Beyond the Marketing

Although human papillomavirus (HPV) is the world’s most common sexually transmitted infection, most people never know they are infected, says medical anthropologist Samantha Gottlieb ’00. She examines the marketing of the HPV vaccine Gardasil in her new book, Not Quite a Cancer Vaccine: Selling HPV and Cervical Cancer.

“Vaccines are important,” she says, “but we need to understand how they have been developed, marketed, and promoted to us, which shapes how we understand their utility and how we are able to evaluate their benefits.”

What did you discover?

How important it was to understand the HPV vaccine in the context of broader U.S. debates about vaccination. Merck’s decision to present this as a cervical cancer vaccine, rather than to focus on the STI protective benefits, had a huge impact on how the public came to understand it. It is now approved for both boys and girls, which wasn’t originally the case. The newer Gardasil 9 vaccine provides much better coverage for the many types of HPV that can cause cancer, making it a better vaccine overall.

Is Gardasil a wonder drug?

It’s easy to think, Wow, we have a really amazing first step against cancer. We should think that we’ve known for nearly 40 years that cervical cancer is caused by a virus. And now we know other cancers—such as oral, anal, and penile—also have a viral cause. So, is it great that we have a way to prevent against a virus that can mutate into cancers? Yes! But the story is more complex and reveals historical, gender, and commercial biases that have contributed to the development of a vaccine that many people still distrust.

What does it mean to call this a “cancer” vaccine?

I think it has done a huge disservice to the vaccine’s potential in the U.S.—its value is quite different in countries where the deaths due to cervical cancer remain devastatingly high. Thus, I think the reasons to vaccinate against HPV in the U.S. are not the reasons that Merck, clinicians, and public health officials have insisted upon.