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

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

chapter twelve Sex, Science, and the Politics of Biomedicine Gardasil in Comparative Perspective Steven Epstein and April N. Huff 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 by demonstrating the complex interplay among biopolitics, biomedicalization , and the often bitterly fought politics of sexuality in the presentday United States.1 We address this interplay by examining an apparent contradiction suggested by the case of Gardasil, in light of episodes in the politics of science and the politics of sexuality during the presidential administration of George W. Bush. With regard to sexuality, both domestic and international public health policy became sharply conservative during the Bush administration. On his third day in office, President Bush reinstated the “Mexico City Policy,” which prevents international nongovernmental organizations from receiving federal funding if they provide or promote abortions.2 The president’s Emergency Plan for AIDS Relief of 2004 gave a significant amount of funding to HIV prevention programs that emphasized abstinence from sex outside marriage and monogamy inside 214 Focus on the Family marriage as the central methods for reducing the spread of HIV abroad.3 Of particular interest, however, is the relation between such sexual conservatism and the politics of science and medicine. In repeated cases involving sexuality policy, powerful actors within key federal government agencies privileged a Christian Right moral agenda over the mainstream scientific consensus.4 More precisely, right-wing activists both inside and outside government sought to influence federal policies by deploying a scientific counterexpertise that aligns with conservative Christian values, using the idiom of science to call into question the conventional scientific wisdom. While “science wars” have played out in diverse arenas and with reference to a range of topics (global climate change being a noteworthy example), it is striking how often these debates have turned to matters of sexuality and sexual health.5 Right-wing activists have influenced federal health agencies by marshaling data intended to show that condoms have a high failure rate, that abortion increases the risk of breast cancer, and that teenage abstinence is the only sure path to well-adjusted adulthood . They also have sought to block federal funding for research on sexual topics that they find distasteful, nearly succeeding in some instances.6 This activism at the intersection of science and morality was facilitated by what one analyst has described as an “avalanche of religious right appointments” to various federal agencies, including the advisory committees to federal health agencies such as the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC).7 In relation to such developments, the puzzle is that Gardasil prompted comparatively little right-wing opposition at the level of federal policymaking. Despite strong concerns expressed by some commentators about promoting teen sexuality, despite insistence from some quarters that the best defenses against HPV infection were abstinence and monogamy—indeed, despite the fact that a doctor affiliated with the prominent conservative Christian advocacy group Focus on the Family sat on the CDC’s Advisory Committee on Immunization Practices—the HPV vaccine received a rapid, ringing endorsement from two federal agencies: the FDA, which approved the vaccine just six months after receiving the manufacturer’s application, and the CDC, which recommended it for universal use in girls just weeks later.8 An openness to Gardasil was manifested even in the White House: “There’s nothing new about requiring a vaccine that will protect the health of people in our country,” First Lady Laura Bush told CNN’s medical reporter, Dr. Sanjay Gupta, when asked about the new vaccine in a televised interview, adding, “It’s just like getting the flu shot.”9 Sex, Science, and the Politics of Biomedicine 215 To be sure, sharp controversy did subsequently break out into the open, but it was largely confined to the question of whether, at the level of state government, vaccination with Gardasil ought to be made mandatory for school attendance or should simply be recommended. Opposition to mandatory vaccination policies was voiced not only by social conservatives but by actors from across the political spectrum who made diverse arguments against this policy approach. However, at the level of federal health policy, the tone...