Negotiating Uncertainty: Risk, Responsibility, and the Unsettled Facts of HPV Vaccination in the United States.

Abstract

This dissertation explores the ethical reflections of parents as they negotiate the uncertain cultural, moral, and corporeal risks and benefits of the human papillomavirus (HPV) vaccine with desires to protect their children from potential harm. The “facts” of the HPV vaccine remain unsettled and highly contested. Within the scientific and medical community, as well as the public sphere, consensus over the benefits, risks, and safety of the vaccine has not been reached. Despite these uncertainties, significant promotional efforts have been made by pharmaceutical companies and governmental agencies to encourage (or mandate) parents to vaccinate their children, constituting parents as moral subjects responsible for protecting their children against HPV and, by extension, ensuring the health of the nation. Drawing from ethnographic field research among parents living in the San Francisco Bay Area, this dissertation examines how parents are negotiating these uncertainties, and considers how categories of risk and responsibility are being configured through—and configuring—these deliberations. My results suggest that communication between healthcare providers and patients play a significant role in HPV vaccination decisions. Additionally, I found that the majority of parents who had not yet vaccinated their child expressed desires to delay rather than refuse vaccination based on uncertainties regarding the safety of the vaccine, temporal assessments of their child’s sexuality (in)activity and perceived risk, and provider support to delay vaccination. In conclusion, I identify novel ways in which social workers can assist in assessing structural and interpersonal factors contributing to health outcomes inside the clinical encounter as well as in complementary arenas of policy and research external to direct clinical care.