The sordid details of the elaborate fraud perpetuated by Dr. Andrew Wakefield continue to emerge and astound. And the impact of the purported link between the measles-mumps-rubella (MMR) vaccine and bowel disease and autism continues to be seen daily in a resurgence of eradicated childhood diseases across the Western world and, close to home, emergency rooms overflowing with flu sufferers.
The British Medical Journal revealed in Thursday's edition that the disgraced researcher had planned to sell diagnostic tests for the invented condition, and estimated his company would reap $112-million a year. He stood to bring in another $43-million annually for a measles vaccine he invented to replace MMR.
Colleagues were quoted in the BMJ as saying Dr. Wakefield was convinced he would win a Nobel Prize, even though he falsified medical records and recruited patients unethically (for example, drawing blood from children at a birthday party) in a bid to "prove" the theory.
While Dr. Wakefield's bid for fame and fortune has crumbled under the weight of disgrace, he has left an indelible mark.
But it is a legacy of preventable death and disease.
While the MMR-autism link has been thoroughly discredited, Dr. Wakefield and his allies continue to sow seeds of doubt about the safety of childhood vaccines with selective use of data and elaborate conspiracy theories.
"As a result, a generation of parents and their children have grown up afraid of vaccines and resulting outbreaks of measles and mumps have damaged and destroyed young lives," Dr. Gregory Poland of the Mayo Clinic's Vaccine Research Group in Rochester, Minn., wrote in Thursday's edition of the New England Journal of Medicine.
The damage has been most extensive in Britain and Ireland, where MMR vaccination rates fell below 80 per cent. In Ireland, an outbreak of measles - a disease that has essentially been eradicated by immunization - led to more than 100 children being hospitalized and three deaths.
Dr. Poland said the anti-MMR sentiment has spilled over to other vaccines, with predictably tragic consequences. California is currently in the midst of its worst outbreak of pertussis (whooping cough) in half a century, and 10 children have already died.
In Canada, childhood vaccination rates have not fallen as sharply as in parts of Europe and the U.S., but our psyche is wounded, too.
There are worrisome trends like the steep drop in those getting flu shots, most unfortunate in a year when seasonal influenza (H3N2) is proving to be nasty.
ERs and hospital beds packed with patients suffering from vaccine-preventable illness such as the flu are just some of the daily impacts on the health system in the 12 years since the MMR-autism theory gained prominence.
Dr. Noni MacDonald, a professor of pediatrics, microbiology and immunology at Dalhousie University in Halifax, said a significant minority of parents delay vaccination until they are forced to act, such as when children enter daycare or school, and that puts their babies at risk of infectious diseases.
Just as importantly, she said, it takes much more time to counsel parents because they have so many fears, chief among them a worry that the MMR vaccine can cause autism and that vaccines contain "poisons" such as mercury and adjuvants.
"It's not wrong that parents have questions - in fact, it's welcome. What's troubling is that there are so many smart people with elaborate conspiracy theories that blind them to the very real benefits of immunization," Dr. MacDonald said.
Prior to the MMR-autism scare, the challenge for public health officials was getting to people living on the margins of society so immunization would be universal.
Now, they face an even more difficult task, to convince people in the mainstream to not turn their backs on a health intervention with proven benefits and only minimal risks so that vaccination rates don't fall below 90 per cent. At 90 per cent to 95 per cent, there is herd immunity, a phenomenon where disease essentially does not circulate, so even those who are not vaccinated are not at risk. Yet, paradoxically, it's easy to criticize immunization because it is so effective.
Once common childhood diseases and their sometimes tragic consequences - mental retardation caused by measles, children left deaf by the mumps, blinded by rubella, pneumonia caused by Hib (Haemophilus influenzae bacterium), the crippling effects of polio, to name only a few - are now largely invisible.
With horrors out of sight, benefits are out of mind. Instead, there is an almost obsessive focus on side effects - and, yes, vaccines, like all drugs, can have side effects.
So what is to be done?
First and foremost, "we must continue to fund and publish high-quality studies to investigate concerns about vaccine safety," Dr. Poland said. That includes monitoring and compensating those who are harmed by vaccines.
Dr. Poland said health-care professionals have to learn to "counter anti-vaccinationists' false and injurious claims." In other words, public health has to start talking up the benefits of vaccines and exposing the lies of those hawking bogus "alternatives." Education programs are required to inform a confused public.
There also needs to be a recognition that this part of the MMR-autism debate is over.
The money and energy invested in trying to replicate Dr. Wakefield's sham research has diverted time, energy and money away from other investments that could benefit children. We could have improved vaccines and maybe found the real cause(s) of autism - and beneficial treatments.
"There's a real tragedy here: Countless millions have been spent - no, wasted - because of this fraud," Dr. MacDonald said. "Not to mention that children have died and been sickened because of unsubstantiated fears."
But if there is a silver lining, Dr. MacDonald said, it is that immunization, which was long taken for granted, "is now on the front burner.
"Now, if we could only get it on the right front burner."