The “Pro-Life” Party’s Long Fight Against Vaccines

“I will tell you that I had a mother last night come up to me here in Tampa, FL,” a Republican politician appearing on The TODAY Show said, “and tell me that her little daughter took that vaccine, that injection, and she suffered from mental retardation thereafter.”

“It can have very dangerous side effects,” the politician added, while the anchors failed to interrupt the stream of falsehoods. “The mother was crying when she came up to me last night.”

“This is a very real concern, and people have to draw their own conclusion.”

You could be forgiven for thinking that politician was currently in office and talking about COVID-19 vaccines, though none is currently yet approved by the U.S. Centers for Disease Control and Prevention for children under 12 and none has been shown to have side effects remotely akin to permanent cognitive impairment. But, actually, then-Rep. Michele Bachmann (R-MN) made that statement during her ultimately unsuccessful run for the Republican presidential nomination in 2011 … and she was talking about the Gardasil vaccine that protects against the human papillomavirus (HPV) and thus cervical cancer (as well as vaginal, vulvar, anal, penile, and oral cancers).

She was, of course, hardly the only one: Between 2007 and 2012, the conservative backlash against a series of state legislative initiatives—often initiated by Republicans—to add Gardasil to one of a number of mandated vaccines for school-age children with all the normal opt-outs showed a generation of ambitious, right-wing firebrands that there was plenty to be gained politically by opposing public-health initiatives in the name of parental rights and so-called liberty, and very little to lose by putting people’s lives at long-term risk for a political messaging campaign.

Perhaps, then, it’s no wonder that, a decade later, Republicans seem to feel there will be no consequences for opposing other game-changing vaccines, like the ones against COVID-19.

But back in 2006, the initial formulation of Merck’s Gardasil, a three-shot vaccine series for anyone ages 9 through 26 received FDA approval without a lot of immediate controversy; it covered four types of HPV known to cause 75 percent of cervical cancers, most of the HPV-related anal, vaginal, vulvar, penile, and oral cancers and 95 percent of genital warts. (There are more than 100 strains of HPV, which is the most common STI.) The current formulation in the United States, Gardasil-9, was approved in 2014 for people from ages 9 through 45 and covers nine strains of HPV—the original four, plus an additional five cancer-causing strains). It is nearly 100 percent effective at preventing cancers for the seven strains it covers, which are responsible for at least 90 percent of all cervical cancers and most of the HPV-related anal and oral cancers.

In other words, for cervical, anal, and oral cancers, Gardasil was (and is) a game-changer. 

Just take the case of Australia, which instituted a mandatory vaccination program for girls ages 12 and 13 in 2007 (with a catch-up program for girls and women up to age 26) and expanded it to boys in 2013 (with a similar catch-up program). They are on track to reach what public health officials would consider to be the elimination threshold for cervical cancer by 2028, according to a 2018 Lancet study.

Meanwhile, in the United States—which, again, has had access to a version of this vaccine since 2006—the American Cancer Society predicts that 14,480 people will be diagnosed with invasive cervical cancer in 2021, and the CDC estimates that about 11,000 cases of cervical cancer found in any given year will be HPV related; more than 4,000 people will die from cervical cancer this year. And that’s just cervical cancer: There will also be 5,000 cases of vaginal or vulvar cancers, 3,500 of which will be HPV-related, from which more than 1,000 people will die; there will be more than 1,400 cases of penile cancer, 900 of which will be HPV-related, from which 400 will die; there will be more than 7,000 cases of anal cancer of which 6,500 will be HPV related, from which more than 1,100 will die; and there will be about 20,000 cases of oropharyngeal cancers not related to tobacco or alcohol, of which 14,000 will be linked to HPV.

In 2016, then–Vice-President Biden was tasked with heading up a “cancer moonshot”—but, in fact, millions of Americans had already had access to a vaccine for many cancers for nearly ten years. Yet even after Michael Douglas revealed in 2013 that his 2010 throat cancer was HPV related—which people at the time all but laughed off—many Americans continued to reject the vaccine that would prevent cancers like his.

Gardasil is most effective in people who have never been exposed to HPV; that generally means children prior to the onset of puberty will benefit the most from Gardasil. It is important also to note that victims of childhood sexual abuse are already relatively likely to contract HPV as a result of their abuse, as well as that being raped as a child, adolescent, or young adult has been shown to increase the risk of early onset invasive cervical cancer. (Subsequent studies of Gardasil 9 have, however, shown that it’s still quite effective in preventing cancers in older people who have been sexually active for longer, which is why, in 2018, the FDA extended the age at which one can receive the vaccine to include people ages 27 to 45.)

Still, the early studies are why, after it was approved, advocates (and Merck lobbyists) focused on the idea of a school-age mandate, akin to the kind that has since been shown to be so effective in Australia. After all, historically, school-age vaccine mandates had been quite effective in expanding vaccination rates for a variety of vaccines, even given the American tradition of allowing for religious exemptions in many cases.

But a funny thing happened on the way to eliminating cervical cancer and vastly reducing the incidence of anal, vaginal, vulvar, penile, and oral cancer in Gen Z: a conservative political backlash rooted in ideals of total parental control of children’s bodies, tied to once-ideologically incompatible concerns about corporate profits that ultimately found its full expression in scientifically implausible anti-vaccine conspiracy theories that have led to ongoing mistrust of a life- (and, for some people, fertility-saving) vaccine that ultimately undermined the theretofore effectiveness of mandatory school-age vaccinations.

It started in Texas where, in February 2007, then-Gov. Rick Perry (R) issued an executive order that all girls in the state should receive Gardasil starting in February 2008 unless their parents opted out. Opposition began immediately from groups like the conservative Texas Eagle Forum, the national organization of which was then still run by Phyllis Schlafly, who personally inveighed against it. Focus on the Family referred to HPV in an interview with the Dallas Morning News as “a purely sexually transmitted disease,” said that the mandate was “taking away parental rights” and then offered angry Texans this gem: “Does the public health industry truly believe that all children and adolescents are sexually active? This is not something kids are going to contract sitting in the classroom.”

That messaging was reflected in the criticism lawmakers received demanding that the legislature override Perry’s executive order. (Today, Focus on the Family still opposes Gardasil mandates and thinks that abstinence until marriage and monogamy within it is a better method of cancer prevention than vaccines, but at least acknowledges that sexual assault victims can be exposed to HPV and that previously abstinent and currently faithful spouses can be unknowingly exposed within their marriages by partners who were or are not. Meanwhile, at least one state chapter of the Eagle Forum continued to promote misinformation about the vaccine for a decade.)

The Texas legislature overturned Perry’s order in May 2007, at which time he noted—accurately—that the decision put the lives and health of Texas women at risk and, even if his opponents were right and the mandate encouraged women to have premarital sex (there is no indication that it does), the “greater imperative is to protect life.”

Legislators were unmoved, but left a provision in to allow themselves to reconsider a mandate in 2011; in the wake of the controversy in Texas and a similarly failed campaign in South Carolina in which then-rising star state Rep. Nikki Haley was similarly briefly embroiled, Merck abandoned its lobbying campaign to encourage school age mandates entirely and Texas never instituted one.

That was not the end of the Gardasil controversy.

In the 2010 Texas Republican gubernatorial primary, then-Sen. Kay Bailey Hutchison (R) attacked Perry for the mandate, suggesting it meant he was both beholden to special interests and willing to override parental rights (to leave their children vulnerable to cancer as a judgment for their potential future moral failings). Democrats in the state, many of whom had initially backed the mandate, picked up on the line of criticism in the general election later that year with an ad that stated “Imagine a governor who wanted to take a needle, fill it with a controversial drug for sexually transmitted diseases and inject it in every 11- and 12-year-old girl in Texas.” 

Still, Perry—who won first the primary and then the election—stood behind his initial stance on Gardasil for one more year… until he began his ultimately unsuccessful bid for the Republican presidential nomination. He finally backed away from his own mandate in August 2011, telling a crowd of New Hampshire Republicans who asked him about the issue that “what we should have done was a program that frankly allowed them to opt-in.”

A month later, Perry’s mandate was a line of attack against him at the Republican debate on CNN by Bachmann and then-Sen. Rick Santorum (R-PA).

Bachmann said, “And to have innocent little 12-year-old girls be forced to have a government injection through an executive order is just flat out wrong. That should never be done. It’s a violation of a liberty interest.” 

Santorum piled on: “There is no government purpose served for having little girls inoculated at the force and compulsion of the government.”

Perry’s defense—that he should’ve gone about it differently but he was ultimately trying to save those girls’ lives—didn’t help him. Then-former Gov. Sarah Palin (R-AK) said on Fox News the next day (after Bachmann alleged on The TODAY Show that the vaccine caused cognitive impairment) that his mandate was just “crony capitalism” overriding parental rights. 

The Gardasil vaccine was hardly the only issue to doom Perry’s 2012 presidential campaign. But the controversy not only showed that politicians could capitalize on a distinct separation in the conservative base between the phrase “pro-life” and actual policies that would save lives; it showed they could build upon people’s preexisting discomforts with certain kinds of government mandates as well as a growing interest in “parental rights” and anti-capitalist rhetoric.

Lines of attack from the Gardasil controversy can be seen in today’s backlash to the COVID-19 vaccines and vaccination campaigns, from the hysterical allegations that a door-by-door outreach campaign in Delta variant hotspots is fascist overreach to the conspiracy theories that the vaccines and campaigns to get people vaccinated are simply profit-motivated to the latest theories that vaccination campaigns targeting teens who are currently eligible for vaccination and may legally get it without a parent’s permission in some states (since they are significant contributors to COVID-19’s spread and can suffer greatly when they contract it) are simply an attempt to undermine parental rights.

And if you still don’t think there’s a link: The Tennessee Department of Health fired its medical director for vaccine-preventable diseases and immunization programs, Dr. Michelle Fiscus, this week, reportedly in part because she reminded the state’s medical providers of a 30-year-old judicial ruling that allows teens over 14 years of age to get vaccines without a parent’s permission. In response to conservative backlash to her routine letter noting the medical providers’ legal requirements under state law, Fiscus noted in a public statement about her firing that the department has since canceled all outreach to and about teens on all vaccines in the state, be it on measles, second-dose COVID shots, or one other vaccine they normally inform people about: “No messaging around human papillomavirus vaccine [has gone out] to the residents of the state with one of the highest HPV cancer rates in the country.”