The Monovalent Mirage
A pretend alternative to the MMR exists, just ask Andrew Wakefield
Yesterday Deputy Health and Human Services Secretary and Acting CDC Director Jim O’Neill decided to resurrect President Donald Trump’s absurd claims about the need to “break it up” regarding the measles-mumps-rubella (MMR) vaccine. There is another Advisory Committee on Immunization Practices (ACIP) meeting in a couple of weeks, so presumably O’Neill was laying the groundwork for what I suspect will be a top item on the agenda: descheduling the combination MMR.
Trump’s chaotic press conference where he expanded on his theory of how autism caused by Tylenol was somehow also caused by the MMR. Specifically, Trump said that the MMR—a trivalent combination of 3 vaccines—needed to be broken up into its monovalent components. Where did this idea come from? I doubt Trump has been running non-inferiority trials on childhood vaccine formulations while ushering in the MAGA Golden Age of authoritarian rule, so he must have got it somewhere.
I also doubt that Trump is reading ancient retracted papers in The Lancet, or reading The Lancet at all, so I’m guessing that this came from HHS Secretary Robert F. Kennedy, Jr. Kennedy isn’t just reading the paper in question, he’s besties with the guy who wrote it, disgraced and disbarred physician Andrew Wakefield.
Wakefield and Kennedy’s friendship is forged in the fire of profiting handsomely by lying about Wakefield’s thoroughly debunked finding that the MMR vaccine causes autism. Wakefield has been described by a former CDC epidemiologist as “the chief architect of a body of work that Kennedy believes and follows to this day.”
The MMR vaccine does not cause autism and Wakefield’s study could not have shown that even if it did. However, Wakefield and Kennedy continue to claim otherwise, alleging a conspiracy by Big Pharma to silence their brave, quavering voices in order to profit from pushing dangerous, useless autism vaccines on children. Though their ideas are discredited, they have spent the last two decades cashing in on their persecution with lawsuits, fundraising by Children’s Health Defense (the anti-vax activism organization Kennedy founded), media content, and wellness scamming.
Kennedy is a lawyer and he’s good at finding loopholes to exploit in his neverending quest to end vaccination. He found one in Wakefield’s invalidated paper: the idea that the combined MMR vaccine causes autism, but the monovalent M, M, and R vaccines implicitly do not.
Although the combined MMR does not cause autism at all, that will not stop Kennedy’s anti-vax minions on the ACIP from descheduling it on that basis and recommending monovalent vaccines in its place.
Bye Bye MMR
The ACIP will go over more than five decades worth of data for the MMR showing it is safe and effective and eliminated measles from the US and saved millions of babies from congenital rubella syndrome. They will fixate on the tiny risk of febrile seizures in children under age 4, just as they did at the last ACIP meeting for the MMRV. They will say the risk of febrile seizures can’t be reduced with acetaminophen because it causes autism. They will make up or manipulate data to suggest that there is evidence the MMR causes autism, which should not be difficult considering Kennedy has installed David Geier and Mark Blaxill, two of his favorite MMR-causes-autism anti-vaxxers, at CDC to do so. ACIP will assert that monovalent formulations are safer alternatives to the combined MMR. They will vote to not recommend the MMR to children under age 4. It will be removed from the Vaccines for Children (VfC) program and no longer covered by many insurance companies as well as Medicaid. Millions of people will lose access to the MMR.
Monovalents are very inconvenient for people who would like to not get measles, mumps, or rubella, because it means 6 shots instead of 2. That alone will discourage uptake, but it may not matter if monovalents aren’t on the market at all. Currently, monovalents are not available because they are not FDA approved. The manufacturers (Merck and GSK) can submit licensing applications for monovalent formulations, but they will be unlikely to carry out the clinical trials needed to get approval. Kennedy announced in May that all new vaccines will be required to undergo placebo-controlled trials. No Institutional Review Board (IRB; clinical trial ethics oversight body) would ever approve a clinical trial that exposed babies to potentially deadly or permanently disabling diseases when a safe, effective vaccine exists. Kennedy knows that. If there is no FDA approval for monovalent formulations and access to the combined MMR, then effectively the entire US will lose access to any type of immune protection to measles, mumps, and rubella.
I don’t think most people realize that this means recurrent epidemics of deadly viruses raging through their children. Rubella epidemics will cause spontaneous abortions, stillbirths, and congenital disabilities to skyrocket, in addition to deaths from the acute disease. Not only will millions get measles, but the resulting immune amnesia at scale will predispose huge populations to other infections. People will die of SSPE caused by measles decades after being infected as unvaccinated children. It will make everyone sicker. It will kill a lot of people.
Kennedy, Wakefield, and all their fellow anti-vax travelers have yearned for this outcome for years. They are committed to ensuring as many children meet this fate as possible. Survival of the fittest babies.
I spend a lot of time thinking about why anti-vaxxers believe what they do. Leaders of the movement like Kennedy and Wakefield are not dangerous because they irrationally believe their own crackpot ideas about how viruses and immunity work, but because they also are very rational about how to destroy vaccination to realize their goals (and make money while doing it). They not only lie, but they know the best lies to tell. Kennedy is very effective at using obviously untrue, pseudoscientific garbage to justify wildly irresponsible and dangerous health policies. Lying about monovalent MMR will be one more feather in his cap, with the next generation of Americans paying the price.
As an immunologist I despair at seeing so much scientific progress being undermined by false claims made by non-experts in the field for what appear to be spurious ideological reasons. Our immune systems have evolved to deal with an environment filled with enormous numbers of different pathogens and their associated antigens which we encounter almost daily, so combining vaccines isn't likely to overwhelm the immune system, and has the advantage as you say of reducing the total number of visits to become fully vaccinated.
Particularly with the highly infectious Measles virus, which has the potential to cause immune amnesia by wiping out memory of other infections and vaccinations, there is an imperative to ensure that the child is protected from an early age. Anything that makes it less likely that parents will be non-compliant with the full schedule of vaccination is thus undesirable.
Finally what happens in the USA has a knock-on effect around the world, because most pharmaceutical companies prefer to market similar formulations across global markets for obvious commercial reasons of scale, reproducibility and profit margins. So even though I don't see any evidence of our NHS changing guidelines and recommendations for vaccinations, will all the products continue to be manufactured and available and at a reasonable price into the future?
Beautiful commentary!! What is wrong with Kennedy? Is he that greedy or does he need to be put on a pedestal and admired. Why can’t he see what he is doing. Reminds me of Alex Guinness in bridge over the river Kauai when he said “ oh my God what have I done “.