Thoughts on the HPV Vaccine

Vaccine Policies and Discourses in the media

The HPV vaccine has been widely called ‘the anti-cancer vaccine’ and campaigns throughout the UK, the US and Europe have focused on vaccination for young girls as a preventative measure for cervical cancer. In October 2007 the UK Government, Scottish and Northern Ireland Executives, and the Welsh Assembly, announced the national immunisation programme. The HPV vaccination programme for girls aged 12-13 was officially launched on 3 September 2008, supplemented by catch-up campaign to vaccinate all girls until the age of 18 by 2010/11. The aim of the policy is to achieve a 90% uptake rate for the HPV immunisation programme within the defined cohort of children1.

Objections to the measure mainly concern the health risks of the vaccination procedure and less the efficiency of the drug. Some discussion has emerged around the preference of the UK health services to administer the cost effective Cervarix2, which protects against types 16 and 18 of the virus but not the types related to genital warts. Recently, a number of teenagers who suffered various side effects relating to the vaccine, launched the first legal action against GSK3. In the US, religious conservatives object to the policy (or other sexual health prevention measures) because it is believed to increase promiscuity.

The HPV immunisation program in the UK includes at the moment girls aged 9-18 with the Department of Health (DH) considering the possibility of future inclusion of boys. The urge (and recent request for further acceleration by the DH) with which the program was introduced to girls and the simultaneous caution towards boys, makes this an issue of feminist interest. Girls are the receivers of a medical intervention that has debatable benefits. It is important that the vaccine is presented as a means of prevention for cervical cancer and that the distinction between the HPV virus and cervical cancer is not highlighted. In the news, the vaccine is constructed as a preventive measure for a ‘female cancer’ and the focus shifts from the prevention of STDs. In a similar manner during the early 1900s, gonorrhoea was set apart from syphilis and other venereal diseases, whilst emphasis on the effects on women’s reproductive health led to vaccine therapy. At the time, feminist campaigners like Christabel Pankhurst used the argument of prostitution versus quantity of future generations in order to request political equality for women4. It is anticipated that, today, by creating distance from other STDs, the vaccine managed to surpass objections from moral right wing or religious groups as is the case in the US. It would be interesting to trace how the vaccine and the program of immunisation has been constructed as a women’s-health issue in the UK, drawing on parallel developments in the US and rest of EU, and how the representation of the vaccine has departed from ontological aspects (of the virus) to the physiological and gender specific (cervical cancer).

A survey conducted by Cancer Research UK (2007) found that 80% of the mothers agreed that the appropriate age for vaccination was between 10-14, and that 75% of mothers said they would probably or definitely accept the HPV vaccine for their daughter5. The Independent Joint Committee on Vaccination and Immunisation advised that HPV vaccination would be most efficiently delivered through schools (NHS, 2007). At the same time, the policy is controversial regarding personal choice and parental responsibility. It states:

‘Competent young people are entitled to give consent to treatment when they have sufficient understanding and intelligence to understand fully what is

involved in treatment but ideally their parents will also be involved. When a young person has signed the consent form, the school nurse should complete

a ‘Checklist for Competency to Consent Form’ (2008: 6).

Anti-vaccination movements have predominately concerned childhood immunisation and public health threats. They have involved a wide range of individuals from various backgrounds and with diverse beliefs, but mainly focused on moral issues and personal freedom from state intervention6. The number of parents who resist routine childhood immunisations continues to grow7 and research has indicated that their fears concern safety rather than effectiveness8. Moving the responsibility for consent to children, as in the case of the HPV vaccination, has ethical implications while it practically eliminates the possibilities for anti-vaccination campaigns. This opens up the discussion around tensions created between age and sexual maturity, care and personal freedom9.

The vaccine brings together some of the discourses that have concerned feminisms, namely sexuality, technologies and reproduction. This vaccination program needs to be examined within the context of other technological interventions like IVF, and the context of feminist politics, especially as the intervention concerns the daughters of women who generationally might have lived through the echo of the Women’s Movement in Britain. The campaigning and research activities of feminist health and health technology professionals, but also the pro-choice movement play a significant role in the construction of woman’s health as a central issue for policy.

Notes

1‘This immunisation programme must be in line with the Department of Health (2006) guidance ‘Immunisation against infectious disease and in conjunction with the Health Protection Agency’s standards of competence and guidelines on immunisation (HPA 2005)’, source ‘Trust policy for the implementation of the HPV vaccination programme’, Southern Health and Social Care Trust, 2008

2 By GlaxoSmithKline http://www.cervarix.co.uk/index.asp . The US FDA has approved Gardasil manufactured by Merck in 2006.

3Lucy Johnston, ‘Teenage girls sue over cancer jab’, April 19,2009, Daily Express, [online]

http://www.express.co.uk/posts/view/95924/Teenage-girls-sue-over-cancer-jab [accessed 10 May 2009]

4 Worboys, M. (2004) ‘Unsexing Gonorrhoea: Bacteriologists, Gynaecologists and Suffragists in Britain, 1860-1920’, Social history of Medicine, Vol. 17:1

5Cancer Research UK [online] [available from] http://info.cancerresearchuk.org/news/archive/pressreleases/2007/january/277742 [accessed 8 May 2009]

6During the 1853 Compulsory Vaccination Act, the anti-vaccination movement was constituted of both middle and working class people who saw public health policies as examples of class-focused legislation. Policies were compulsory, targeting working-class infants. Nadja Durbach (2000) explains how anti-vaccination campaigns helped to reorganize working-class identities around what was interpreted as violation of their bodies. It is interesting how a similar approach was used by E.P. Thompson (1963) when discussing the Luddist movement not as anti-technological, but as pivotal to the formation of the English working class.

7Levi, B., H. (2007) ‘Addressing Parents’ Concerns About Childhood Immunizations: A Tutorial for Primary Care Providers’, Pediatrics, Vol. 120: 1

8 Kumanan Wilson, Meredith Barakat, Sunita Vohra, Paul Ritvo and Heather Boon (2008) ‘Parental views on pediatric vaccination: the impact of competing advocacy coalitions’, Public Understanding of Science; 17; 231

9The discussion on vaccination is tangible to meanings of the Welfare State and national identity. In the US there has been discussion around the compulsory vaccination of immigrants entering the country. Even though this is not the case in the UK, there is controversy around discourses of the vaccine as a measure against an infectious disease and the vaccine as the prevention for cancer. This controversy opens up the discussion about ‘our’ girls, in need of protection, and the ‘other’ girls bringing the virus in the nation.

Suggested Bibliography


Abraham J. (1995) ‘Science, politics and the pharmaceutical industry: controversy and bias in drug regulation’, New York: St Martin’s Press.

Balsamo, A. (1996) ‘Technologies of the Gendered Body’, Duke UP

Brabin L, Roberts SA, Stretch R, Baxter D, Chambers G, Kitchener H and McCann R (2008) Uptake of first two doses of human papillomavirus vaccine by adolescent girls in Manchester: prospective cohort study, British Medical Journal, 336 (May), pp.1056-1058.

Castellsagué X, de Sanjosé S, Aguado T, Louie KS, Bruni L, Muñoz J, Diaz M, Irwin, K, Gacic M, Beauvais O, Albero G, Ferrer E, Byrne S, Bosch FX (editors), HPV and cervical cancer in the world: 2007 report, Geneva:WHO. Available from the WHO website.

Daly, M. (1978) ‘Gynecology: The Metaethics of Radical Feminism’, Boston: Beacon Press

Durbach N. (2000) ‘They might as well brand us’: working class resistance to compulsory vaccination. Social History of Medicine 13: 45-62 OK

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  3. Harran, J., Kitzinger, J., McNeil, M., O’Riordan, K. (2008) ‘Human Cloning in the Media: From Science Fiction to Science Practice’, Routledge

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  5. Hinds, H. and J. Stacey (2001) ‘Imaging Feminism, Imaging Femininity: The Bra-Burner, Diana, and the Woman who Kills’, Feminist Media Studies 1(2): 153–77

Keller, E. F. (1995) ‘Re-figuring Life: Metaphors of Twentieth Century Biology’, Columbia UP

Kennedy, Helen (2005) ‘Subjective Intersections in the Face of the Machine: Gender, Race, Class and PCs in the Home’, European Journal of Women’s Studies 12(4).

Lowy DR and Schiller JT (2006) ‘Prophylactic human papillomavirus vaccines’, Journal of Clinical Investigations, 116(5), pp.1167-1173.

MacLeod RM. (1967) Law, medicine and public opinion: the resistance to compulsory health legislation 1870-1907, Public Law, p. 107-128, 189-211

  1. Moran et al. (2008) ‘From compulsory to voluntary immunisation: Italy’s National Vaccination Plan (2005–7)’, Journal of Medical Ethics, 34: 669-674

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Porter D, Porter R. (1988) ‘The politics of prevention: anti-vaccinationism and public health in nineteenth-century England’, Medical History, Jul;32(3):231-52

Rivett G. (1998) From cradle to grave: fifty years of the National Health Service. London: King’s Fund.

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  3. Walkowitz J. (1980) Prostitution and Victorian society: women, class and the state. Cambridge: Cambridge University Press.

Wilson, K., Barakat, M., Vohra, S., Ritvo, P., Boon, H. (2008) ‘Parental views on pediatric vaccination: the impact of competing advocacy coalitions’, Public Understanding of Science, Vol. 17, No. 2, 231-243 (2008)

Wood-Harper, J., (2005) ‘Informing Education Policy on MMR: balancing individual freedoms and collective responsibilities for the promotion of public health’, Nursing Ethics, Vol. 12, No. 1, 43-58

  1. Worboys M. (2004) ‘Unsexing gonorrhoea: bacteriologists, gynaecologists and suffragists in Britain, 1860-1920’, Social History of Medicine 17: 41-59

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