Putting public health infrastructures to the test: introducing HPV vaccination in Austria and the Netherlands

Abstract

This article presents two cases of policymaking concerning the vaccine against Human Papilloma Virus (HPV), which is sexually transmitted and carcinogenic. Our analysis focuses on its introduction in Austria and the Netherlands. In both contexts, we find prevention and screening to be at once complementary and competing public health logics and we draw on the concept of 'infrastructure' to understand their roles in shaping the reception of the vaccine. We reveal how the HPV vaccine had to be made 'good enough', much like the Pap smear (Casper and Clarke ), by means of diverse tinkering practices that transformed both the technology and the infrastructures in which they emerged. At the same time, it was important that the vaccine would not come to problematise Pap smear-based screening. The article points to the contextually contingent nature of policymaking around new medical technologies, and the skillful care with which public health infrastructures such as immunisation and screening programmes are handled and tinkered with.

What kind of ‘a girls’ thing’? Frictions and continuities in the framing and taming of the HPV vaccine in Finland

“…The vaccine needs also to be framed to ‘satisfy pertinent “social worlds” to become embedded in them’ (Paul et al . : 69). The ‘a girls’ thing’ campaign was created for this, to embed the vaccine in the social world and the landscape of meaning of vaccination‐aged girls.…”

“…In Finland, however, the adoption of the vaccine into the NVP caused no remarkable political or public contestation compared to other European countries, such as Austria and the Netherlands (Paul , Paul et al . ), and especially to the United States (Gottlieb ). Hence, it is reasonable to move the focus on the relatively low HPV vaccination coverage in Finland to the potential frictions between the framings and tamings of the directors of the vaccination campaign and the framings and tamings of the girls targeted for the vaccination.…”

“…The clinical effectiveness of the screenings was thus promoted over HPV vaccination in epidemiological and economic terms until the end of the first decade of this century. The effective screening programme is also the main reason for the late adoption of the HPV vaccine in the Finnish NVP (Nohynek 2008, see also Casper and Clarke 1998, Gericke 2008, Hestbech et al 2016, Paul et al 2018. 3 The cognitive and behavioural aspects of HPV vaccination are attracting increasing attention among health scientists.…”

Collective organization of discourse expertise using information technology – CODE IT!

“…This newly developed methodology was motivated by a strong desire to move beyond conventional political science methods, such as expert interviewing [15] for two reasons: first, our previous research had focused on experts themselves [16], and we wanted to explore a "different way of knowing" [1] about HPV in this otherwise very expert-centered policy field. We did so by tapping into the perception and skills of those typically not involved in either policy research or policy debate: target groups of particular policies.…”

“…Second, coders had to be able to assign text passages to particular existing codes (known as deductive coding) listed in the application, and had to be able to create new codes based on text passages (inductive coding). The existing codes were derived from an earlier research project [15,16] and were listed with short single sentence narrative explanations. These codes were, in essence, statements about the text, that could be indicated as absent (red button) or present (green button) (see above).…”