Vaccine in the Crossfire

At a Republican presidential candidates debate in September, then-candidate Michelle Bachmann derided Texas Governor Rick Perry’s decision to “force innocent little 12-year-old girls” to have “a government injection through an executive order.” Perry’s 2007 executive order, which was overturned by the Texas legislature, had required that all 6th grade girls receive the HPV vaccine Gardasil. HPV, the human papillomavirus, can be transmitted through sexual contact and causes certain cancers. Bachmann’s comments reignited controversy about the HPV vaccine and sexuality.

Initially, the FDA had approved Gardasil amid few objections. According to Three Shots of Prevention: The HPV Vaccine and the Politics of Medicine’s Simple Solutions, a 2010 volume edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz, Merck, the drug-maker that developed the vaccine, framed Gardasil© as a vaccine against cancer rather than a sexually transmitted virus (HPV). This frame insulated Merck’s product from a politics of sexuality that Epstein and co-author April Huff say has “privileged a Christian Right moral agenda over the mainstream scientific consensus.”

To overcome the image problem associated with giving “innocent little girls” a vaccine to prevent an STI, Merck cast the drug as a tool of female empowerment. “I chose to get my daughter vaccinated,” said a mother pictured in a 2008 advertisement. In another ad, a young woman boldly proclaimed, “I chose to get vaccinated.” The spots concluded with the feminist tagline: “You have the power to choose.” Merck presented young girls as “health consumers who, by making the ‘right choices,’ can realize their imagined disease-free adult bodies,” according to Three Shots’ contributors Laura Mamo, Amber Nelson, and Aleia Clark.

But while Merck’s desexualization of HPV may have been successful in insulating Gardasil from controversy, it obscured questions of risk for women and men. Merck’s ads never mention, according to Epstein and Huff, that “lack of access to routine health care services, exposure to misinformation or a lack of sexual health education, and structural and cultural obstacles to condom use” place girls at increased risk for contracting the virus.

Epstein further notes that desexualizing HPV has caused the public debate to largely ignore gay men and their risk of anal cancer from HPV. Even though the vaccine was approved for boys in 2009, it took nearly two years for the Center for Disease Control to recommend that boys receive it. HPV has, in the meantime, become one of the leading causes of throat cancers, in addition to causing mouth, anal, penile, and cervical cancers and genital warts.

Perhaps it’s too much to expect that a major drug company would highlight health inequities and challenge homophobia in an ad campaign. Still, the case of Gardasil exposes the inadequacy of a health system where pharmaceutical companies dominate the flow of information about diseases. As Three Shots reminds us, “The U.S. public health infrastructure needs to be wrestled away from capital (pharmaceutical and biotechnology companies) and returned to a multidisciplinary set of social thinkers and actors who weigh global and local STI risks, preventions, and treatments, including but not limited to the HPV-cancer link,in the interests of public good.” While Bachmann’s adoption of unscientific anti-vaccine rhetoric dominated media attention, issues of public health and equity went largely unaddressed.