For 32 years, Dan Piraro has been illustrating cartoons for Bizarro, a nationally syndicated cartoon panel appearing in over 350 daily and Sunday newspapers. On March 8, Piraro published a cartoon about autism and vaccines. The result, he said, caused more controversy than any other cartoon in his 32-year career.

The cartoon, which illustrates a meeting of mythical creatures, shows a mermaid gesturing to a vial, stating, “I’d like to welcome our newest member to the group, the vaccine that causes autism.”

“I’ve been responsible for creating a new joke and drawing to go with it 365 days a year for over 32 years, so I’m always looking for something new to write about,” Piraro told The Mighty. “Lately I’ve been disheartened by the massive move in the U.S. away from science and facts and towards myths and ‘alternative facts.’”

After searching the web, Piraro decided to illustrate the myth that vaccines cause autism. “[I] happened to come across something about the autism/vaccine myth, which I was familiar with already, of course, but the combination of that kind of myth with other known myths – mermaids, unicorns, etc. – suddenly struck me as a good way to illustrate the folly of this kind of thinking in a simple, graphic way.”

The idea that vaccines cause autism has been widely debunked a number of times over the past decade. In 1998, the Lancet published a study which claimed autism was linked to the measles, mumps and rubella (MMR) vaccine. The Lancet then retracted the study in 2010 after scientists were unable to replicate its findings, and the study’s author, Andrew Wakefield, had his medical license rescinded.

Since publishing, Piraro’s cartoon has sparked widespread criticism from anti-vaxxers as well as parents who felt he was making a joke out of autism, rather than vaccines. “ I knew it would kick up some dust, but I had no idea the backlash would be so widespread and vitriolic,” Piraro said. “I’ve done many cartoons about controversial topics in the past – legalization of marijuana, marriage equality, terrorism, Trump – and am used to getting hate mail, but this one broke all previous records.”

“As a parent of two adult daughters, it is easy for me to understand why there is so much emotion around this subject and also why this myth has been so pervasive for so many years. People worry about few things more than the health of their own children,” Piraro added.

From letters to the editor at daily newspapers to comments on Piraro’s Facebook page, people fought to have their voices heard. In having this debate, we often leave out autistic individuals who are left to feel like their existence is a disease that needs a named cause. While we understand the challenges with autism can be more significant for some individuals and their loved ones, we must be careful in the messages we send people on the spectrum when we discuss the vaccination controversy.

In a blog post addressing the controversy, Piraro wrote:

I’ve read a lot about this issue over the years and especially in the past week and one thing I’m certain of is that unless you are a trained scientist in areas that relate to this, it is very easy to be confused by what is true and what is myth. That’s why in these cases, there is no logical position to take other than to side with the majority of experts. I’m not a doctor or a scientist, but it is clear that the vast majority of doctors, scientists, and medical organizations whose job it is to study, research, and know this stuff still adamantly say there is no causal relationship between vaccines and autism.

Not all of the feedback has been negative, Piraro said. “Many doctors and other people in and around the healthcare world responded very positively and asked if they could use the cartoon in their efforts to inform the public,” he added. “I always love it when my cartoons get used as teaching tools.”