Monday, August 06, 2012

Gardasil: Gender, Science, and Public Rhetoric

There's a lot to say about Gardasil controversy. It brings up many of our favorite problem subjects that invite polemic from all sides--sexuality and sex practices, sexual behavior of girls, women's health, efficacy of vaccines, rights to refuse vaccines, et cetera.

This "Comment" piece I read today in The Guardian, "To deny schoolgirls a cervical cancer jab on religious grounds is scandalous" (quick side note, I absolutely LOVE the difference between calling a vaccine a "jab" instead of a "shot") brought the issues of gender as well as scientific versus public rhetoric to light in what I thought were some very interesting ways.

Gardasil vaccine controversy has some significant differences from your garden-variety MMR vaccine refusal or flu vaccine skepticism for one major obvious reason: until recently, the vaccine was chiefly marketed as the "anti-cervical cancer" vaccine, and hence was only advertised (and FDA-approved) for girls and young women.

Yet, HPV infection causes more than cervical cancer and affects more than women--HPV is the cause of genital warts in both men and women, is more common among men than women, and causes throat and anal cancers in both sexes. (See this and this and this for some NYT coverage of new research about the prevalence and consequences of HPV infection in both sexes as well as this research published in the Journal of Clinical Oncology on HPV infection and throat cancers.) Now it is recommended for both boys and girls as young as 9. The vaccine is still only recommended until age 26.

Doctors were only ever interested in Gardasil as cancer prevention, not as one against genital warts or other non-sex-specific problems that arise from HPV infection, so the product was always intended for women and girls. Possible uses for boys and men emerged later.

This, to me, is an interesting space where scientific and public rhetorics clash.

On the one side, you can see the trajectory of thinking in the scientist's brain here: Isn't it amazing that a virus causes cancer? We can vaccinate against viruses. Wouldn't it be amazing if we could vaccinate against that virus, hence eliminating cancer? What kinds of that virus cause the most cancer, giving us the biggest bang for the buck? Oh, 4 virus types cause 70% of cancer in the cervix. Let's vaccinate against those. Only women have cervixes. Let's only do clinical trials on them. Wow, the vaccine works! And it's approved! Yay, science! (Or something like that.) In this sense, this is truly groundbreaking stuff with incredible implications for the future of virology and cancer research.

Yet this incredible discovery looks very different in the (bright, unforgiving) light of public opinion. The message goes from being "this vaccine can prevent cancer" to "you should vaccinate your daughter against this sexually transmitted disease." Uh oh. That will (and did) revive every argument ever created about sexual behavior and gender-based expectations.

Not only did that result in an initial negative reaction among parents (along the lines of "my daughter will never have sex outside of marriage, so she doesn't need to worry about this") but gender continues to be central in public debates about the safety, efficacy, and availability of Gardasil.

I'm not going to even try to capture all of the arguments how unsafe Gardasil is. Just Google "Gardasil Injury" and you'll see hundreds of websites, videos, blogs, organizations, support groups, etc. that have all amassed to argue that injuries from Gardasil vaccination span a range of problems, from acute, severe reactions to long-term chronic illnesses that have destroyed healthy girls and vibrant families. Women are, in these narratives, innocent victims of a scientific community that demanded compliance, injured countless women, and remains insensitive to their pain.

Those who support the vaccination also use gender to argue for increased availability of the vaccine; as the article in The Guardian demonstrates, advocacy for the vaccination is seen as protection of women's health, and lack of access to the vaccine is seen as further intrusion of the state into the health issues of women, echoing public debates we have about abortion and contraception. By both sides of the debate, girlhood and womanhood are used to create claims of coercion and victimization by entities that either demand that they do or do not get the vaccine.

For all of these reasons, and many more, Gardasil functions as a fantastic example of how science and the public clash over vaccinations when scientific discoveries become divorced from the realities of their public purpose. I wonder how the (continuing) lessons of Gardasil will (or will not) impact the next new vaccine and the sex-based distinctions researchers make as their products are developed, tested, and marketed for targeted populations.

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