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Three Shots at Prevention

The HPV Vaccine and the Politics of Medicine's Simple Solutions

edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz

Publication Year: 2010

In 2007, Texas governor Rick Perry issued an executive order requiring that all females entering sixth grade be vaccinated against the human papillomavirus (HPV), igniting national debate that echoed arguments heard across the globe over public policy, sexual health, and the politics of vaccination. Three Shots at Prevention explores the contentious disputes surrounding the controversial vaccine intended to protect against HPV, the most common sexually transmitted infection. When the HPV vaccine first came to the market in 2006, religious conservatives decried the government's approval of the vaccine as implicitly sanctioning teen sex and encouraging promiscuity while advocates applauded its potential to prevent 4,000 cervical cancer deaths in the United States each year. Families worried that laws requiring vaccination reached too far into their private lives. Public health officials wrestled with concerns over whether the drug was too new to be required and whether opposition to it could endanger support for other, widely accepted vaccinations. Many people questioned the aggressive marketing campaigns of the vaccine's creator, Merck & Co. And, since HPV causes cancers of the cervix, vulva, vagina, penis, and anus, why was the vaccine recommended only for females? What did this reveal about gender and sexual politics in the United States? With hundreds of thousands of HPV-related cancer deaths worldwide, how did similar national debates in Europe and the developing world shape the global possibilities of cancer prevention? This volume provides insight into the deep moral, ethical, and scientific questions that must be addressed when sexual and social politics confront public health initiatives in the United States and around the world.

Published by: The Johns Hopkins University Press

Title Page, Copyright

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pp. iii


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pp. v-vii

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pp. ix-x

The science of immunology has spawned many dramatic developments over the years, yet its by-products, from transplantation to vaccination, are frequently shadowed by debate and controversy. In 2008, Julie Livingston, Steven Epstein, Robert Aronowitz, and I brought together a group of scholars (from sociology, history, medicine...

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Introduction: A Cancer Vaccine for Girls? HPV, Sexuality, and the New Politics of Prevention

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pp. xi-xviii

The first advertisements for Gardasil in the United States in 2006, part of Merck’s “One Less” campaign, featured an array of active adolescent girls—soccer players, double-dutch rope jumpers, and other youngsters—staring defiantly into the camera. Each one declared her intention to be vaccinated against the...

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Vaccine Time Lines

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pp. xix-xxx

Five selective time lines place the HPV vaccine controversies in broader context. Scientific, clinical, and policy developments appear in them alongside social, cultural, economic, and political influences on vaccine debates in general and on the HPV vaccine debate in particular....

Part I / The Knownand the Unknown: Vaccination Decisions amid Risk and Uncertainty

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pp. 1

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Chapter One. The Coercive Hand,the Beneficent Hand: What the History of Compulsory Vaccination Can Tell Usabout HPV Vaccine Mandates

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pp. 3-20

The licensure of Gardasil in June 2006 set off a flurry of legislative activity as states around the country took steps to maximize the benefits of the product among their populations. States select from a variety of policy approaches to increase uptake of a vaccine. They can...

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Chapter Two. Gardasil: A Vaccine against Cancer and a Drug to Reduce Risk

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pp. 21-38

Merck began its “One Less” advertising campaign for Gardasil, its vaccine against human papillomavirus, in 2006, not long after Gardasil received U.S. Food and Drug Administration approval. In a widely broadcast television advertisement, girls and young women of...

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Chapter Three. HPV Vaccination Campaigns: Masking Uncertainty, Erasing Complexity

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pp. 39-60

On June 8, 2006, the U.S. Food and Drug Administration (FDA) approved Gardasil, a quadrivalent vaccine marketed by Merck & Company to prevent anogenital infection with human papillomavirus types 6, 11, 16, and 18. A bivalent vaccine produced by GlaxoSmithKline, which...

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Chapter Four. The Great Undiscussable: Anal Cancer, HPV, and Gay Men’s Health

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pp. 61-90

In the United States, the ubiquitous direct-to-consumer advertising by the pharmaceutical company Merck has offered a public face for the vaccine Gardasil: young, active, multiethnic, well-informed, self-assertive, and—needless to say—female. After...

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Chapter Five. Cervical Cancer, HIV, and the HPV Vaccine in Botswana

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pp. 91-100

It is late in the afternoon and the dry African heat is starting to wear off. It has been a long day in the clinic, and only one patient remains to be seen, a typical Motswana woman of traditional build, anywhere between 30 and 40 years old, with an open, pleasant face. Her present complaint is not unusual; she has been referred by her local...

Part II / Girls at the Center of the Storm: Marketing and Managing Gendered Risk

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pp. 101

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Chapter Six. Safeguarding Girls: Morality, Risk, and Activism

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pp. 103-120

In a March 2007 article entitled “Who’s Afraid of Gardasil?” published in the progressive journal Nation, columnist Karen Houppert condemned the widespread skepticism about attempts to mandate vaccination of all adolescent girls. These “strange bedfellows,” Houppert...

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Chapter Seven. Producing and Protecting: Risky GirlhoodsLaura Mamo, Amber Nelson, and Aleia Clark

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pp. 121-145

Medical innovations and practices have long been viewed as suspect sites for women’s health and bodies (Reismann 1985), and medicine has been seen as a site of social control (Zola 1972). As medicine gradually extended beyond mandates to cure the ill, a medicalization of daily living emerged; an increasing number of classifi cations and treatments...

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Chapter Eight. Re-Presenting ChoiceTune in HPV

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pp. 146-162

Merck’s 2008 Gardasil TV spots add two words to their “One Less” advertising mantra: “I Chose.” In these spots, mothers repeat the line “I chose to get my daughter vaccinated” and young women boldly proclaim, “I chose to get vaccinated.” The spots conclude...

Part III / Focus on the Family: Parents Assessing Morality, Risk, and Opting Out

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pp. 163

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Chapter Nine. Parenting and Prevention: Views of HPV Vaccines among Parents Challenging Childhood Immunizations

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pp. 165-181

Parents employ various strategies to make decisions they believe are in their children’s best interests. Their decisions are informed by and reflect a complex web of meaning made up of interpretations of culture, experience, tradition, media, peers, expert advice, and...

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Chapter Ten. Decision Psychology and the HPV Vaccine

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pp. 182-195

New medical advances pose new decision-making challenges for patients and their families. When a medical intervention is made available, patients must decide what information to gather about this new option and under what circumstances they would want to receive it. The introduction of a vaccine for human papillomavirus gives...

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Chapter Eleven. Nonmedical Exemptions to Mandatory Vaccination: Personal Belief, Public Policy, and the Ethics of Refusal

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pp. 196-212

Do “good” parents refuse to vaccinate their children? Should policymakers allow parents to opt out of having their children vaccinated based on the parents’ personal beliefs about the safety of vaccination, even if there is no scientific evidence to support these beliefs?...

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Chapter Twelve. Sex, Science, and the Politics of Biomedicine: Gardasil in Comparative Perspective

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pp. 213-228

The advent of human papillomavirus vaccines such as Gardasil and Cervarix—vaccines designed to interrupt transmission of a sexually transmitted infection in order to prevent the development of cancer—holds enormous public health significance. But these developments also provide insight into central aspects of political life...

Part IV / In Search of Good Government: Europe, Africa, and America at the Crossroads of Cancer Prevention

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pp. 229

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Chapter Thirteen. Vaccination as Governance: HPV Skepticism in the United States and Africa, and the North-South Divide

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pp. 231-253

Perhaps more than other medical technologies, vaccines—invasive processes whose benefits emerge through counterfactual reflection on the absence of disease—condense and highlight relationships of trust or skepticism between the state and its citizens and subjects. So it is not surprising that across the globe, wherever the prospect...

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Chapter Fourteen. Public Discourses and Policymaking: The HPV Vaccination from the European Perspective

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pp. 254-269

By 2007 most “old” member states of the Europe an Union (those states that either had been founding members or had joined the European Union by 1995) had introduced the human papillomavirus vaccine into their national public health programs or had...

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Chapter Fifteen. HPV Vaccination in Context: A View from France

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pp. 270-292

Medical innovations need to make a place for themselves among prevailing concepts, practices, professional traditions, material constraints, institutional variables, beliefs, attitudes, and power relations. They are also, to a large extent, local developments. The globalization and...

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Conclusion. Individualized Risk and Public Health: Medical Perils, Political Pathways, and the Cultural Framing of Vaccination under the Shadow of Sexuality

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pp. 293-302

Given the difficulty of confronting the fundamental social and environmental causes of disease, vaccines stand out as a supposedly simple solution, and they are widely acknowledged to be our best means of disease prevention. Modern history is replete with vaccine...


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pp. 303-307


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pp. 309-320

E-ISBN-13: 9780801899591
E-ISBN-10: 0801899591
Print-ISBN-13: 9780801896729
Print-ISBN-10: 080189672X

Page Count: 352
Illustrations: 8 halftones
Publication Year: 2010