Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: firstname.lastname@example.org
Vaccine Confidence Project [to 17 February 2018]
A global girl gang
Heidi J Larson. 2018. The Lancet 391(10120), p527–528. https://doi.org/10.1016/S0140-6736(18)30193-4
If there is one time of life when emotional ups and downs are particularly steep—with roller-coaster highs and lows, risky behaviour, and attention seeking at an all-time high—it’s adolescence. It is an exciting, scary, and vulnerable time. Many cultures around the world recognise this liminal and transformative time with initiation rites to mark the passage from childhood to adulthood. Heads are shaved, genitals cut, tests of courage and strength performed, and ceremonies held to mark sexual maturity, reproduction, and changing roles in family and society. With this transition, is the loss of innocence, of virginity, of purity.
Throughout history, myths have been written and artists have portrayed virgins—as a most precious gift— being sacrificed to the gods, for redemption and protection of whole populations. The notion of sacrificing a virgin for the greater good is the theme of a three-part YouTube series, intended to be woven into a documentary film, called Sacrificial Virgins. In this case, though, filmmaker Joan Shenton challenges the notion that the human papillomavirus (HPV) vaccine is for the greater good, titling part 1 of the series, “Not for the Greater Good”.
The film opens with 16-year-old Ruby—long brown hair, glasses, and wearing a salmon-coloured T-shirt with “Girl Gang” written across the front—capturing well the sentiments of her age. In her gentle voice, she talks about her pain and fatigue; as her mother moves her in a swing, her legs and arms are limp and she’s unable to stand without support. Ruby is convinced that the HPV vaccine caused her situation, and the video series goes on to tell other stories as the filmmaker interviews young girls, their mothers, and scientists who present alternative views and questions around the safety and need for the HPV vaccine. There are no positive voices about the HPV vaccine in this video series. There are no interviews with the Nobel Laureate Harald zur Hausen, who discovered the link between HPV infection and cervical cancer, or with Lasker Award-winning scientists Douglas Lowy and John Schiller for their research on the HPV vaccine, or even with girls or parents who think differently about the positive value of the HPV vaccine and the prevention of cervical cancer.
Documentary films and social media, now enabling the viral spread of photos and videos worldwide, are becoming the media of choice among those most critical of vaccines. Films and social media can channel emotions and provide a platform to share personal testimony as compelling “evidence” that cannot be conveyed in scientific articles and randomised controlled trials.
The HPV vaccine brings out particularly strong emotions. It provokes cultural, religious, and political reactions from the public more than most other vaccines, not in small part because it touches on sensitivities around sexuality and reproduction, as well as the vulnerable emotions and individuation of adolescent girls. Some of these emotions and anxieties have been pointed to by the medical community as contributing to the range of symptoms reported by young girls—dizziness, fainting, eating disorders, and walking difficulties—while those who experience them are convinced they are caused by the HPV vaccine.
Sacrificial Virgins is not a series on its own. It is another film produced on a growing theme of The Vaccinated Girls (De Vaccinerede Piger), as a Danish TV documentary was titled. The documentary was broadcast in Denmark in March, 2015, is still circulating on YouTube, and has prompted other films—in the Netherlands, Ireland, and Colombia—where girls share their personal testimonies, and their symptoms, suspected to be caused by HPV vaccination. Danish HPV vaccine anxieties posted on YouTube or Facebook have influences well beyond Denmark, travelling afar with English or other subtitles. Video clips of Colombian girls telling their stories in Spanish are subtitled in English with voiceover in Japanese. Japanese anti-HPV vaccine sentiments and YouTube images have meaning beyond Japan, shared globally with multilanguage subtitles and images that often speak for themselves. The stories from Japan have travelled particularly widely, and featured in many online discussions, Facebook pages, and YouTube testimonies, including in part 3 of Sacrificial Virgins. The Japanese Government suspended their proactive recommendation of the HPV vaccine in June, 2013, in reaction to reported vaccine reactions and public pressure. Although the independent committee that investigated the cases found no evidence of a link between the vaccine and the reported symptoms, more than 4 years later, the recommendation is yet to be reinstated and HPV acceptance rates have plummeted from over 75% to under 1%. Meanwhile, those around the world who are increasingly anxious, concerned, or convinced they have been injured by the HPV vaccine point to the Japanese Government’s decision as an endorsement of their concerns.
Teenage social networks are increasingly created online with intimacies, sensitivities, and experiences shared across the globe in search of like-minded friends. Sometimes these new media offer a space for friendship and sharing, but they have also opened the gates for the viral spread of panic, such as around HPV vaccine risks. These stories are a growing narrative co-created and posted by the girls and circulating globally that fuel a social amplification of risk and anxiety. As with street gangs that create their own brands and loyalty, these girls are creating their own evidence.
The impact of this growing trend of globally shared personal testimonies, risk perceptions, and vaccine critiques is no longer fringe. The impacts are evident in the high level of reported adverse events after HPV vaccination and the less than optimal levels of vaccine acceptance in countries where the vaccine is available and recommended. As poorer countries, with some of the highest cervical cancer burdens, start to introduce the HPV vaccine into their national programmes, anyone with internet and social media access will be exposed to the Babelian mix of trust-building as well as trust-breaking posts about the vaccine. Although most reported adverse events have not been confirmed as being caused by the vaccine, they reflect the heightened perceptions of risk, suspicion, and distrust around HPV vaccination. The trust levels are low.
Building trust among young girls is critical. They are future mothers, and their personal experiences with vaccines will be remembered. Symptoms suspected to be caused by HPV vaccination, such as those portrayed in Sacrificial Virgins, need empathy, counselling, and support. The questions, symptoms, and concerns are real for those who experience them and dismissing them as being unrelated to vaccination will only provoke more distrust and alienation. Disseminating better messages is not the point. These stories are about a broken relationship and need repair. They need listening, not instructing. They need dialogue, not dismissal.