You only need to look at the title of the book to know that something’s wrong. “Melanie’s Marvelous Measles” is an anti-vaccination book aimed at children, written by Australian activist Stephanie Messenger. Although it’s been around for a few years, it’s garnered attention recently following the Disneyland measles outbreak in December - the book has had nearly 1000 1-star reviews on Amazon.com. Here’s the blurb from the back cover:

Melanie’s Marvelous Measles was written to educate children on the benefits of having measles and how you can heal from them naturally and successfully. Often today, we are being bombarded with messaged from vested interests to fear all diseases in order for someone to sell some potion or vaccine, when, in fact, history shows that in industrialised countries, these diseases are quite benign and, according to natural health sources, beneficial to the body.

First off, there’s nothing benign about measles. The World Health Organisation (WHO) estimates that in 2013, there were around 146000 measles-related deaths across the globe – an increase from 122000 the previous year. The complications that can arise as a result of contracting the illness can be anything from diarrhea and earache, to liver infections, meningitis, and very rarely, encephalitis. None of these things are ‘beneficial to the body’. It shouldn’t need to be said, but Messenger’s promotes a dangerous worldview about measles – and vaccines – that isn’t based in robust scientific evidence.

Thankfully, common sense seems to be prevailing in the Amazon comments section, and the vast majority of responses are either scathing derision, or heartbreakingly poignant. Nevertheless, Messenger’s book highlights two interconnected issues: the power than anti-vaccination conspiracy beliefs can have over people who are undecided about vaccines, and the continuing, devastating impact of Andrew Wakefield’s false claims about the dangers of the MMR vaccine.

Anti-vaccination rhetoric affects vaccination intentions

In a 2014 paper in PLOS ONE, Daniel Jolley and Karen Douglas at the University of Kent looked at the link between being exposed to anti-vaccination conspiracy theories, and intentions to vaccinate children. In one study, they gave participants information relating to anti-vaccination conspiracy theories (which included information such as “there is a significant amount of evidence that vaccines hurt more than they help”), information that countered anti-vaccination claims (for example, “…whilst millions of people have been immunized over the years, less than .005% have ever had an adverse reaction to a vaccine…”), or no information at all (the control condition).

They were then given a scenario in which they had to decide whether to have a fictitious child vaccinated for a fabricated disease. In general, they found that the participants who had been given anti-vaccination information were much more reluctant to have a child vaccinated than those who had been given anti-conspiracy information. This finding seemed to occur in part because of perceived dangers of vaccines, as well as feelings of powerlessness and mistrust in authorities.

This presents a clear problem in situations where parents are undecided about whether to vaccinate their children. The medical evidence is clear – vaccines for measles are extremely effective, and while they can be associated with serious adverse events, these are extremely rare. On balance, the sensible, evidence-based decision is to vaccinate. However, medical evidence isn’t always that easy to get a hold of – much of it is behind journal paywalls, and if you’re not in the privileged position of having university/institutional access to these journals, the price of knowledge can be prohibitively high. Moreover, reading these sorts of papers, even with the relevant sort of training to be able to understand the prose, can be like wading through treacle. So unfortunately, we’re in a position where relatively low cost (or free) alternatives to objective medical evidence, presented in an easy-to-read format (like a children’s book) are able to proliferate and sway opinion.

The MMR vaccine and autism – the myth that will not die

Of course, we likely wouldn’t be in this mess if it wasn’t for the legacy left behind by Andrew Wakefield. In 1998, he co-authored a study published in the Lancet, implying a link between the MMR vaccine and a ‘new syndrome’ involving autism and bowel disease. No such link has ever been scientifically validated, and the paper itself has now been retracted amid claims of fraud and data fabrication. Wakefield, who had his medical license revoked by the GMC in the wake of the scandal, claims that he is the victim of an international conspiracy of public health officials, pharmaceutical companies and bloggers to discredit his work. In the aftermath, he seems to have spent a considerable amount of time suing (or threatening to sue) bloggers and journals for defamation, or pitching reality TV shows based on his discredited research.

The reality of the situation is that Wakefield’s claims sowed a seed of doubt about the safety of the MMR vaccine in the mind of the public, and we’re still seeing the repercussions of that today. Melanie’s Marvelous Measles is just the latest in a long trail of nonsense starting in 1998 which has rambled via high-profile celebrities claiming a vast conspiracy theory, and newspapers giving him unnecessary airtime. When I put these accusations to Messenger, she replied “Clearly Pete you are not very good at what you do as What [sic] you have written below in regard to Wakefield is absolute rubbish. His work has been duplicated and also there was a whistleblower from the CDC Just [sic] mid last year who said his study actually showed the MMR vaccine is causing autism.” Presumably, the whistleblower in question concerns the story of William W Thompson, a CDC official who allegedly confessed about a coverup concerning the supposed autism-MMR vaccine link. This is a notion that has since been debunked.

So it’s great that so many people are poking fun at Messenger’s book – it shows that common sense still prevails. But the fact that we’re still seeing anti-vaccination nonsense crop up so frequently shows how much work still needs to be done in making robust scientific evidence about vaccines easily available and easy to understand. Incidents like the Disneyland measles outbreak – in which most cases occurred in unvaccinated individuals – attest to that fact.