It's hard to estimate the exact damage -- both financial and social -- caused by the 1998 study linking vaccines to autism and the ensuing decline in vaccination rates. But we can try to at least understand some of the impact.
Early last year, The Lancet retracted the study by the now disgraced former British doctor Andrew Wakefield. And last week, the British Medical Journal published an investigative report by journalist Brian Deer documenting how Wakefield altered facts about medical histories of patients to support his claim of a "new syndrome" -- autism and bowel inflammation -- that can be induced by the MMR (measles, mumps and rubella) vaccine (the discrepancies are summarized in this table).
An accompanying editorial in the British Medical Journal explains how the damage to public health from Wakefield's fraudulent study continues.
Vaccinations Save Money Down the Road
Indeed, vaccine economics is simple enough. "Vaccines are one of the most successful and cost-effective public health tools for preventing disease and death" the Centers for Disease Control and Prevention in Atlanta writes in its 2010 budget justification, citing a 2005 study. Every $1 spent on the childhood series of seven vaccines (DTaP, Td, Hib, polio, MMR, hepatitis B, and varicella) saves $16.50 of medical spending later.
"Routine childhood vaccination with these seven vaccines resulted in annual cost savings of $9.9 billion in direct medical costs and an additional $33.4 billion in indirect cost savings." The vaccinations prevent more than 14 million cases of disease and more than 33,000 deaths over the lifetime of children born in any given year.
With such benefits, it's clear why vaccination programs, which have been responsible for nearly eradicating several infectious diseases, are backed by the government. Nevertheless, says the CDC, "Despite this achievement, some vaccine-preventable diseases continue to place significant burden on the public's health."
Naturally, it doesn't help when studies like Wakefield's scare parents. In the U.K., for example, vaccination rates dropped to 80% in the years following the study -- much lower than the 95% the World Health Organization recommends to ensure herd (or community) immunity.
Cost of Outbreaks
By 2008, measles has become endemic for the first time in the U.K., and the U.S. reported the most cases since 1996. And it's not just measles. There have been several outbreaks of childhood diseases in recent years, many of them either in low-vaccinated communities or when one unvaccinated child was infected and exposed others.
For example, in 2008 a measles outbreak in San Diego -- the first since 1991 -- was caused by a 7-year-old boy who was intentionally unvaccinated and contracted the disease in Switzerland. In all, 839 people were exposed, and 11 other unvaccinated children were infected. The high vaccination rate in the rest of the community helped keep the outbreak from becoming an epidemic, according to research published in the journal Pediatrics.
The financial toll of that single outbreak amounted to about $177,000. The cost per case was $10,376.
Other documented cases further emphasize the economic burden of outbreaks caused by unvaccinated individuals:
The total cost of containing one case of measles after an unvaccinated student returned from India in 2004 to Iowa was $142,452.
Another mumps outbreak in Nova Scotia in 2007 -- traced back to an inadequate immunization regimen among a certain age group of Canadians -- cost an estimated total of nearly CDN$2.5 million or $3,511 per case.
A 2002-2033 measles outbreak in Italy, which led to the hospitalizations of more than 5,000 people, had a combined estimated cost between 17.6 million euros and 22.0 million euros. That amount of money could have inoculated between 1.5 million and 1.9 million children with a dose of the MMR vaccine.
Depending on the severity of the outbreak and the disease, the economic toll can be high. But how can anyone really put a price tag on the 10 infant deaths in this year's outbreak of whooping cough in the U.S.?
Few of us really know what it was like before vaccines became common, or can imagine what would happen if we stopped vaccinations. And with the low visibility of the now-controlled diseases, it's easy to imagine that they're relatively harmless. That's one reason why the anti-vaccination movement was able to spread as fears about vaccines grew in the minds of some people to outweigh their fears about poorly recalled infectious diseases. The Wakefield study simply gave the anti-vaccine movement a shot in the arm (pun intended), and the pain is still being felt.
Vaccination rates have never fully recovered from the decline caused by the Wakefield study, despite at least 25 published, peer-reviewed studies that found no link between MMR and autism, and despite autism cases multiplying in Japan even after the MMR vaccine was withdrawn there in 1993 due to fears that one component might be causing meningitis. Judging from the reactions within the anti-vaccine community, the BMJ report is unlikely to sway the true believers. Unfortunately, the costs -- in money and in lives -- are likely keep mounting for all of us.