Question

Taylor is a 1 year old male at the doctor for his first-year wellness visit and necessary immunizations.

Taylor's mother approaches the pharmacist abour concerning regarding the link between autism and immunizations. How would you respond to the concerns of his mother? Write an ethical response to her question (500 words roughly).

Answer 1

Autism is a developmental disability caused by differences in functioning of the brain. Taylor’s mother concern that autism is linked to vaccines, may be due to the report on MMR (measles, mumps, rubella) vaccine in the 1998. British gasteroenterologist Andre Wakefield and his colleagues published a paper in lancet journal that indicated autism in eight children out of 12 that showed symptoms of autism within a month of receiving MMR vaccine. The report indicated that MMR vaccine caused chronic inflammatory bowel disease that could lead to autism. However, this report did not include any control children. Hence, the report could not be authenticated. As a result of this report, measles vaccination dropped in Uk from 92-95% to 60-80%. This effect also spread to Canada. Despite several reports later in 2001 showing no link between MMR and autism, the vaccination numbers were affected.

In 2004, legal action was taken by parents of the children affected by autism after MMR vaccination against the MMR vaccine company. Lancet editor Dr. Richard Horton indicated involvement of attorneys that were going to file lawsuits against vaccine manufacturers in the Wakefield study. The Wakefield report had no nondisclosure of conflict of interest. Some of the co-investigators were unaware of the contract and payment related to legal cases. Due to no disclosure of conflict of interest, the conclusions of the Wakefield study cannot be evaluated as the results can be assessed by the researcher opinion cannot be sought for conclusions. Lancet retracted the Wakefield paper in 2010, when many of the co-authors of the report retracted from the study. There were also allegations of fraud by Wakefield due to falsifying data. Reports by Institute of Medicine in 2011 revealed no incidence of autism in children given eight vaccines. A 2013 CDC study has also not shown any link between vaccines and autism.

The MMR study by Wakefield and its ethical concerns caused an international debate whether the money spent on MMR and autism studies could have been better utilized for other valuable research areas.

Vaccines contain an ingredient thimerosal, which has been studied extensively for its link to autism. Thimerosal is used as a preservative to prevent contamination of multidose vials of vaccines. Thimerosal has mercury in it. Concerns were raised since, mercury from fish is toxic to humans. This mercury is called methylmercury and cannot be metabolized by the body, causing its excretion. High exposure to critical levels of this compound causes neurological effects that are harmful. However, thimerosal has ethylmercury, which can be metabolized by human body, which is much less harmful than ethylmercury. This preservative has been removed from vaccines now, despite it being shown that there is no link between thimerosal and autism. The only vaccine that has thimerosal is flue multidose vaccines. Institute of medicine reported in 2004 that mercury in vaccines had no effect on neurological disorders.

Concerns were also raised against increasing use of vaccines in children, which may result in autism. However, no report has indicated that increased exposure to vaccines can cause autism. Aluminum used in vaccines was also linked to autism. However, the amount of aluminum used in vaccines is very low in quantity as compared to breast milk and formula milk. Aluminum is also not linked to any infant of childhood heath issues.