True breakthroughs are rare (the cause of Aids; Dolly the Sheep) and almost none is granted the kind of establishment send-off as the research unveiled that morning. For months, private briefings had teased the press regarding what was coming. The hospital installed answering machines to field the alarm it expected. And both its medical school’s dean and a top professor stepped forward with a mid-rank lab researcher to introduce a “study” that wouldn’t only stalk the nightmares of a generation of young parents, but shovel trenches for a war that has raged ever since.

“The study has identified a possible link between gut disorders in children and autism,” a press release explained, with 21 minutes of video clips to maximise TV pick-up. “In the majority of cases, the onset of symptoms occurred soon after the MMR vaccination.”

Ahh, MMR: the measles, mumps, and rubella shot. What Brit beyond their teens never noticed the fallout that rained from that morning’s event? Over months and years, vaccination rates slumped, and measles returned to kill or maim children as the most agonising health scare since the early years of Aids unleashed outbreaks of fear, guilt, and disease. That night, TV news tracked the Royal Free script:

“Questions were raised today about the safety of the combined mumps, measles, and rubella vaccine…”

“Claims there could be a link between a common childhood vaccine and autism…”

This was February 26, 1998, with the paper datelined to the following Saturday. Beneath a technobabble title, 13 authors were listed. But only one wrote it: Andrew Wakefield. Then aged 41, a bowel surgeon by training, he had a large-chested voice, a patrician manner, and what admirers described as “charisma”. Dressed in a black suit at a blue-clothed table, with the dean stood to his left and the professor sat to his right, he pitched a story to draft a page in medical history. He had gathered data from a series of 12 developmentally challenged kids, anonymised in the paper by number. They had been admitted to the Royal Free for an unprecedented five-day battery of tests he had devised, including needles into their spines, tubes deep into their guts, brain scans, x-rays, and blood work.

His first “finding” would echo down the decades like machine-gun fire in a cathedral. For eight of the 12 (aged from three to nine), the paper said their parents, quizzed by doctors running the tests, recounted a terrifyingly similar experience: a son or daughter was developing normally, received a shot of the three-in-one “live virus” MMR, and showed autistic symptoms within days.

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The paper further claimed discovery of a new medical “syndrome” of both brain and bowel disease in the children. All but one, it reported in text and tables, had developmental issues plus “chronic enterocolitis” — inflammation of both the large and small intestine. “It’s a moral issue for me,” Wakefield told his audience, calling for MMR to be suspended in favour of single shots for measles, mumps, and rubella. “I can’t support the continued use of these three vaccines, given in combination, until this issue has been resolved.” The dean equivocated, but the professor backed Wakefield. And so was born an intractable controversy as the paper was leveraged to launch a crusade: first against this vaccine, then later another… and another… all the way to SARS-CoV-2.

“It’s not a vaccine at all,” Wakefield would rail against the latter at the height of the Covid pandemic. “It’s actually genetic engineering.” Back in 1998, his ground had been firmer, even based on a mere dozen patients. Many medical insights begin with short case series. Autism: 11 kids in the Baltimore area, for example. Aids: five men in Los Angeles. That Thursday, it seemed possible the Royal Free had got lucky: maybe catching the first snapshot of a hidden epidemic of catastrophic injuries to kids. Massive studies around the world, however, found nothing to confirm this, leaving a whale of a riddle rotting on the beach. If parents of two-thirds of 12 children with developmental issues blamed the triple shot for the sudden onset of autism, why weren’t vaccine victims everywhere? Wakefield doubled down, claiming they were. But, while the medical establishment sought refuge in authority, urging the public to trust experts, not a lone-voice maverick, an old-school Sunday Times investigation, run by me, would pepper revelations across more than the next decade, revealing what this doctor had done.

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Our first report splashed in February 2004, almost exactly six years after the press conference. “Revealed: MMR research scandal,” was the front page, igniting a new media firestorm. We had discovered a monstrous conflict of interest that Wakefield kept hidden, then denied. For two years before his “moral issue” surfaced — and before any of the children set foot in the hospital — he had been payrolled by a small-town solicitor named Richard Barr to help lead an attack on MMR. Unlike expert witnesses, who give advice and opinions, the doctor was delegated to arrange the tests, building pressure for a speculative lawsuit.

“I have mentioned to you before,” Barr wrote to Wakefield, six months before the Royal Free event, “the prime objective is to produce unassailable evidence in court so as to convince a court that these vaccines are dangerous.” Barr filed the lawsuit at the Royal Courts of Justice eight months after the breathless press conference. Wakefield claimed fees of £150 an hour (about £254 an hour at late 2022 values), drawn from the government’s legal aid fund. So, as he recruited the children and wrote the paper, he had a financial incentive not only to trigger a client-grabbing furore, but to keep it going for as long as he could.

Those clients poured in — nearly 1,600 families — as journalists were duped to fuel the scare. And by late 2003, when Barr’s lawsuit collapsed, Wakefield had. been handed £435,643 (about £738,000, or nearly US $900,000, at last year’s values), plus expenses, in taxpayers’ money. But as he gazed into the glare of TV lights, his legal deal was only one of his secrets. As he’d made his call for a switch to single vaccines, he forgot to mention that eight months previously he’d filed a confidential claim at the London Patent Office for his own, supposedly safer, single vaccine.

His shot wouldn’t have worked. When I asked experts about it, they laughed. But four days after the Royal Free event, he put it to the medical school that they start a joint company to raise money for this, and other products he’d imagined, which only stood much chance of enticing investors if confidence in MMR was damaged. Yet this doctor wasn’t shy of shady stuff, even hopelessly suing me for what a High Court judge described as “public-relations purposes”. So I carried on digging for years, on-and-off, exposing secrets and lies by the bucket. “If my son really is Patient 11, then the Lancet article is simply an outright fabrication,” complained the father of a California boy brought to London for the tests, after I found the dad and showed him a copy. “I know that paper is not right and fraudulent,” the mother of another boy, from the north of England, emailed me. “I can see that from what was written about my son.”

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Confidential medical records (lawfully checked) confirmed the parents’ right to be angry. Some of the kids said to have symptoms days after MMR, actually had them before or up to nine months later. Some were reported with “autism” without this diagnosis. Tests for bowel disease came back normal. None of Wakefield’s data revealed enterocolitis: the chief gastrointestinal symptom was constipation. Parents blaming the shot, moreover, wasn’t even a “finding” — it was a covert qualification to take part. Records showed that not eight, but 11 of the kids’ families named the vaccine at the hospital (the 12th’s later joined them to file a claim in the lawsuit) — a give-away number, sure to provoke questions, if Wakefield hadn’t airbrushed the figures. The poisonous truth was that all but the American family had links with vaccine activists caught up in Barr’s plans, pointing them to Wakefield’s project. And, surprise, legal aid authorities at the time insisted that, for cases to qualify for public funding, alleged symptoms must follow within days.

Wakefield was finished, but he couldn’t say sorry. And when The Sunday Times ran with “MMR doctor fixed data on autism”, he fought back, denying all error. “The notion that any researcher can cook such data in any fashion that can be slipped past the medical community for his personal benefit is patent nonsense,” he argued, in one of countless lengthy rejoinders. He wasn’t alone in not wishing us well. Much of the medical establishment was aggrieved. “I will now defend the heretic Dr Andrew Wakefield,” sneered, for instance, Bad Science author Dr Ben Goldacre. “The media are fingering the wrong man, and they know who should really take the blame: in MMR, journalists and editors have constructed their greatest hoax.”

But tunes changed abruptly in May 2010, after a hearing longer than the trial of OJ Simpson in which the General Medical Council vindicated what we’d published and scrubbed Wakefield from the doctors’ register. The Lancet, which for 12 years defended the paper, retracted it. And, after opposing the GMC proceedings, the British Medical Journal highlighted the irony. “It has taken the diligent scepticism of one man,” the BMJ said in an editorial, “standing outside medicine and science, to show that the paper was in fact an elaborate fraud”.

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I won’t forget that, and not just for my name-check but because the establishment mobilised to vilify journalists rather than hold a mirror to themselves. How could it be that all the doctors and professors, royal colleges and government experts, steeped in more medicine than I’d know how to spell, failed to spot that the paper was a scam? It was as if they couldn’t accept the ugly truth was even possible. A chap wouldn’t do such a thing. So, in plain view of a dozen co-authors, platformed by a hospital and its medical school, and published after peer review in a most prestigious journal, he’d effortlessly exploited conceits and vulnerabilities that remain below the radar to this day.

Personally, I’d trust The Daily Mail before The Lancet (especially the football and TV data). But, if Wakefield had ploughed a field of less instant public interest — say, psychogeriatrics or kidney surgery — his chances of getting caught were close to zero. He might have published fake findings until the day he retired, and no newspaper reporter could have convinced their editors to pay for what it would take to prove what happened. So, the next time you read of some medical marvel, remember the lesson of the Wakefield scandal. As I put it in The Doctor Who Fooled the World, (published after he’d moved on to trashing Covid vaccines): “If he could do what he did — and I’ll show you what he did — who else is doing what in the hospitals and laboratories that we may one day look to for our lives?”

Vaccines really do work, and have saved millions of lives — indeed, it’s perhaps the biggest irony in medicine that one of the most effective and beneficial interventions known to humanity is the one that’s regarded with the most mistrust and suspicion. With the Prime Minister, we might ask: why can’t these recalcitrant anti-vaccine fools just trust the experts?

But it might be unwise to take such a black-and-white view of the anti-vaccination movement. For although the evidence on the effectiveness and safety of vaccines is clear, scientists and doctors have been anything but immune to missteps and errors in how they’ve dealt with them over the years. Pitting the wacky, hidebound anti-vaxxers against the sober, all-knowing experts risks glossing over the mistakes those experts have made in the past — and failing to learn from the cautionary tales.

Last week was a big week for vaccines. As well as the government’s flu vaccine push, initial results from two new COVID-19 vaccine trials appeared in the journal The Lancet — one from the UK and one from China. They join a US trial from the week before in showing that their candidate vaccines have tolerable side-effects and definitely do cause an immune response. These Phase I and Phase II trials are just the first — albeit crucial — steps on the way to finding a working vaccine. Next, we move to larger, Phase III trials that involve many thousands of people, testing whether those who get the vaccine are actually less likely to catch Covid-19 than those who are injected with a placebo.

It does feel somewhat ironic that The Lancet in particular is taking the lead in publicising the research on Covid-19 vaccines: besides being a super-prestigious medical journal, the main public claim to fame of that particular journal is in publishing one of the worst and most damaging vaccine studies of all time. That was, of course, Andrew Wakefield’s notorious Lancet article linking the MMR vaccine to autism. Its appearance in 1998 fanned the flames of the anti-vaccine movement, with crushing media suspicion falling on the MMR — and a resulting deadly surge in measles cases in the UK and worldwide.

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Many large, high-quality studies have since found that Wakefield’s MMR-autism correlation — as well as his cockamamie theory about how the attenuated virus from the vaccine causes gut- and brain-related symptoms — is untrue. Worse, though, is the fact that Wakefield wasn’t just wrong — he was a fraud. He fabricated the medical records of every single one of the children in his study to make it appear as if their autism symptoms had come just after the MMR, whereas many had shown symptoms before, or a long time after, receiving the vaccine.

The publication of the Wakefield paper will forever be a stain on The Lancet, and on the peer-review process of science more generally. Even without the fraud, a study with such earth-shattering implications that only included twelve patients should never have been published somewhere so prominent. Compounding the damage was the sheer amount of time it took for the paper to be officially retracted – an astonishing twelve years. All the while, anti-vaxxers could point to a peer-reviewed study — in The Lancet, no less! — to support their view.

Wakefield was pushing at a door that, while perhaps not fully open, was certainly ajar. The anti-vaccination movement has been with us for a long time — indeed, as long as vaccines. Some renowned historical scientists have been a part of it: for example, Alfred Russel Wallace, who came up with the idea of natural selection independently of Charles Darwin, was an implacable opponent of the smallpox vaccine during the late 19th Century.

Whereas Wallace was certainly a bit “nuts” — he spent a great deal of time trying to convince his peers that spiritualist mediums really could talk to the dead and take photographs of ghosts — his approach to analysing the effects of vaccines (he argued they were actively dangerous) was statistically quite sophisticated for the time. And given that statistics were in such an early phase of their development, the pro-vaccine side hardly had much more convincing data to oppose him.

Wallace also expressed his opposition in terms of anti-paternalism (he wrote that compulsory vaccine laws were “a gross interference with personal liberty and the sanctity of the home”) and even socialism, claiming that vaccines were seen as a quick fix that failed to “get rid of the foul conditions” that caused disease to spread among the poor of Victorian Britain. These arguments were, of course, completely wrong-headed, but they weren’t the ravings of a madman, and they hint at the complexity of the anti-vaccine position: defenders of vaccines need to work on multiple fronts to combat objections that are anything but easily-debunked.

Psychologists are fond of invoking a whole series of cognitive biases to explain why people are irrational about vaccines: the availability heuristic (where people focus too much on a few scary stories at the expense of a more rational appraisal of the situation), omission bias (where having committed an act, like getting your child vaccinated, feels worse if something goes wrong than having not done anything), and so on.

But more recent evidence seems to suggest a simpler reason is at play: if people think there’s a high chance they’ll regret vaccination, they’re less likely to do it. Evidence that we can change people’s beliefs about vaccines for the better is scarce; but changing them for the worse by providing more credible-sounding reasons for regret — like Wakefield’s MMR-autism connection — is much easier.

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Alas, the publication of Wakefield’s study is far from the only significant fumble by vaccine scientists and regulators over the years. Relatively soon after his phony paper was published, the US and the EU capitulated to anti-vaccine campaigners on the issue of thiomersal (sometimes spelled thimerosal), a mercury-containing chemical that had long been used as a preservative in vaccines, and had been — you guessed it — linked to autism by the anti-vaxxers.

The idea of injecting mercury into your child’s arm can be made to sound very frightening, but the type of mercury in thiomersal (ethylmercury) isn’t the same as the type we normally discuss with reference to mercury poisoning (methylmercury, which stays in the bloodstream for far longer and can have seriously damaging effects even at small doses). There was never any evidence to support campaigners’ assertions that vaccines containing thiomersal were linked to autism, but something certainly appeared to be going on once the health experts suddenly decided that thiomersal had to go, banning it from almost all vaccines given to children from around the turn of the century.

Those authorities began speaking out of both sides of their mouths, at once saying thiomersal was completely safe and also recommending it should be removed from vaccines “as expeditiously as possible”. What were parents supposed to think? Again, anti-vaccine campaigners used the confusion to boost their message, with a flare-up of the mercury-autism controversy — as well as a plethora of personal injury claims in courts — occurring after the preservative had needlessly been removed from the vaccines.

Not only did the experts put other countries that still used thiomersal in their vaccines — particularly those in the developing world — in an invidious position, they also torpedoed their own future authority. Any use of “completely safe” or “no evidence for adverse effects…” would now be met with references to their seeming lack of straightforwardness on thiomersal.

This history of vaccination gives numerous further examples. The rushed, politicised rollout of the flu vaccine in the US in 1976 — and the potential increase it caused in the rare neurological condition Guillain-Barré Syndrome — has been blamed for spawning anti-vaccine suspicion; as have the catastrophic lab errors that caused live polio viruses to be injected into 200,000 children in 1955, permanently paralysing hundreds and killing ten.

Although safety procedures have since improved dramatically, disasters do still occur, such as the 2016 case of the faulty dengue fever vaccine in the Philippines which ended up making the illness worse. Other failures are not the fault of doctors or scientists, but still produce terrible PR for vaccines: who could forget, for example, the fake vaccination programme used by the CIA to spy on Osama bin Laden’s secret compound and get his family’s DNA?

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So do you have to be “nuts” to hesitate about vaccines? Certainly, you have to be somewhat detached from reality to believe, as some do, that Bill Gates is only helping fund the development of a Covid-19 vaccine so he can inject us all with microchips. And to be an anti-vaxxer, you have to be grossly ignorant of the evidence for the near-miraculous effects of vaccination on human wellbeing. But in seeking to persuade those who aren’t hardcore members of the movement, scientists, doctors, and politicians need to learn the lessons from the list of historical precedents where things haven’t gone to plan.

Those lessons are obvious, but underappreciated. We mustn’t underplay any side-effects of the Covid-19 vaccine. We mustn’t provide confident-sounding yet contradictory advice — as we already have during this pandemic in the case of facemasks, first advising that they were useless and maybe even dangerous (which may or may not have been a “noble lie” to preserve mask stocks for healthcare workers), then mandating their use in shops and on public transport. We mustn’t give any credibility to conspiracy theories. And we must above all be honest and transparent about how the vaccine works, who is prioritised to get it and when, and what our targets are for its eventual rollout across the population.

When the Covid-19 vaccine comes — and let’s not hold our breaths, but the early signs are promising — it’ll join the ranks of the most important medical discoveries of all time. Let’s use the failures of the past to inoculate ourselves against errors in the future — and ensure that the vaccine becomes the pandemic-stopper we need it to be.

Stuart Ritchie is the author of, Science Fictions: Exposing Fraud, Bias, Negligence and Hype in Science