consensus from all members of the group on this, but that is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.
INTERVIEWER: Now what you seem to be indicating is that there’s … the effects are on this intestinal disease of the gut and also autism which is a personality disorder. What’s the link there? How can there be a link?
DR ANDREW WAKEFIELD: Well this is intriguing of course. We’ve been looking for the cause of autism in the brain for many many years and yet have failed to define it. People have been saying for some time, people on the periphery of autism, have been saying for some time that this may well be related to bowel damage. The Italians for example have found that children who are autistic have in many cases a leaky intestine. Others, biochemists, have been saying that it may be a toxic state that absorption of chemicals such as opioid, peptides, morphine like substances from the gut that you and I produce in our diet from milk and wheat, are actually getting access through that leaky gut into the developing brain. And perhaps if that occurs at a particular time of life, when the brain is rapidly developing, then it is susceptible to long term damage. And that is intriguing again, because many parents report that certain foodstuffs make their children’s behaviour much worse, and that withholding that food, those foods, improves their behaviour. What we’ve been able to do here, by directly visualising and biopsying the bowel, is to confirm, at least in this group of children, that there is a link, it may well be a link between gut inflammation and behavioural abnormalities.
INTERVIEWER: Is this likely to be permanent damage or can, can it be treated?
DR ANDREW WAKEFIELD: We simply don’t know at this stage. We have … We entered this as a pilot study to look at ten children, we’ve now looked at 40 children,we’ve been going for a year; we sincerely hope that we can (CUTS) something to ameliorate the damage that has been done, but we do not yet know whether that’s the case.
INTERVIEWER: Of course there’ll be many parents whose children have had this MMR vaccine who will now be concerned about what may happen to their children. What advice would you give to them?
DR ANDREW WAKEFIELD: Well, the interesting thing is that the damage, the behavioural or developmental change tends to occur quite soon after administration, and this is where, why parents or GPs or paediatricians have been able to make the link, the association with MMR. So if that hasn’t happened then it is extremely unlikely to happen.
INTERVIEWER: But there are going to be parents now whose children are about to have the vaccination, and they’re gonna say: I’m not gonna risk it. What would you say to them?
DR ANDREW WAKEFIELD: Well, my message is for the Department of Health and the regulatory authorities, and that is that this needs urgent investigation; it needs funding and it needs the appropriate level of commitment in terms of basic scientific research and clinical research to answer the question. And until that time we cannot offer any definitive evident, any definitive message to parents about this.
INTERVIEWER: Sounds to be saying, you seem to be saying perhaps don’t?
DR ANDREW WAKEFIELD: My opinion, again, is that the monovalent, the single vaccines, measles, mumps and rubella, are likely in this context to be safer than the polyvalent vaccine.
INTERVIEWER: That’s the MMR vaccine?
(INTERVIEW ENDS)
