The Epidemiology of Truth: A multi-method ethnography of HPV vaccine hesitancy in the Republic of Ireland
Lead Research Organisation:
University College London
Department Name: Anthropology
Abstract
It is widely remarked that vaccination is one of the most significant breakthroughs in
modern medicine. The WHO reports that the Measles vaccine saved an estimated 17.1
million lives since its introduction, with 546,000 measles-related deaths at the beginning
of the century to 114,900 by 2014 (WHO 2015). Alongside the success of vaccination in
medicine since the work of Jenner and Pascale in the 19th century, there has been a
culture of vaccine resistance. As Wolfe (2002) documents in their study of the 19th
century anti-vaccination movements, the UK parliament passed passing the Vaccination
Act of 1853 which making immunisation mandatory for all infants in the first three
months of life, with penalties of fine or imprisonment for non-compliance. Violent riots
followed the passage of the law, alongside spirited campaigning by anti-vaccination
movements. As Woolfe conclude their review 'this opposition began with the first
vaccinations, has not ceased, and probably never will... [it] will not leave us and cannot
be cured by force alone'. The relationship between institutions and the populace,
information practises, personal rights goes to the heart of vaccination. As Berezin and
Eads state 'vaccination is a social as well as a medical act'.
Contemporary concerns not only echo those of the relationship between citizenry,
healthcare and the state, but today deeply involved in shifting informational practises
and social dynamics which messily constitute the sociality of vaccination.
This is particularly the case with the Human Papillomavirus (HPV) vaccine, which
involves a unique range of intersectional problems. HPV is one of the most widespread
sexually transmitted infections (STIs) in the world. Whilst in many cases it remains
symptomless, Type 16 and 18 HPV is responsible for a range of cancers (cervical, anal,
oropharyngeal, vaginal and penile) and genital warts. In the US alone, 79 million are
infected with the disease and a further 14 million new infections occur each year. there
are likewise 4,000 diagnoses of HPV-related cancer made per year (Texas Health and
Human Services Commission 2016). The HPV vaccine has been subject to recent
global spikes in public concern. Another high profile case One of the most high profile
instances can be found in 2008, when Texas state governor Rick Perry attempted to
mandate vaccination using Gardrasil for school-age girls. Social conservatives voiced
concerns that the vaccine legitimated and encouraged sexual promiscuity, whereas
evidence of a close relationship with the vaccine manufacturer brought about further
criticism of corporate interests (Eggen 2011). These concerns are not unique to Texas
or the US. Pop (2016) highlights narratives of purity and corruption in Romanian
relationships to the HPV vaccine, whilst noting the failures of national HPV vaccination
campaigns. As she puts it, 'the HPV vaccine made some parents uneasy in ways that
no other vaccine did' (ibid, p.564) highlighting that 'to evoke the possibility of STIs in the
lives of young girls was to contradict the innocence they represented' (ibid, p.568).
Concerns over side effects are also significant; Japan withdrew its recommendation to
vaccinate for HPV in 2015 (Morimoto et al. 2015), whereas in Denmark rates of HPV
vaccine coverage have dropped as low as 17% in 2017, down from 80% full coverage in
1998-2000 (Skortstengaard, Thamsborg and Lynge 2017). In other contexts, more localised social disparities are at work - with research focusing on divergences in HPV
vaccination rates between ethnic groups in the US (Burdette et al. 2016; Galbraith et al.
2016). Such studies highlight the ongoing need for 'alternative theoretical frameworks
grounded in culture' (Galbraith et al. 2016, p.123).
modern medicine. The WHO reports that the Measles vaccine saved an estimated 17.1
million lives since its introduction, with 546,000 measles-related deaths at the beginning
of the century to 114,900 by 2014 (WHO 2015). Alongside the success of vaccination in
medicine since the work of Jenner and Pascale in the 19th century, there has been a
culture of vaccine resistance. As Wolfe (2002) documents in their study of the 19th
century anti-vaccination movements, the UK parliament passed passing the Vaccination
Act of 1853 which making immunisation mandatory for all infants in the first three
months of life, with penalties of fine or imprisonment for non-compliance. Violent riots
followed the passage of the law, alongside spirited campaigning by anti-vaccination
movements. As Woolfe conclude their review 'this opposition began with the first
vaccinations, has not ceased, and probably never will... [it] will not leave us and cannot
be cured by force alone'. The relationship between institutions and the populace,
information practises, personal rights goes to the heart of vaccination. As Berezin and
Eads state 'vaccination is a social as well as a medical act'.
Contemporary concerns not only echo those of the relationship between citizenry,
healthcare and the state, but today deeply involved in shifting informational practises
and social dynamics which messily constitute the sociality of vaccination.
This is particularly the case with the Human Papillomavirus (HPV) vaccine, which
involves a unique range of intersectional problems. HPV is one of the most widespread
sexually transmitted infections (STIs) in the world. Whilst in many cases it remains
symptomless, Type 16 and 18 HPV is responsible for a range of cancers (cervical, anal,
oropharyngeal, vaginal and penile) and genital warts. In the US alone, 79 million are
infected with the disease and a further 14 million new infections occur each year. there
are likewise 4,000 diagnoses of HPV-related cancer made per year (Texas Health and
Human Services Commission 2016). The HPV vaccine has been subject to recent
global spikes in public concern. Another high profile case One of the most high profile
instances can be found in 2008, when Texas state governor Rick Perry attempted to
mandate vaccination using Gardrasil for school-age girls. Social conservatives voiced
concerns that the vaccine legitimated and encouraged sexual promiscuity, whereas
evidence of a close relationship with the vaccine manufacturer brought about further
criticism of corporate interests (Eggen 2011). These concerns are not unique to Texas
or the US. Pop (2016) highlights narratives of purity and corruption in Romanian
relationships to the HPV vaccine, whilst noting the failures of national HPV vaccination
campaigns. As she puts it, 'the HPV vaccine made some parents uneasy in ways that
no other vaccine did' (ibid, p.564) highlighting that 'to evoke the possibility of STIs in the
lives of young girls was to contradict the innocence they represented' (ibid, p.568).
Concerns over side effects are also significant; Japan withdrew its recommendation to
vaccinate for HPV in 2015 (Morimoto et al. 2015), whereas in Denmark rates of HPV
vaccine coverage have dropped as low as 17% in 2017, down from 80% full coverage in
1998-2000 (Skortstengaard, Thamsborg and Lynge 2017). In other contexts, more localised social disparities are at work - with research focusing on divergences in HPV
vaccination rates between ethnic groups in the US (Burdette et al. 2016; Galbraith et al.
2016). Such studies highlight the ongoing need for 'alternative theoretical frameworks
grounded in culture' (Galbraith et al. 2016, p.123).
