WEBVTT - HPV: Unpacking Papilloma 0:00:04.880 --> 0:00:05.800 What's a jackalope. 0:00:08.600 --> 0:00:12.560 A jackalope is a mythological creature, a sort of iconic 0:00:12.600 --> 0:00:15.760 to the American West. It's a combination of a jack 0:00:15.880 --> 0:00:18.280 rabbit and a prong horn antelope. So it's a jack 0:00:18.360 --> 0:00:22.480 rabbit that has antlers or horns, and it exists richly 0:00:22.520 --> 0:00:25.919 in the imagination of Americans, especially in the West. But 0:00:26.040 --> 0:00:27.840 it is a mythological creature. 0:00:28.680 --> 0:00:31.520 This is Michael Branch, a man who loves the jackalope 0:00:31.560 --> 0:00:33.800 so much that he wrote a book about it. It's 0:00:33.840 --> 0:00:36.960 called On the Trail of the Jackalope. Is that a 0:00:37.040 --> 0:00:39.400 jackalope on your shirt? Or am I mistaken? 0:00:40.360 --> 0:00:43.880 Yeah, that's a jacalobe. Of course. Jacoalobe kitch is a 0:00:43.960 --> 0:00:47.159 huge part of the phenomenon. And so you know, if 0:00:47.200 --> 0:00:49.560 you've ever seen a jacalobe bumper stick or t shirt, 0:00:49.600 --> 0:00:53.080 shot glass, taxidermy mount, you're part of the hoax. You're 0:00:53.120 --> 0:00:53.800 in on the joke. 0:00:55.400 --> 0:00:58.280 The jackalope is a myth, but there are in fact, 0:00:58.440 --> 0:01:01.800 real horned rabbits. Is an expert on these two, and 0:01:01.880 --> 0:01:05.080 those horned rabbits led to a key breakthrough in understanding 0:01:05.160 --> 0:01:11.320 how viruses cause disease. Today on the show Horned rabbits, 0:01:11.800 --> 0:01:17.920 human papilloma virus AKAHPV, and a vaccine backlash. This is incubation. 0:01:18.200 --> 0:01:31.600 I'm Jacob Goldstein. So there's this myth of the jackalope 0:01:31.600 --> 0:01:36.280 in the US. There are mythological horned rabbits, and in fact, 0:01:37.360 --> 0:01:40.560 there are real horned rabbits in the world. Right, we've 0:01:40.560 --> 0:01:43.080 been talking only of myth. But tell me about tell 0:01:43.080 --> 0:01:45.200 me about real horned rabbits. 0:01:46.240 --> 0:01:50.520 So called horned rabbits are actually various species of rabbits 0:01:50.520 --> 0:01:55.000 that develop these weird, grotesque growths on their heads, sometimes 0:01:55.040 --> 0:01:58.440 on their faces, and they're produced by a papilloma virus. 0:01:58.760 --> 0:02:03.960 And both hunters and common people and also naturalists have 0:02:04.120 --> 0:02:07.760 noticed these forever without having any idea what caused them. 0:02:08.000 --> 0:02:09.120 And what does it look like. 0:02:12.680 --> 0:02:15.200 Let me put it this way. When the slide of 0:02:15.240 --> 0:02:18.560 an actual horn rabbit comes up when I'm doing book talks, 0:02:18.639 --> 0:02:21.639 you can hear a collective groan from the audience. I mean, 0:02:21.680 --> 0:02:26.399 it is quite grotesque. And if you can just imagine bumpy, wordy, 0:02:26.680 --> 0:02:29.919 caratinous black growths all over the face or head of 0:02:29.960 --> 0:02:31.920 an animal, that's what it looks like. 0:02:32.360 --> 0:02:36.720 So you mentioned that that these horns, these growths are 0:02:36.760 --> 0:02:40.000 caused by a papolloma virus, which turns out to be 0:02:40.040 --> 0:02:44.120 important in the history of understanding viruses and ultimately in 0:02:44.160 --> 0:02:45.200 the history of human health. 0:02:45.400 --> 0:02:48.320 Right yeah, And it involves a guy named Richard shop 0:02:48.600 --> 0:02:51.240 who had actually been involved in trying to figure out 0:02:51.240 --> 0:02:54.440 what had caused the global pandemic of nineteen eighteen. By 0:02:54.440 --> 0:02:56.800 the time he got interested in horn rabbits, he was 0:02:56.880 --> 0:03:00.040 already a well known virologist. This would have been the 0:03:00.120 --> 0:03:04.120 late nineteen twenties early nineteen thirties, and he had come 0:03:04.160 --> 0:03:06.880 from his home in Iowa to Princeton to take up 0:03:06.880 --> 0:03:10.440 this research position as a medical researcher. And he heard 0:03:10.480 --> 0:03:14.280 stories from his friends back in Iowa and Kansas who said, hey, 0:03:14.320 --> 0:03:16.760 you know, sometimes when we're out rabbit hunting, we kill 0:03:16.840 --> 0:03:19.760 these rabbits that have these weird growths on them. And 0:03:19.840 --> 0:03:23.720 of course, you know, being a scientific researcher guy interested 0:03:23.720 --> 0:03:27.079 in viruses, you know, he immediately wanted to see one 0:03:27.080 --> 0:03:28.920 of these rabbits. In fact, he wanted to see him 0:03:28.960 --> 0:03:31.920 so badly that he made a special trip back to 0:03:32.000 --> 0:03:34.720 Iowa with a hunter who had claimed to have shot 0:03:34.760 --> 0:03:38.240 a number of these rabbits, and Shope himself hunted specifically 0:03:38.320 --> 0:03:40.880 to try to get one of these rabbits with the 0:03:40.880 --> 0:03:43.720 strange growths. After four days, he was unsuccessful and he 0:03:43.760 --> 0:03:46.440 had to go back to Princeton. There was a young 0:03:46.520 --> 0:03:48.640 young kid who had been hunting with them, and he 0:03:48.720 --> 0:03:50.840 told that kid, Hey, I'm going to leave you a 0:03:50.840 --> 0:03:54.280 five dollar bill and a bottle of glycerol solution, and 0:03:54.320 --> 0:03:57.200 if you can find one of these rabbits, cut off 0:03:57.240 --> 0:03:59.920 its horns, put him in the solution, mail them to me, 0:04:00.080 --> 0:04:03.560 and I'll give you another five dollars. He could see 0:04:03.600 --> 0:04:06.840 from the very beginning that if he could demonstrate a 0:04:06.920 --> 0:04:10.520 link between viruses and cancer in a mammal that he 0:04:10.520 --> 0:04:13.520 would be opening the way to research that might ultimately 0:04:13.560 --> 0:04:15.440 address that question in human beings. 0:04:15.720 --> 0:04:19.680 Ah. So he wants to find out whether a virus 0:04:20.160 --> 0:04:23.320 is causing these growths, these horns to grow out of 0:04:23.320 --> 0:04:25.839 the heads of rabbits exactly. 0:04:25.960 --> 0:04:28.760 And soon as Chope left Iowa, this kid just made 0:04:28.800 --> 0:04:31.960 it his mission to get one of these rabbits, and 0:04:32.000 --> 0:04:34.480 he did so. He mailed Shope the horns in the 0:04:34.520 --> 0:04:37.839 glyceral solution. He got his other five dollars, and after 0:04:37.880 --> 0:04:40.520 that the word get out among the communities of hunters 0:04:40.560 --> 0:04:44.120 in Kansas and Iowa, and people began to literally mail 0:04:44.560 --> 0:04:48.040 specimens of horn rabbits to shop in Princeton. 0:04:48.440 --> 0:04:51.560 So he's there in Princeton and he goes down and 0:04:51.600 --> 0:04:54.159 gets his like whatever, his insurance bill, and then a 0:04:54.200 --> 0:04:56.480 box with a dead rabbit in it, exactly. 0:04:56.960 --> 0:04:59.240 And he started working on horn rabbits there at the 0:04:59.320 --> 0:05:02.320 Rockefeller Inns Institute in nineteen thirty two with the goal 0:05:02.400 --> 0:05:06.599 of understanding what caused those odd growths. He is especially 0:05:06.640 --> 0:05:10.040 interested in viruses, and he is doing his work at 0:05:10.040 --> 0:05:14.279 a time when the consensus in the scientific community is 0:05:14.320 --> 0:05:18.120 that it is impossible that a virus could cause cancer, 0:05:18.240 --> 0:05:21.200 especially in a mammal. And at the time, you know, 0:05:21.279 --> 0:05:24.920 nobody knew what caused these weird growths, and he wanted 0:05:24.960 --> 0:05:28.120 to find out what caused them, but he suspected that 0:05:28.200 --> 0:05:30.039 it was a virus, and so he set out to 0:05:30.240 --> 0:05:34.120 sort of test that hypothesis through his own experimental method. 0:05:35.800 --> 0:05:38.359 So when you say his own experimental method, what do 0:05:38.400 --> 0:05:39.120 you mean, what do you do? 0:05:40.600 --> 0:05:44.280 Well? First, he samples these weird growths on the rabbit's heads, 0:05:44.960 --> 0:05:48.400 and he takes those samples and pulverizes them, adds them 0:05:48.400 --> 0:05:52.080 to a saline solution and then runs them through a centrifuge. 0:05:52.600 --> 0:05:55.320 And then he takes the fluid that has been produced 0:05:55.360 --> 0:05:58.359 by that process and then does what is really the 0:05:58.400 --> 0:06:02.039 most important thing. That is, he takes that fluid and 0:06:02.080 --> 0:06:05.919 puts it through a filter. Now, back in the nineteen thirties, 0:06:06.440 --> 0:06:10.039 in the kind of pioneering era of viral research, these 0:06:10.120 --> 0:06:13.719 porcelain filters were very important because they could filter out 0:06:13.760 --> 0:06:18.080 bacteria and other larger things. The only thing small enough 0:06:18.160 --> 0:06:20.760 to go through these filters was a virus. Huh. 0:06:20.800 --> 0:06:24.160 It's interesting, right, because that it seems sort of primitive 0:06:24.200 --> 0:06:27.840 to us on a certain level, but also kind of ingenious, right, Like, 0:06:28.680 --> 0:06:31.599 they know not that much about viruses at the time, 0:06:31.600 --> 0:06:34.360 but they know they're way smaller than bacteria and that 0:06:34.400 --> 0:06:38.080 those are the two main kind of disease causing pathogens, right, 0:06:38.360 --> 0:06:40.960 And so they're like, Okay, let's just make a filter 0:06:41.080 --> 0:06:43.200 that will take out bacteria and anything else that can 0:06:43.240 --> 0:06:45.520 cause a disease, but that will allow viruses to pass 0:06:45.560 --> 0:06:47.800 through that we know that that's the only pathogen that 0:06:47.839 --> 0:06:48.680 could be left in here. 0:06:49.480 --> 0:06:53.120 Exactly exactly the fact that he uses this technique to 0:06:53.160 --> 0:06:55.159 make sure that the only thing that can come through 0:06:55.200 --> 0:06:58.080 that porcelain filter. Is a virus is kind of a 0:06:58.160 --> 0:06:58.719 key moment. 0:06:59.000 --> 0:07:01.920 Okay. So now he has his whatever, his gou his 0:07:02.000 --> 0:07:06.400 solution that we know has no bacteria in it that 0:07:06.480 --> 0:07:08.320 he's going to do something with. What's he do with it? 0:07:09.240 --> 0:07:12.600 Okay? So he takes live rabbits that are healthy. He 0:07:12.760 --> 0:07:14.840 shaves a little bit of their fur off and then 0:07:14.920 --> 0:07:17.559 scarifies their skin, just roughs it up just a little 0:07:17.560 --> 0:07:20.520 bit with some sandpaper, and then he takes that fluid 0:07:20.560 --> 0:07:24.080 that has gone through the filter and applies it to 0:07:24.120 --> 0:07:27.240 that little spot on the rabbits. And the idea is 0:07:27.400 --> 0:07:29.920 right that since this fluid has been taken from the 0:07:29.960 --> 0:07:32.680 horns of disease rabbits, and since it's been filtered to 0:07:32.720 --> 0:07:35.040 make sure the only thing that can be in it 0:07:35.080 --> 0:07:39.360 is viruses, he has essentially applied a fluid to these 0:07:39.680 --> 0:07:42.760 healthy rabbits. So the whole idea is to wait and see. 0:07:42.920 --> 0:07:45.880 Having no idea if virus is the cause, or if 0:07:45.920 --> 0:07:49.120 it is what the incubation period might be, he applies 0:07:49.200 --> 0:07:52.080 this to these patches on his test rabbits, and sure enough, 0:07:52.120 --> 0:07:54.960 after about ten days, all of the rabbits that he 0:07:55.000 --> 0:07:59.000 has inoculated with this fluid begin to develop exactly the 0:07:59.040 --> 0:08:02.520 same kinds of growth that were present on the diseased rabbit. 0:08:03.160 --> 0:08:05.520 And that's sort of the Eureka moment in the story, 0:08:05.960 --> 0:08:09.920 because that's the moment at which Shope has essentially proven 0:08:10.320 --> 0:08:13.360 that the growths on horned rabbits are in fact caused 0:08:13.400 --> 0:08:14.080 by a virus. 0:08:14.760 --> 0:08:17.239 Does he publish the results? How does this finding land? 0:08:18.080 --> 0:08:20.840 He publishes his work the following year, which is nineteen 0:08:20.920 --> 0:08:24.600 thirty three, in a watershed article in the Journal of 0:08:24.640 --> 0:08:28.760 Experimental Medicine, and you know, outside of fellow researchers in 0:08:28.800 --> 0:08:31.560 the virology community, it really doesn't go far at all, 0:08:32.480 --> 0:08:34.079 even though it's a huge breakthrough. 0:08:35.240 --> 0:08:39.840 After his paper comes out, do people recognize that viruses 0:08:39.880 --> 0:08:41.760 can cause cancer in mammals? 0:08:43.720 --> 0:08:46.760 They do, but it takes a while, you know. I 0:08:46.760 --> 0:08:49.960 think that the scientific community was so thoroughly resistant to 0:08:50.000 --> 0:08:53.760 this idea that it wasn't as if everyone realized right 0:08:53.800 --> 0:08:56.440 away what the implications of the work were. That's going 0:08:56.520 --> 0:08:59.280 to be left to other researchers, most importantly a guy 0:08:59.360 --> 0:09:02.400 named peyton Us who was a colleague of Shops at 0:09:02.400 --> 0:09:05.480 the Rockefeller Institute. Peyton Russ will go on to do 0:09:05.559 --> 0:09:09.319 the extended studies that will prove the hunch that showpad 0:09:09.360 --> 0:09:12.520 all along, which is that some of those growths can 0:09:12.640 --> 0:09:13.680 become cancerous. 0:09:13.920 --> 0:09:18.000 Aha. So that's ultimately showing Shope's work and the work 0:09:18.000 --> 0:09:22.240 of his colleague shows that in fact, a virus is 0:09:22.360 --> 0:09:24.400 causing cancer in a mammal. 0:09:24.520 --> 0:09:28.200 That's the kind of big breakthrough exactly. And so that's 0:09:28.200 --> 0:09:31.400 sort of the first step toward working on viruses as 0:09:31.440 --> 0:09:34.480 cancer causing agents in human beings. It's going to take 0:09:34.520 --> 0:09:40.400 several generations of scientists to explore the implications fully. 0:09:41.520 --> 0:09:44.520 In the decades after Shope did his studies on rabbits, 0:09:44.800 --> 0:09:49.320 scientists kept studying papillomaviruses. They discovered a human version of 0:09:49.360 --> 0:09:53.040 the papaloma virus, which reasonably enough, they called the human 0:09:53.160 --> 0:09:56.800 papalomavirus or HPV, and in work that wound up winning 0:09:56.800 --> 0:10:03.479 a Nobel Prize, another researcher definitively HPV to cervical cancer. Eventually, 0:10:03.520 --> 0:10:07.000 we learned that over ninety percent of cervical cancer cases 0:10:07.000 --> 0:10:10.160 are caused by HPV, and that HPV is also a 0:10:10.200 --> 0:10:14.600 common cause of throat cancer. Despite all that, when a 0:10:14.640 --> 0:10:19.160 new vaccine promised to prevent HPV, infection. Not everybody was excited. 0:10:19.679 --> 0:10:31.240 That's after the break the first HPV vaccine was rolled 0:10:31.240 --> 0:10:34.520 out nearly twenty years ago. People in the vaccine world, 0:10:34.760 --> 0:10:37.560 in the public health world, and the cancer world were 0:10:37.800 --> 0:10:41.520 very excited. This was a vaccine that could prevent cancer 0:10:41.800 --> 0:10:45.240 or at least some kinds of cancer, and HPV vaccines 0:10:45.280 --> 0:10:48.200 are in fact used around the world today. As it 0:10:48.240 --> 0:10:51.080 turned out, though back when the vaccine was first approved, 0:10:51.520 --> 0:10:53.439 many people were not excited. 0:10:53.960 --> 0:10:56.600 Support was coming from everywhere, but backlash was coming from 0:10:56.600 --> 0:11:00.920 everywhere too, like all over the political spectrum. Exaggeration to 0:11:00.960 --> 0:11:02.120 say it's a total mess. 0:11:03.120 --> 0:11:06.200 This is Elena Konis. She wrote a book called Vaccine Nation, 0:11:06.520 --> 0:11:10.720 America's Changing Relationship with Immunization, and she told me that 0:11:10.760 --> 0:11:14.360 the controversy over the HPV vaccine was really part of 0:11:14.360 --> 0:11:17.520 this much bigger story. She said, it was the culmination 0:11:17.720 --> 0:11:20.920 of this deep seated conflict that had been building for decades. 0:11:21.600 --> 0:11:25.280 In my view, you really can't understand what happens with 0:11:25.320 --> 0:11:28.560 the HPV vaccine in the early two thousands unless you 0:11:28.679 --> 0:11:32.440 rewind the clock back to the nineteen fifties actually, and 0:11:32.520 --> 0:11:35.920 that was because that was a decade when we got 0:11:35.920 --> 0:11:40.440 a new vaccine, the polio vaccine that was desperately hoped 0:11:40.480 --> 0:11:44.120 for the entire public. Really in some level was invested, 0:11:44.840 --> 0:11:48.280 and when that vaccine was developed and rolled out to 0:11:48.320 --> 0:11:51.600 the public in nineteen fifty five, it ushered in a 0:11:51.679 --> 0:12:00.480 new era of vaccination in the US. We started vaccinating kids, 0:12:00.880 --> 0:12:06.199 especially against a wide range of diseases. We started ensuring 0:12:06.360 --> 0:12:10.280 that they were vaccinated by making vaccines required for kids 0:12:10.320 --> 0:12:14.200 to enroll in school. We made them required by passing 0:12:14.280 --> 0:12:17.920 laws and regulations at the state level, and we did 0:12:17.960 --> 0:12:23.640 all of this with a lot of federal support. Polio, smallpox, measles, mumps, rubella. 0:12:24.120 --> 0:12:27.079 What's important about this list of diseases is that they 0:12:27.080 --> 0:12:31.400 were really different in kind. Polio and smallpox were widely 0:12:31.520 --> 0:12:36.880 feared dreaded diseases. The policies that we developed for polio 0:12:37.120 --> 0:12:39.440 ended up being applied to these other vaccines. 0:12:39.840 --> 0:12:43.600 Policies meaning state laws requiring them for kids to go 0:12:43.640 --> 0:12:47.360 to school, and the federal government supporting and even subsidizing 0:12:47.400 --> 0:12:48.120 those laws. 0:12:48.480 --> 0:12:52.520 Yes, and this is happening in the nineteen sixties. It's 0:12:52.559 --> 0:12:57.040 coinciding with the rise of all of the social movements 0:12:57.080 --> 0:13:00.880 of that decade that are encouraging young people in particular 0:13:01.000 --> 0:13:05.200 to question authority and to ask for more information and 0:13:05.280 --> 0:13:08.800 to push back against institutions. 0:13:09.200 --> 0:13:14.120 I mean, very broadly, more distrust of authority. Right plainly, Yes, 0:13:14.240 --> 0:13:18.000 Certainly in the nineteen seventies, if not before, people in 0:13:18.080 --> 0:13:21.960 many domains began to trust institutions and authority less, and 0:13:22.000 --> 0:13:22.719 that persons. 0:13:22.640 --> 0:13:26.360 Absolutely, And that actually leads into a kind of ironic 0:13:26.440 --> 0:13:31.040 moment in this late twentieth century history of vaccination, because 0:13:31.120 --> 0:13:36.840 by the nineteen eighties we have an organized vaccine safety movement, 0:13:37.040 --> 0:13:39.040 and I should say this is how they describe themselves. 0:13:39.080 --> 0:13:42.880 They don't call themselves anti vaccinationists. They lobbied for and 0:13:43.000 --> 0:13:47.400 ultimately succeeded in getting a change in federal legislation. In 0:13:47.480 --> 0:13:51.560 nineteen eighty six, Reagan signs a new law to provide 0:13:51.600 --> 0:13:56.560 compensation to individuals and families who have suffered injuries from 0:13:56.640 --> 0:14:03.800 mandated vaccines, and also creates the infrastructure for a nationwide 0:14:03.840 --> 0:14:07.720 system to monitor the public for vaccine injuries. So we 0:14:07.760 --> 0:14:09.640 get to the end of the eighties with the very 0:14:09.760 --> 0:14:13.640 organized and very successful national movement, and in the meantime, 0:14:13.679 --> 0:14:19.000 a handful of other childhood vaccines come out in the background. However, 0:14:19.360 --> 0:14:23.680 this organized self described vaccine safety movement has not stopped. 0:14:27.080 --> 0:14:30.080 So tell me the story of the HPV vaccine and 0:14:30.120 --> 0:14:30.680 it's rollout. 0:14:31.560 --> 0:14:36.360 So the HPV vaccine is so interesting in the history 0:14:36.360 --> 0:14:39.240 of vaccination because it comes out in the early two 0:14:39.280 --> 0:14:44.360 thousands and its rollout really represents a turning point. And 0:14:44.520 --> 0:14:47.600 when I talk about the HPV vaccine, initially, I'm talking 0:14:47.640 --> 0:14:49.239 about Merk vaccine Gardasil. 0:14:49.600 --> 0:14:52.520 That was the first HPV vaccine approved in the US. 0:14:52.760 --> 0:14:55.200 Yes, that was the first one approved for use in 0:14:55.240 --> 0:14:59.600 the US. It protected against four strains of HPV, and 0:15:00.080 --> 0:15:04.960 scientists knew very well that those four strains were linked 0:15:05.040 --> 0:15:09.000 to a very high proportion of cases of cervical cancer 0:15:09.040 --> 0:15:13.240 in the US. So there's multiple ways of getting cervical cancer, 0:15:13.280 --> 0:15:16.480 but one really important way is infection with HPV, and 0:15:16.560 --> 0:15:20.400 this vaccine protected against four strains known to be linked 0:15:20.440 --> 0:15:24.800 to cervical cancer. Mirke was excited about this. Reproductive health 0:15:24.840 --> 0:15:29.080 advocates and providers were excited about this, but Mirk knew 0:15:29.120 --> 0:15:32.960 that it faced a problem. HPV was not a virus 0:15:33.000 --> 0:15:35.800 that the public knew much about at all. In fact, 0:15:35.920 --> 0:15:39.280 they had hardly even heard of it, and that meant 0:15:39.360 --> 0:15:42.320 that they really didn't know about the link between HPV 0:15:42.440 --> 0:15:47.360 and cervical cancer. So before the HPV vaccine was approved, 0:15:47.520 --> 0:15:51.880 Merk ran an ad campaign, and the ad campaign specifically 0:15:51.880 --> 0:15:56.120 targeted women and told them that there was a virus 0:15:56.160 --> 0:15:59.600 called HPV and that it was linked to cervical cancer. 0:16:00.520 --> 0:16:02.200 I don't know why people don't know about this. 0:16:02.240 --> 0:16:03.440 I don't know why I didn't know. 0:16:03.520 --> 0:16:05.720 I've never heard of this. I'm just shocked. I just 0:16:05.720 --> 0:16:08.800 found out that cervical cancer is caused by certain types 0:16:08.840 --> 0:16:11.040 of a common virus, HPV. 0:16:12.440 --> 0:16:17.760 Merk knows that without awareness of this virus or its 0:16:17.840 --> 0:16:21.200 link to cancer, it's not going to get anywhere in 0:16:21.240 --> 0:16:24.200 the marketplace. So it makes sense why they do this. 0:16:24.440 --> 0:16:28.840 Reproductive advocates are thinking, hey, here is a vaccine that 0:16:29.320 --> 0:16:32.800 is not only a new tool against reproductive cancer, but 0:16:33.040 --> 0:16:36.840 a way of eliminating disparities in who gets cancer. In 0:16:36.880 --> 0:16:39.440 other words, there at the time were racial and income 0:16:39.520 --> 0:16:43.440 disparities in cervical cancer rates, and so the thinking on 0:16:43.480 --> 0:16:47.000 the part of reproductive health advocates were use a vaccine, 0:16:47.600 --> 0:16:51.560 administer it alongside other vaccines, and then people will be 0:16:51.640 --> 0:16:57.920 protected against cervical cancer, regardless of wealth, or race or ethnicity. 0:16:58.360 --> 0:17:03.359 Everybody's excited. Everybody's expecting a seamless rollout of this vaccine. 0:17:03.880 --> 0:17:08.120 So FDA approves guard to CEL, and the CDC Advisory 0:17:08.119 --> 0:17:11.879 Committee concludes that since the vaccine was tested in women, 0:17:12.480 --> 0:17:17.000 it should be administered only to females, and because HPV 0:17:17.119 --> 0:17:21.840 is sexually transmitted, it should ideally be administered to females 0:17:22.359 --> 0:17:24.919 as young as say sixth grade. 0:17:25.400 --> 0:17:28.240 So, just to be clear, the idea is to vaccinate 0:17:28.280 --> 0:17:31.240 people before they have sex and are therefore exposed to the. 0:17:31.280 --> 0:17:36.000 Virus exactly exactly, yeap, catch them before they're sexually active, 0:17:36.119 --> 0:17:38.800 so that there is little to no chance that they 0:17:38.800 --> 0:17:40.840 would have encountered this virus otherwise. 0:17:41.400 --> 0:17:43.360 And then, as I understand it, right, there was this 0:17:43.480 --> 0:17:47.880 like sample legislation that was drafted to encourage states to 0:17:47.960 --> 0:17:51.879 mandate the vaccine. And this is essentially the playbook of 0:17:51.960 --> 0:17:55.119 how vaccines had been rolled out for decades at this point. 0:17:54.920 --> 0:18:00.320 Right, absolutely, absolutely, The only change really is that this 0:18:00.359 --> 0:18:03.520 is a very new vaccine targeting and infection that the 0:18:03.560 --> 0:18:06.920 public really wasn't aware of yet, and that they were 0:18:06.920 --> 0:18:08.080 targeting only girls. 0:18:09.200 --> 0:18:09.480 Well. 0:18:09.520 --> 0:18:14.359 As soon as lawmakers introduced these bills, debates erupted in 0:18:14.440 --> 0:18:19.480 state houses and what happened was the anti pharma backlashed, 0:18:19.640 --> 0:18:24.919 combined with a conservative trend in sexual education, combined with 0:18:26.000 --> 0:18:30.120 the advent of kind of religious conservatism, meant that there 0:18:30.200 --> 0:18:34.040 was pushback coming from a handful of different spheres, all 0:18:34.080 --> 0:18:38.280 of whom had their own reasons for arguing against these 0:18:38.520 --> 0:18:43.040 HPV vaccination mandates. They said, vaccines are for children to 0:18:43.160 --> 0:18:46.680 protect them against diseases that are spread in the school environment. 0:18:47.080 --> 0:18:49.520 HPV is not. Let's leave it out of it. The 0:18:49.560 --> 0:18:54.920 best protection against sexually transmitted infections anyway, they said, was abstinence, 0:18:55.119 --> 0:18:59.400 not vaccines, and were probably quote unquote encouraging promiscuity if 0:18:59.400 --> 0:19:04.000 we use this vaccine. It made some people, especially a 0:19:04.000 --> 0:19:08.040 bunch of people who self identified as feminists and women's 0:19:08.080 --> 0:19:11.920 rights activists, say, hold on, why should it be women's 0:19:12.000 --> 0:19:16.280 or girls sole responsibility to prevent the spread of a 0:19:16.320 --> 0:19:22.120 sexually transmitted infection. That's sexist and unfair. And so what 0:19:22.160 --> 0:19:26.400 this did was it contributed another argument to the backlash, 0:19:26.520 --> 0:19:30.040 and it's another part of why the HPV story is 0:19:30.080 --> 0:19:33.440 so interesting because support was coming from everywhere, but backlash 0:19:33.480 --> 0:19:37.480 was coming from everywhere too, like all over the political spectrum. 0:19:37.119 --> 0:19:39.240 And clearly there are a lot of particular things, things 0:19:39.280 --> 0:19:41.920 that are particular to this vaccine. But when you zoom 0:19:41.960 --> 0:19:44.960 out and you think about the bigger historical arc, why 0:19:45.040 --> 0:19:48.520 is this an important moment beyond this one vaccine. 0:19:48.760 --> 0:19:53.479 It's an important moment for this reason. About two dozen 0:19:54.160 --> 0:19:59.679 states considered laws or regulations to make HPV mandatory for 0:19:59.720 --> 0:20:02.320 young girls, and this was between two thousand and six 0:20:02.359 --> 0:20:05.520 and two thousand and eight, and only one of them succeeded. 0:20:06.359 --> 0:20:09.640 So was that the first time that this decade's old 0:20:09.680 --> 0:20:11.840 sort of playbook of a new vaccine comes out and 0:20:11.880 --> 0:20:13.880 it's mandated in state after state? Was it the first 0:20:13.920 --> 0:20:14.920 time that had failed? 0:20:15.560 --> 0:20:18.879 Yes? What happened was all these lawmakers in these states 0:20:18.920 --> 0:20:21.760 and then others that were watching, they rolled back and 0:20:21.800 --> 0:20:24.520 they took the mandates off the table. So it's a 0:20:24.560 --> 0:20:27.840 really important moment because we see the public being really 0:20:27.920 --> 0:20:32.960 successful in pushing back against this era of child vaccination mandates. 0:20:33.600 --> 0:20:36.639 So the rollout does not go as planned. The HPV 0:20:36.760 --> 0:20:41.479 vaccine does not join all the other childhood vaccines that 0:20:41.520 --> 0:20:43.040 are mandated in many states. 0:20:44.119 --> 0:20:48.639 What happens, Yeah, So what happens next is really interesting. 0:20:49.040 --> 0:20:54.040 Epidemiologists who weren't studying HPV before started to say, hmm, 0:20:54.480 --> 0:20:57.560 this is interesting. Does it make sense to only vaccinate girls? 0:20:57.840 --> 0:21:01.960 What about boys? What about other forms of cancer other 0:21:02.040 --> 0:21:05.439 types of Researchers too, start asking questions about it. In 0:21:05.520 --> 0:21:11.400 other words, the existence of the vaccine invites further scientific 0:21:11.480 --> 0:21:15.080 study and scrutiny of its target infection. What we learn 0:21:15.200 --> 0:21:18.919 with HPV is that, yes, there's a link to cervical cancer, 0:21:19.480 --> 0:21:23.160 but males get infected with HPV two, and it can 0:21:23.200 --> 0:21:27.120 cause forms of reproductive cancers in males, and it can 0:21:27.160 --> 0:21:29.879 cause cancers in other parts of the body as well. 0:21:30.840 --> 0:21:35.360 So what's interesting about what happens next is that slowly 0:21:36.200 --> 0:21:40.639 we change HPV's reputation and we change or start to 0:21:40.760 --> 0:21:47.400 change public understanding and scientific understanding first of HPV's relationship 0:21:47.440 --> 0:21:52.880 to cancer generally, males are eventually added. Another HPV vaccine 0:21:52.920 --> 0:21:57.680 is approved for market, and there are more and more 0:21:57.760 --> 0:22:02.600 efforts promoting education and an awareness of both HPV and 0:22:02.680 --> 0:22:07.040 the vaccine for males and females. After a decade on 0:22:07.080 --> 0:22:12.080 the market, there is way more knowledge about the vaccine's 0:22:12.160 --> 0:22:19.160 safety profile. HPV becomes normalized. For about the first ten 0:22:19.359 --> 0:22:24.800 years of the HPV vaccine's existence, we were stuck at 0:22:25.040 --> 0:22:29.840 below fifty percent, like around forty percent uptake of this vaccine, 0:22:30.280 --> 0:22:32.920 and a lot of lawmakers and a lot of parents 0:22:33.000 --> 0:22:35.880 just kind of unwilling to touch it or talk about it. 0:22:36.119 --> 0:22:39.760 But the trajectory is pretty steadily upward, and in fact, 0:22:39.880 --> 0:22:45.200 it's continued upward since then. By the early twenty twenties, 0:22:45.440 --> 0:22:50.840 uptake is over sixty percent across young teens male and 0:22:51.000 --> 0:22:52.040 female in the US. 0:22:52.520 --> 0:22:56.560 So most teenagers now, even in the absence of mandates, 0:22:56.640 --> 0:22:59.359 largely are getting vaccinated against HPV. 0:23:00.080 --> 0:23:02.840 Yeah, most teenagers, and in fact, I think that in 0:23:02.880 --> 0:23:06.359 the last couple of years the numbers have continued to 0:23:06.440 --> 0:23:07.280 march upwards. 0:23:08.960 --> 0:23:11.120 If we sort of think here about you know, what's 0:23:11.160 --> 0:23:15.720 happened with the HPV vaccine and this longer history of 0:23:15.840 --> 0:23:19.159 vaccine mandates in general, what do you think at this 0:23:19.280 --> 0:23:21.760 point about state mandates for vaccines. 0:23:22.680 --> 0:23:25.920 This is one of those things where this is so 0:23:26.359 --> 0:23:30.760 politicized that I want to be very careful about what 0:23:30.880 --> 0:23:37.560 I say. Mandates are political tools, and in this country, 0:23:39.720 --> 0:23:43.119 since the era of mandates began at the turn of 0:23:43.160 --> 0:23:48.040 the twentieth centuries, we have included exemptions to those mandates. 0:23:48.400 --> 0:23:54.360 Three kinds of exemptions historically a medical exemption, a religious exemption, 0:23:54.440 --> 0:23:58.639 and a philosophical exemption or a belief based exemption. Those 0:23:58.760 --> 0:24:03.800 exemptions are to me an indication of how political a 0:24:03.960 --> 0:24:09.239 tool vaccine mandates are. We knew from the outset that 0:24:09.280 --> 0:24:13.600 mandates were the best way of ensuring the broad and 0:24:13.720 --> 0:24:17.320 widespread use of a vaccine, But we also knew that 0:24:17.359 --> 0:24:19.480 there was going to be resistance because this is a 0:24:19.520 --> 0:24:23.680 country that was founded on enlightened principles of individual liberty 0:24:23.760 --> 0:24:30.240 and autonomy, and these ideas about individual rights were in 0:24:30.240 --> 0:24:35.200 an inherent conflict with the idea of a state mandated 0:24:35.280 --> 0:24:43.560 vaccination program. The exemptions reconciled those two things. So my 0:24:43.720 --> 0:24:47.959 feeling is that mandates are an incredibly powerful tool, and 0:24:48.000 --> 0:24:52.240 that when you have a disease as horrifying as smallpox 0:24:52.600 --> 0:24:57.720 was in its earliest forms, they are a really important 0:24:57.760 --> 0:25:03.719 way of stopping this of those diseases. When I, as 0:25:03.760 --> 0:25:06.440 a historian of medicine, think about the history of disease, 0:25:07.400 --> 0:25:10.479