Three Shots at Prevention: The HPV Vaccine and the Politics of Medicine's Simple Solutions

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

chapter nine Parenting and Prevention Views of HPV Vaccines among Parents Challenging Childhood Immunizations Jennifer A. Reich 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 their own sense of morality (Bobel 2001; Hulbert 2003; Lareau 2003). The interplay between parents’ interpretations of cultural meaning and parenting strategies can be seen most clearly in parents’ decisions whether to consent to childhood immunizations. Although all states require certain vaccinations to attend schools, the safety and necessity of vaccines remain controversial (Colgrove 2006). The availability of a vaccine against human papillomavirus raises additional issues as well (Casper and Carpenter 2008). As an elective vaccine not marketed for the collective good (an ethos that underscores compulsory childhood vaccine laws) but for individual benefit against a virus that is transmitted through sexual contact, it prompts new questions . Using multiple sources of qualitative data from interviews with parents and from Web sites aiming to support parents who choose to refuse vaccinations , I explicate this complex interplay in the lives of families as they contemplate vaccine choices more generally and the HPV vaccine specifically. In this 166 Focus on the Family chapter, I show that parents—even those generally supportive of vaccine policy—are resistant to the HPV vaccine for reasons not often discussed. Perceiving Risk, Seeking Prevention We know that before individuals become motivated to seek out health interventions , they must perceive that they are susceptible to a particular health problem, that the health problem is a serious one, that utilization of a treatment or medication will reduce risk of that condition, and that there are no serious barriers preventing access to the treatment (Rosenstock 1966). Consumers (or patients) must also find ways that the prescribed treatment fits their lives and matches their own goals and lifestyle (Conrad 1985). Risk of disease—for example, cervical cancer—is often framed in terms of what Deborah Lupton calls “lifestyle risk discourse.” As she explains, “lifestyle risk discourse is the responsibility of the individual to avoid health risks for the sake of his or her own health as well as the greater good of society” (2009:463). Girls and their parents are told abut the risks of HPV with data showing the high rates of HPV infection in the population, suggesting a high likelihood of infection upon initiation of sexual activity. They are also given information on how cervical cancer is caused by the virus (even though the limited number of strains that are carcinogenic is not always clearly communicated ). To want the vaccine, parents need to be convinced that their daughters are at risk of cervical cancer from a nearly ubiquitous virus that is sexually transmitted, that the vaccine—given in early adolescence and before sexual activity begins—is the best prevention for that disease, and that despite the significant costs for the three-part inoculation, the vaccine mitigates risk. As Lupton notes, the discourse of risk is weighted toward the high probability of disaster, in this case, the development of a preventable illness. Yet to persuade parents to seek out the vaccine, promoters must also convince parents that risk and protection lie outside of the parent-child relationship and are best met by pharmaceutical companies. Methods This chapter uses two sources of qualitative data, collected as part of a larger ongoing study of parents’ health care and vaccine decisions. First, data were collected during in-depth interviews with twenty-one parents who are modify- Parenting and Prevention 167 ing existing compulsory vaccination schedules for their children, by opting out completely, by providing consent to select vaccines on a schedule of their own choosing, or by negotiating alternative schedules in some way with their health providers. These parents do not represent the views of all parents and are not representative of the larger world of parental decision making. Yet these parents are already engaged in complex efforts to challenge physician knowledge and public health prescription and are strategizing these health care decisions based on their own understandings of health, illness, risk, corporate power, and trust. As such, they are an important group ready to discuss their concerns about new HPV vaccines. These parents (twenty mothers and one father) all reside in Colorado. Colorado had until recently the lowest rates of vaccination in the...