After their COVID success, antivaxxers are going old school on MMR

Stephen King once wrote, “Sooner or later, everything old is new again.” Apparently, however, there is now a caveat. Everything old is new again, except when it’s old again. Let me show you what I mean, with one of the oldest targets of the antivaccine movement of all, the MMR vaccine.

The MMR (measles-mumps-rubella) vaccine became a major focus of the antivaccine movement based on Andrew Wakefield‘s fraudulent case series published in The Lancet in 1998 that falsely linked MMR to autism based on what was discovered by Brian Deer over a decade later to have been fraudulent research. So how is everything old from antivaxxers repurposed to attack COVID-19 vaccines become old again (or been repurposed against an old vaccine)? Simple. I saw a Substack article yesterday about MMR and COVID-19 vaccines that brought this point home to me. In this case, the antivaxxer is James Lyons-Weiler, an “old school” antivaxxer known for demonizing aluminum adjuvants who rapidly pivoted to COVID-19 disinformation when the pandemic hit, and the Substack article is entitled The Next Battle Will Be Over Measles Vaccine Failure. Here is Our Preemptive Strike of Facts, Rationality, and Kindness. You’ll know where he’s coming from with respect to MMR immediately upon reading the tag line for the post: “Failure to update the measles vaccine has made it impossible to expect sustained protection in many of the vaccinated. Evolution is real.”

Evolution is indeed real, and it has been the force that has led to the emergence of COVID-19 variants, such as Delta and then Omicron, each acquiring ever more “skills” at evading preexisting postinfection immunity due to prior variants, with Delta evading immunity from the Wuhan strain, and Omicron evading immunity from the Wuhan and Delta strains, and now newer Omicron variants evading immunity from previous Omicron variants. Antivaxxers love to try to blame vaccines for this evolution, conveniently forgetting to note that these variants are at least close to as capable of evading “natural” immunity from previous infection as they are at evading immunity due to COVID-19 vaccines. It’s evolution. Letting a virus circulate so widely in such a huge population provides fertile ground for selective pressure from “natural” and vaccine-induced immunity to work on the virus and promote the evolution of variants able to evade prior immunity due to either or both. The way to minimize that evolution and the likelihood of variants emerging is to decrease the circulation of the virus as much as possible.

That’s not the argument James Lyons-Weiler makes, of course.

The Gish gallop against MMR begins

Lyons-Weiler’s article is very long and cherry picks a lot of studies, while citing Andrew Wakefield a lot. I’m not so much going to discuss each and very claim in the article, as that would soon balloon this post to a book-length size that would be long even by Orac standards. (Lyons-Weiler is indeed good at the Gish gallop—or, as it’s now more commonly called, firehosing—in which he throws claim after claim and study after study out there, each of which could take a blog post to refute by itself, leading those seeking to refute him to become exhausted by the effort. Instead, I’ll try to stay at a (mostly) high level overview of the overall argument and how it’s the same damned argument about MMR and measles being recycled to COVID-19 and then back to MMR and measles again.

Here’s how Lyons-Weiler introduces his idea regarding measles and MMR:

This article is designed to arm the public with the specific facts and citations they need for the impending restart of the war on facts and information that will be based on deaths reported to be due to measles. There is a slew of links to my pre-COVID articles at the end; each of those, also is a resource for those of you who will show up and educate the committees and legislators on the facts of measles vaccine failure. It will take a while, but read to the end. I offer a protocol to fight for. There’s a lecture by me on HPV Type Replacement and a quote and a video lecture from Dr. Wakefield. – JLW

Vaccines have stripped the human population of a valuable asset against measles virus infection-related immunity, and we’re going to see larger numbers of cases, hospitalizations, and deaths – in populations that prior to the vaccine program were, well, immune. You need resources to be able to explain this reality. Here they are.

Here you see the “old” antivax narrative that “natural immunity” is better and that “vaccine” immunity somehow “stripped the human population” of immunity against pathogens. Longtime regulars and people who have followed the antivax movement for along time will immediately recognize this particular “natural immunity” trope and how antivaxxers have long claimed that “natural immunity” against measles is far superior to MMR-induced immunity. More importantly, Lyons-Weiler is setting up a narrative in which he takes an older narrative about MMR and measles that was repurposed for COVID-19 and then “back purposes” it to measles and MMR again.

He begins by attacking Dr. Vincent Iannelli for his refutation of Robert F. Kennedy Jr.’s letter to the Prime Minister of Samoa during a deadly measles outbreak there in the beforetime—the immediately beforetime, actually, namely fall 2019—in which measles killed dozens of children. To understand the misdirection, you have to know that the measles vaccine in the MMR is a live attenuated virus vaccine, in which a weakened form of the measles virus that can provoke immunity to measles but not cause disease. I’m not going to rehash this whole antivax trope and its refutation other than to mention that a key claim by RFK Jr. in his letter was that what was really killing all those children in Samoa wasn’t “wild type” measles but rather a mutated measles strain derived from the MMR vaccine. Lyons-Weiler, in what he thinks is a “gotcha” moment, claims that Dr. Iannelli got it wrong and missed an article that used PCR to show that 38% of cases of measles during the Disneyland. He didn’t; he addressed that claim and pointed to real data and how the data were analyzed by the California Department of Public Health. Yes, children can have a febrile rash in reaction to recent vaccination with MMR, which is why using PCR to differentiate vaccine strain measles from wild type measles is important to prevent unnecessary isolation and treatment. Indeed, the authors of the paper wrote:

During measles outbreaks, it is important to be able to rapidly distinguish between measles cases and vaccine reactions to avoid unnecessary outbreak response measures such as case isolation and contact investigations.

And:

During measles outbreak investigations, rapid detection of measles vaccine reactions is necessary to avoid unnecessary public health 

Any pediatrician knows that, but apparently Lyons-Weiler doesn’t. What he does know is how to reprise old antivax arguments against MMR, repurpose them for COVID-19, and then re-repurpose them for MMR again. In this case, he’s resurrected an argument that was made about MMR for measles by Andrew Wakefield right before the pandemic and then repurposed by Geert Vanden Bossche for COVID-19 during the pandemic claiming that it was the vaccine driving the emergence of new variants. Of course, it must be conceded that immunity due to vaccination can be a selective pressure that leads to variants that can evade immunity, but what antivaxxers don’t acknowledge it that “natural immunity” after infection is also such a selective force. To them, “natural immunity” is somehow this mystical magical lifelong immunity, even though in the case of COVID-19 it most definitely is not.

I discussed this argument in depth more than once, first when Wakefield made it about MMR, then when Vanden Bossche made it about the then-new COVID-19 mRNA vaccines, and then when Vanden Bossch made it again, and guess what? Lyons-Weiler is rehashing exactly the same argument again. He even uses the same examples that Wakefield used when warning of a “mass extinction” due to a supposed plethora of ever more immune-evading and deadly measles variants produced by MMR. The idea is that, just as COVID-19 vaccines are “leaky” in that they prevent severe disease but are “leaky” in that they don’t prevent infection or transmission as well, so, too, supposedly are MMR vaccines. Never mind that the measles vaccine is very effective—albeit not 100%—effective at preventing infection, way more effective than COVID-19 vaccines are. Apparently even a failure rate of a few percent is “leaky” to antivaxxers, who do so love the Nirvana fallacy, in which any vaccine that isn’t perfectly effective and perfectly safe is unacceptably dangerous and ineffective.

Wakefield cited a common pre-pandemic example of Marek’s disease in chickens, for which the vaccine only prevents symptoms of the disease, namely the tumors caused by the virus that causes the disease. Vaccinated chickens can still spread disease. Under normal conditions, a highly virulent strain would kill the host before the virus could spread too far, thus selecting for strains that are not too virulent. However, a leaky vaccine changes the selective pressure and permits the evolution of highly virulent strains because the virus retains the ability to continue to spread among vaccinated populations, leading to the vaccine selecting for the most virulent mutations. Basically, Wakefield cited the single example of this phenomenon that has been suggested by experimental evidence, and even the the study’s main author has written that, even if this phenomenon occurs with a human vaccine—it doesn’t, as far as we know, not with MMR and not with COVID-19 vaccines—that’s an even more compelling reason to be vaccinated. After all, if a human vaccine lets deadlier versions of a disease flourish, that is all the more reason to be protected from those deadly strains.

The firehose pivots from COVID-19

Now let’s compare Wakefield in 2019…:

Muñoz-Alía et al. have recently identified a variant of measles virus that escapes neutralization by monoclonal antibodies targeting the neutralizing epitope antigenic site, the main target of protective neutralizing antibodies.13 Two measles virus genotypes emerged in their study: those with (D4.2) and those without (D4.1), the genetic variant that allowed escape from neutralization. The former had emerged in countries that have vaccinated intensively and for prolonged periods against measles (UK and France). The latter was present in isolates from East Africa. The D4.2 subgenotype viruses showed a trend toward diminished susceptibility to neutralization by human sera pooled from North American donors. In other words, a mutant has emerged against which vaccine immunity is reduced in the face of intensive, imperfect vaccination, a situation that deserves our urgent attention.

Let me just briefly mention where Wakefield published the article from which I took the above excerpt, specifically in the Journal of the Association of American Physicians and Surgeons (JPANDS), the house organ of that medical John Birch Society disguised as a medical professional society, the Association of American Physicians and Surgeons (AAPS). At the time, I noted that the study quoted by Wakefield never actually found a statistically significant difference in neutralization—note Wakefield’s weasel words “trend toward”—or showed that the new strains were more virulent or transmissible in vaccinated children.

…with Lyons-Weiler in 2022…:

Another flaw in Ianelli’s logic was to point to the fact that >95% of measles cases did not involve more recently evolved measles types. As a respiratory virus, measles has a seasonality, and newer types require more time than “now” to spread worldwide. In fact, multiple lineages of measles are circulating in the human population, just like in HPV and many other endemic viruses.

Also, in measles, as in all viruses, the most deadly types will die out with their victims. Take, for example, the distant evolutionary branch within measles genotype D4. First described as subgenotype D4.2, the virus can be neutralized by vaccine-induced monoclonal antibodies that target the neutralizing epitope (NE). In fact, subgenotype D4.2 has lost epitopes associated with half of the known vaccine-related antigenic sites.

…who then cites the article:

After several years with a low incidence of measles cases, large outbreaks occurred in Europe between 2010 and 2012 after the introduction of the D4-Enfield lineage at the end of 2007, which replaced the previously circulating D4-Bucharest lineage viruses [1,2]. We have also observed this replacement in Spain, whereby all viruses from samples collected after 2008 belonged to the D4-Enfield lineage, whilst the older ones were of the D4-Bucharest lineage. The reasons for the successful spread of the D4-Enfield lineage MeV in Western Europe [2] are not well understood. The development of major measles outbreaks is related to the presence of susceptible population groups in which the virus can spread easily. However, vaccination coverage in Western Europe and Spain was already high before 2010–2012, when these large outbreaks occurred [3,4]. Among the factors that might have contributed to this widespread MeV dissemination could be the special features of the viruses themselves. 

Lyons-Weiler does cite a different study than the one Wakefield cited. It’s from 2018, and examined the measles strains isolated during major outbreaks in Spain in 2011 and 2012. While Lyons-Weiler blames the emergence on the vaccine, pointing out how Spain was “highly vaccinated,” the authors themselves note that the strain had been found in the UK in 2007 (when UK vaccine coverage was poor, thanks to—you guessed it!—Andrew Wakefield) and India. More importantly, the predominance of various measles strains can vary with time due to reasons other than natural selection from prior immunity. Sometimes, as we often see with different influenza strains, it appears almost random. The authors only speculate about which features of the D4-Enfield lineage might make it more able to infect.

Of course, Lyons-Weiler cherry picks. He ignores evidence that suggests that the long-term continued transmission of measles variants does indeed appear to occur primarily among the unvaccinated in undervaccinated populations, not the vaccinated. I also note that other studies have examined some of the measles variants that have emerged and failed to detect a significant difference in how susceptible these strains are to current measles vaccines, as the authors of one study put it, “thereby substantiating the use of current vaccines to meet measles elimination target of 2023 set by World Health Organization for South-East Asia Region.” While it’s true that an argument has been made for a “paradigm shift” in which the vaccine strain of measles in the MMR needs to be optimized based on the emergence of new measles variants—which, I note, occurred over the course of a couple of decades from all over the world, not in just two years, as has been the case with COVID-19—I noticed that the number one paper making this argument from before the pandemic was co-authored by none other than Didier Raoult, who in the wake of his promotion of hydroxychloroquine early in the pandemic has now found nearly 50 of his papers flagged by PLoS with “expressions of concern.”

In any event, arguments like these fail on their own merit, but we also have to acknowledge another issue.

Why measles is not like COVID-19

Interestingly (to me at least and, I hope, to you), the same authors cited by Wakefield, Muñoz-Alía et al, published a paper in 2021 in which they engineered a large panel of measles virus variants with engineered mutations affecting the proteins on the surface of the virus that the human immune system recognizes and targets via antibodies. They then used these engineered strains to study how well they evaded neutralizing antibodies and found that:

…to escape immunity, a disease-causing, or pathogenic, measles virus would need to generate a large set of mutations — simultaneously — affecting multiple parts of the surface proteins. Simultaneous disruption of at least five antibody targets is required before the virus starts developing resistance to the diversity of neutralizing antibodies in the bloodstream. The authors have characterized the probability of this occurrence as “vanishingly small.” Further, they found that even if a measles virus were to mutate extraordinarily and escape neutralizing antibodies in the blood of a vaccinated person, the resulting strain could not cause disease. It would have lost the ability to bind its receptors which are the “keys” to the “doors” in and out of a cell (read more about one door, called nectin-4, in a 2019 article).

Here’s a link to the original paper, if you’re interested.

This result makes sense because, unlike COVID-19 vaccines, which use only a single protein from the virus as an antigen to provoke an immune response, MMR uses a weakened strain of the measles virus, which would generate many more proteins from the measles virus. Wakefield can’t be said to have ignored this paper, mainly because it hadn’t been published yet when he wrote his fear-mongering screed. Lyons-Weiler doesn’t have that excuse, as this paper was published a year and a half ago. On the other hand, given that Wakefield has apparently updated his “analysis” that supposedly shows that mass vaccination with measles vaccines will somehow result in deadly measles strains that will overcome vaccination and kill us all; so maybe I’m being too kind to him.

In any event, even very low probability events can occur when a disease is circulating very widely, and what’s the difference between measles and COVID-19? COVID-19 is still circulating widely among billions of people, and measles—thankfully!—is not, even if there are occasional major outbreaks in undervaccinated populations. In other words, yes, it’s possible that the selection pressure of MMR might result in a measles strain that evades immunity, but it’s incredibly unlikely based on what we know today. All the Gish galloping firehose of disinformation by Lyons-Weiler is just handwaving to misdirect you from that conclusion.

“The Wheel of Time turns, and Ages come and pass, leaving memories that become legend. Legend fades to myth, and even myth is long forgotten when the Age that gave it birth comes again.”

Robert Jordan, The Wheel of Time series.

Everything old is new again and then old again

Lyons-Weiler concludes with a number of proposals that we’ve seen before many times. For instance, his first four are standard antivax boilerplate:

1. Public health and the vaccine industry should end their attacks on exemptions. That battle is much ado about nothing: further vaccine coverage will not benefit public health further. Their attacks increase vaccine resistance. Respect choice. NO MEANS NO. Take up our cause, and see what happens. You will be amazed.
2. Vaccine injury and death denialism must end. Period. This means by everyone. Doctors first. Special Masters in the NVICP next. Witnesses for the defense (HHS) next. CDC. ACIP. VRBAC. Everyone. You have lost. Take up our cause, and see what happens. I am being dead-sober serious.
3. States without exemptions should put them in place with new legislation. As fast as is humanly possible. There should be bipartisan support for this path forward.
4. Measles vaccination should not be seen as a panacea, but rather a tool in the toolbox that individual persons and families might want to choose for their children or for themselves.

None of this has to do anything with addressing the claimed old-new-old tropes about the measles vaccine that Lyons-Weiler fantasized about in his article, even if they were scientifically valid concerns. True, Lyons-Weiler is nice enough at least to admit that a child with measles or mumps is a danger to immunocompromised individuals and suggest that parents let the school nurse know if their unvaccinated child catches measles, but that’s about it. The rest of his proposals tend to involve treating vitamin A as a panacea and cure-all for measles (it’s not) and updating the measles vaccine every year or two for new strains, which is impractical and unnecessary. It might at some future time become necessary to update the strain of measles used in MMR to “address local strains whenever possible,” but nothing Lyons-Weiler has argued or written suggests that it is necessary now, much less every two years.

Also, let’s say that health officials actually did update the measles vaccine every couple of years to take into account circulating strains. You know what antivaxxers like Lyons-Weiler would say. They’d attack it as “unproven” every couple of years, in exactly the same way they attack influenza vaccines, which are updated every year, as “unproven” and the bivalent COVID-19 booster as inadequately tested and unproven. You know they would. (At least, I do.)

To drive home how everything old is new again and then becomes old again, Lyons-Weiler finishes by arguing that asymptomatic spread of measles in a highly vaccinated population is the real reason why MMR-based immunity is so long lasting and how outbreaks really happen. Even if it is true that asymptomatic infection by measles in the vaccinated exposed to measles is common, guess what? As is the case with COVID-19 vaccines, that is not a reason not to vaccinate, but rather a reason to vaccinate! After all, the purpose of vaccines is to prevent disease; prevention of transmission, while highly desirable, is not as essential.

As you can see, every antivax argument of the sorts repeated Andrew Wakefield, then Geert Vanden Bosssche, and now James Lyons-Weiler was old before COVID-19 ever hit, having first been used against measles vaccines (and, although I didn’t discuss it in this post, pertussis vaccines). Then the arguments were repurposed to be weaponized against COVID-19 vaccines. Now that they’ve been so unfortunately successful in this context and have now taken hold, naturally antivaxxers are revisiting them for MMR, because antivaxxers want to eliminate all vaccine mandates, not just COVID-19 vaccine mandates. They see their success repurposing old antivax tropes against COVID-19 as their opportunity to pivot back to old vaccines like MMR and use these arguments for their original purpose before the pandemic: To attack childhood vaccines. The difference, unfortunately, is that now that they’ve established these arguments against a new pathogen, they might well succeed in using them against the old pathogens against whose vaccines they were originally developed.

Truly, everything old in antivaxland is new again but becoming old again. The Wheel of Time turns.