In mid-October, I posted about a recent study that assesses the relationship between rates of sexual activity-related outcomes and the Human Papillomavirus (HPV) vaccination. The researchers found that injection of the vaccine is not associated with elevated rates of sexual activity-related outcomes in young girls, specifically pregnancy, contraceptive counseling, and sexually transmitted infection testing and diagnosis. While removing the stigma around the vaccine will help girls and women, I asked why the vaccine continues to be associated with women, even though Gardasil is approved for men, too.
Gardasil, the vaccine that prevents 70% of HPV-related cervical cancers and 90% of genital warts, was first approved for use in women by the Food and Drug Administration (FDA) in 2006. Soon after, the Center for Disease Control (CDC) recommended that the vaccine become a part of the normal vaccination schedule for girls. In 2009, the FDA approved the vaccine for men, but the CDC initially did not recommend the vaccine as part of the normal vaccination schedule for boys (the CDC changed its mind in 2011, though). In this next post, I will go into more depth about the research guiding the CDC’s initial decision and suggest that the guidelines were only possible when assuming a heteronormative model of transmission, as well as women’s general responsibility for reproductive health. Both of these assumptions continue to perpetuate the link between the vaccine and women.
Four published studies (Elbasha, Dasbach, and Insinga 2007, Jit, Choi, and Edmunds 2008, Kim and Goldie 2009, Taira, Nukermans, and Sanders 2004) guided the original CDC decision to recommend the HPV vaccine as part of a girl’s, but not a boy’s, normal vaccination schedule. The studies use statistical models that predict the cost effectiveness of different vaccination strategies, specifically the vaccination of girls alone or girls and boys. Then, the researchers determined which of these scenarios presented a “better value.” Three out of four of these studies determined that it was inefficient to vaccinate both boys and girls; a “girls only” strategy was the most cost-efficient. Using the generally medically accepted concept of “herd immunity,” or the belief that the entire population will benefit from the vaccination of a smaller segment, the researchers determined that vaccinating girls would not only allow them to remain HPV-free, but would also prevent the spread of the virus. Since there is no medical cure for HPV, gradually reducing the number of infected people is the only way to (mostly) eliminate the virus from the population.
Unlike the approach to other vaccines which assume most of the population will be vaccinated, the generally accepted medical approach for assessing HPV transmission and vaccination is to disaggregate by gender and assume transmission between men and women. In reality, these models only paint a picture of heterosexual transmission of HPV. There are many problems with this assumption. First, it promotes a heteronormative model of sexual activity among young people. Second, it does not take into account non-heterosexual individuals at risk for other cancers, like oral and anal, also caused by HPV.
Even if we do not challenge the heteronormative assumptions behind the “girls-only” vaccination strategy, we still have to question why girls were chosen over boys. Why aren’t boys vaccinated in service of the entire population? While the research posits the necessity of vaccinating girls under all circumstances, perhaps this assumption is not an “objective” one. In fact, the history of reproductive technologies tells a similar story about women’s responsibility for reproductive issues. Technologies aimed at reproductive health have largely been designed for women, though both women and men may benefit (see, for example, Leonard 2003, Moore 2008). Though these technologies, like many birth control methods, may help individual women and allow them more choices, they also tell us something about gender inequality. Men are not subject to the same responsibilities over health and reproduction; their bodies are not exposed to the same degree of regulation. The approach towards HPV vaccination, then, shows a similar trend: women have the responsibility to be vaccinated not only for their own health, but for men’s health, too.
These assumptions that guided the original research on the cost effectiveness of different vaccination strategies are still alive and well in the current debates and research about the HPV vaccine. The assumption of heterosexual transmission, as well as the relationship between women’s responsibilities and reproductive health, helps sustain the idea that women are the primary target population for this vaccine. In my next post, I will show how some of these assumptions are evident in the actual advertising for the vaccine.
Harding, Sandra. 1993. “Rethinking Standpoint Epistemology: What is ‘Strong Objectivity’?” in Feminist Epistemologies, ed. Linda Alcoff and Elizabeth Potter. New York: Routledge.
Longino, Helen E. 1993. “Subjects, Power, and Knowledge: Description and Prescription in Feminist Philosophies of Science.” Feminist Epistemologies, ed. Linda Alcoff and Elizabeth Potter. New York: Routledge.