If you put the words “Valentino Bocca” and “MMR” into google this week, you will see a page of headlines from news websites to the effect that an Italian regional court has just “proved” the link between the MMR vaccine and autism, by awarding the family of Valentino Bocca ~EU$170k in compensation for a severe adverse reaction he suffered after being administered the vaccine as an infant. Based on the news articles, it appears he suffered a severe fever after his vaccination which resulted in permanent brain damage, and when developmental problems were recognised later, he was diagnosed as autistic.
From the UK’s Daily Mail: “Judge Lucio Ardigo, awarding compensation to the family, agreed. He said it was ‘conclusively established’ that Valentino had suffered from an ‘autistic disorder associated with medium cognitive delay’ and his illness, as Dr Barboni stated, was linked to receiving the jab. Lawyer Mr Ventaloro explained yesterday: ‘This is very significant for Britain which uses, and has used, an MMR vaccine with the same components as the one given to Valentino. ‘It is wrong for governments and their health authorities to exert strong pressure on parents to take children for the MMR jab while ignoring that this vaccine can cause autism and linked conditions.’”
The majority of European countries, recently followed by the UK and the US, now have national compensation schemes in place which compensate the families of children who experience severe adverse events as the result of receiving a vaccination. I fully support that scheme. Adverse events do occur, and they are all the more tragic when they affect children who did not consent to receive the vaccine, and whose parents may not have fully understood the associated risks. Those schemes, however, must be based on demonstrated links between a given type of adverse event and a specific vaccine. Correlation is not causation, and not all illnesses which follow a vaccination are adverse events. The link between MMR and autism which was fraudulently asserted by Andrew Wakefield in the 90s has been demonstrated, time and again, not to exist. This boy deserves compensation because he has a developmental delay as the result of brain damage caused by a severe febrile illness, not because he has autism.
There are complex ethical and scientific issues at play in routine vaccination. The ethics of performing medical procedures on children are murky – we know that adults are comfortable with different levels of risk and complications, as many people refuse chemotherapy. Making these types of decision for children, who can’t make the decision for themselves, is not perfectly straight forward. The risks must be fully understood by the people making the decisions, and weighed against the benefits.
The drop in coverage of the MMR vaccine in the UK, and the subsequent measles outbreaks, demonstrates one of the more straightforward concepts: the risk an unvaccinated child poses to other children, whether they are vaccinated or not, increases substantially as vaccine coverage drops. Likewise, the risk of their becoming infected themselves through more frequent contact with other unvaccinated, infected children rises dramatically. Coverage of the MMR vaccine in the US, for example, is currently estimated at 91.5% for children under three years of age. This is sufficient to prevent sustained transmission of mumps, as mumps is substantially less infectious than measles, and outbreak prevention only requires vaccine coverage over 85%. Because measles is highly infectious, vaccine coverage needs to be over 92% to prevent sustained transmission. The risk to individual unvaccinated children increases very sharply the further coverage drops below this level – but the risk of any adverse events associated with vaccination remains the same.
Assuming that debate on such an emotive issue can be productive, I think this could be a more productive line of argument for those of us who support vaccination to pursue than whether or not the MMR vaccine actually causes autism. Even if it did, unless the risk of autism (or other adverse events) associated with the vaccine was so great that it outweighed the risk of death or disability from measles, mumps and rubella in a community in which insufficient numbers of children were vaccinated, the vaccine would still be worth using. People who oppose vaccination because they believe the MMR vaccine causes autism, therefore, need to demonstrate not only that this is the case, but that it occurs sufficiently often to justify the discontinuation of a vaccine which prevents over a million deaths worldwide each year.