Immunization politicized: the case of HPV

In the late 1990s, medical research made for global headlines when it concluded that infection with specific strains of the sexually transmitted Human Papilloma Virus (HPV) was a necessary agent for the development of cervical cancer, the second most common form of cancer in young women worldwide (Boulet 2008). These findings initiated a major shift in cervical cancer research and treatment: In 2006 and 2007 respectively, two vaccines (Gardasil and Cervarix) were approved by the United States Food and Drug Administration and the European Medicines Agency. These vaccines are intended to immunize women against several strains of HPV, including those that cause cervical cancer. This medical innovation, however, was not only received with enthusiasm. On the contrary, the scenario of immunizing children and young adults against a sexually transmitted, carcinogenic and potentially lethal virus has become a highly controversial topic. Across countries, new diagnostic and prophylactic technologies have become objects of politicization, with important implications for immunization policy and cervical cancer prevention policy more specifically. In England, the vaccine was rapidly integrated into existing cervical cancer prevention programs. In the Netherlands, the vaccine caused some friction but was eventually adopted (Wallenburg, Bal, and Verweij 2008). In Austria, on the other hand, the annual Pap smear test remains the only prevention measure covered by public health insurance, even though cervical cancer rates there are comparatively high (Zechmeister et al. 2009). The present study seeks to explain this variance in HPV immunization policy across these three countries by drawing on the interpretive tradition in policy analysis and conceptual resources from Science and Technology Studies (STS). We argue that the authoritative decision to adopt or not to adopt the new vaccines into a mass vaccination program is the result of a struggle around meanings, understood here as governance, or as the complex, interactive, and informal modes of coordination in which issues become objects of policy, and, in turn, how policy translates into practices (Fischer 2003; Hajer and Wagenaar 2003). We will use qualitative document analysis and in-depth interviews with medical professionals, policymakers, and civil society actors in order to identify the factors that contribute to the understanding of this emerging preventive tool either as a promising `innovation` or as a socially undesirable technology. We propose that these include (i) socio-cultural traditions in the field of medicine, producing a more or less permissive policy stance, (ii) culturally informed notions of women`s health, and (iii) changing institutional arrangements in contemporary health policy.

The introduction of new vaccines frequently leads to controversial debates among both experts and the public. The vaccination against Human Papilloma Virus (HPV), a sexually transmitted virus that may cause different forms of cancer, is a case in point. Approved in 2006 it was received quite differently in countries around the world. The FWF-funded research project Immunization politicized: the governance of cervical cancer prevention led by Dr. Katharina T. Paul (University of Vienna) investigated the nature and outcomes of the political debate around the HPV vaccine in Austria and the Netherlands. Paul found that, as a result of the diverging public debates in these two countries, very different adjustment strategies were required to make the HPV vaccine fit the local public health infrastructures. Beyond contributing to the body of literature in critical policy studies and science and technology studies, Pauls work is of crucial relevance to epidemiologists and public health professionals involved in policy making about vaccines. It allows these stakeholders to better understand why the introduction of vaccines may pose difficulties in certain contexts, and that only considering expert knowledge in the process of introduction may turn out to be counterproductive.Insights from this project have led Paul to pursue the recently completed follow-up citizen science project CODE IT! (FWF TCS14) that involved adolescents as active participants in the research process. By instructing them to code press releases about the HPV vaccine, participants made a crucial contribution to social-scientific research, specifically the analysis of Austrian media coverage of the HPV debate. Paul continues to explore her interest in vaccination policy in her current Elise Richter project funded by the FWF (VA561) where she studies how vaccination registries produce and reproduce relationships between state, science and the public.