The HPV Vaccine Debate: Why News Organizations Need to Carefully Consider Coverage Decisions

--Guest post by Brittany Noble, American University graduate student.


The digital age continues to change news media and the way the public receives information. As a leading example, Americans are increasingly turning to news organizations for information related to the healthcare industry. In fact, they are turning to mass media for medical and health news as often as they do to health care professionals, according to studies (Mebane, 2005).

Research finds that more than 80 percent of Americans believe that news about the health care industry, health and medicine “helps them lead a healthy life.” The public trusts that health and medical information reported in the news will help them, not hurt them. However, journalists generally rely on four main sources of information to write their health-related stories: pharmaceutical companies, the government, advocates and academic researchers – each who have their own point-of-view and goals when discussing medical and health issues.

Without carefully considered newsroom policies informing coverage decisions, say critics, the news media essentially provides free advertising for pharmaceutical companies, such as when the brand name of a drug is mentioned in a story. Conversely, if the story is negative, mentioning the brand name could harm the company. There is also reason for concern when pharmaceutical-industry funded research goes undisclosed.

A 2008 study published in the Journal of the American Medical Association (Hochman et. al,. 2008) found that at the time few policies existed in the news media specific to disclosure when a research study is funded by a pharmaceutical company or when mentioning a brand name of a product. The authors polled editors at the top-read newspapers in the U.S. who claimed to “always or often” reference generic names.  Yet more than half of the articles examined contained brand names.

The issue is compounded when a specific medical issue is framed in a certain way that sets the stage for a pharmaceutical company to provide a single treatment or approach to a health problem or disease.

The Case of the Gardasil Vaccine

This is apparent when analyzing pharmaceutical company framing and media coverage of humanpapilloma virus (HPV) vaccines. HPV is a sexually transmitted disease that consists of hundreds of strands, one of which is known to causes cervical cancer in women. The FDA approved two vaccines that exist in the market today: Gardasil, introduced by Merck in 2006 and Cevarix introduced by GlaxoSmithKline in 2009.  According to the Center for Disease Control (CDC), both vaccines are very effective against cervical cancer-causing strands of HPV and are safe. Gardasil prevents four strands of HPV and is the only one proven effective for males.

Merck’s original framing strategy is analyzed in “SHHHHH! DON’T SAY ‘STD’,” a Masters capstone project by former American University graduate student Jeanine Shipley.   In her analysis, Shipley describes Merck’s “One Less” communication campaign and how it framed the Gardasil vaccine as empowering for women. The report states empowerment for women was “shown throughout the commercials with young women taking control of their health by pledging to be one less life affected by cervical cancer.”

Merck also attempted to distance the vaccine from sexual activity, a major source of controversy for the vaccine.  As Shipley writes: “Merck used framing to define cervical cancer as the problem, diagnose HPV as the cause, and suggest Gardasil as the remedy” (Shipley, 2007).

Media Framing of Causes and Solutions to HPV

Following its 2006 debut, Merck’s frame was quickly adopted by mainstream media. Today, HPV is consistently framed as the cause to a growing problem – cervical cancer. This problem leaves parents seeking a solution.

Gardasil started appearing on parents’ to-do lists shortly after its 2006 debut. Since, it has been increasingly reported on by news media and used as a platform for some politicians.  The vaccine continues to receive support from the government and medical experts.

On Oct. 25, 2011, the New York Times reported that a panel, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, recommended the vaccine for boys age 11 or older.  On Nov. 18, 2011 the GAVI Alliance announced it has started taking steps toward making the HPV vaccine available in other countries.

The boost in vaccine sales contributed to a surge in Merck’s 2011 third quarter sales according to an Oct. 28, 2011 report by the Financial Times.

Merck’s boost in vaccine sales is at least partly attributable to medical and government endorsement. Can the increasing media coverage and the way HPV is framed be attributed to that that boost as well?

It certainly is not hurting.

The effectiveness of Gardasil is not the issue; it is what is, and is not, disclosed in the news, compounded by the way the health issue is framed. It is obvious that cervical cancer is a problem. HPV is a cause of that problem. The media has framed this story as scary and Gardasil as the solution.  

Shifting Frames?

Gardasil was seen as the right solution for Gabi Swank, a young Wichita, Kansas woman. Swank chose to get the HPV vaccine after seeing Merck’s commercials on MTV in order to  “be one less” woman with cervical cancer. She is featured in “The Greater Good,” a documentary film released Nov. 18, 2011 by BNP pictures. The film’s website states that the documentary “looks behind the fear, hype and politics that have polarized the vaccine debate in America today.” Gabi suffered numerous health problems after receiving Gardasil. Health problems, that the documentary contends, are linked to her vaccinations.

On Oct. 19, 2011, the conservative Washington Examiner published the sensationally headlined story, “Feds continue to ignore mounting Gardasil body count,” which discussed the deaths of two young women who according to the Examiner “suddenly dropped dead shortly after receiving their final injection of Gardasil.”

The documentary and Examiner coverage represents a strong rival and what many say is a misleading frame; a focus that alleges the uncertain risks of vaccination and the accountability – or lack thereof – of industry and government.  For public health officials and scientists, this type of framing is very difficult to counter. As a review of the Greater Good in the New York Times put it:

If the title of your documentary is “The Greater Good,” shouldn’t you at least define what that is? Apparently not, as this emotionally manipulative, heavily partial look at the purported link between autism and childhood immunization would much rather wallow in the distress of specific families than engage with the needs of the population at large. 

Orac, the alias of a surgeon and influential blogger, was more succinct in his criticism, calling The Greater Good a “medical propaganda film.”

Gardasil has faced controversy since its debut, but today, as these recent examples indicate, controversy over Gardasil and vaccines in general is likely to continue. As the 2012 election nears, HPV has already been the topic of controversy at a Republican debate as candidate Michele Bachmann questioned its safety. Several conservatives including Washington Post columnist Michael Gerson responded by forcefully countering these positions and backing the position of government experts and scientists.

Despite the efforts of pro-vaccination conservatives like Gerson, it will be interesting to see if the frame of Gardasil as an uncertain, unaccountable problem rather than a solution to cancer gains momentum. Will this have an effect on Gardasil’s vaccine sales in the future, on vaccine-related policies, on regulation, on the overall news framing of the issue, and on public trust in vaccines?

Given the continued debate over vaccines and the likely increase in public demand for information, news organizations and journalists should carefully review and consider the policies and norms that guide their coverage decisions.  Relevant questions include the reporting of generic drug names over brand names, the disclosure of financial sponsorship of research, ensuring that specific statements or characterizations about the product are attributed to the pharmaceutical company; and how to cover the views of advocates, celebrities, and political figures when their often sensational if not outright false claims cut against the recommendations and conclusions of medical experts and government agencies.

--Guest post by Brittany Noble, an MA student in Public Communication at American University in Washington, D.C.  Noble is a full time graduate student and is employed as a Communications Specialist with a strategy and technology consulting firm in Washington, D.C. 

Read other posts from her project team examining social media influence and regulation in the pharmaceutical industry as well posts from other project teams in her course.

References:

Catsoulis, J. (2011, November 18). “The Fight Over Vaccines and Autism, Continued.” The New York Times

Center for Disease Control: HPV Vaccine – Questions and Answers.

Gerson, Michael. (2011, September 15). “A dose of reality for the HPV debate.” The Washington Post

The Greater Good (2011).  

Hochman, M., Hochman, S., Bor, D., McCormick, D. (2008). "News Media Coverage of Medication Research: Reporting Pharmaceutical Company Funding and Use of Generic Medication Names." JAMA: The Journal of the American Medical Association 300(13): 1544-550.

Hollingsworth, B. (2011, October 19). “Feds continue to ignore mounting Gardasil bodycount.” The Washington Examiner

Mebane, F. (2005) The Importance of News Media in Pharmaceutical Risk Communication: Proceedings of a Workshop.” Pharmocoepidemiology and Drug Safety 14(5): 297-306.

Orac. “Anti-Vaccine Propaganda lands in New York City this weekend.” Nov. 18, 2011.

Shipley, J. (2007). “SHHHHH! DON’T SAY STD: How Merck used framing to gain acceptance for its HPV vaccine.” 

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