By Norma Erickson

What happens when a potential blockbuster vaccine (Gardasil, Cervarix, or Gardasil 9) is simply not accepted by the public on the same level as other recommended vaccines?

Do the manufacturers and international health authorities re-examine the product to assess whether or not public concerns are valid? Not often, and when they do it is pretty much a cursory ‘investigation’ where they are quite careful to NOT look in the direction needed to expose any potential problems. What is wrong with this picture?

Could it have anything to do with the fact psychologists and psychiatrists have been studying how to manipulate public behavior for over 35 years?

Could the results of these studies be used by HPV vaccine promoters to manipulate the public, medical professionals and/or politicians to increase the uptake of HPV vaccines?

Think back a few years. Before HPV vaccines were released for public consumption advertisements appeared aimed at creating fear of HPV infections. It didn’t matter that 90% of these infections cleared on their own without medical intervention or symptoms of any kind. It didn’t matter that cervical cancer was under control in most developed countries. Mothers and daughters were told this dreaded infection was likely to doom them to death by cervical cancer. Remember the “One Less Girl” and “Armed for Life” commercials? Were these commercials good marketing, or psychological manipulation?

Many health authorities went out of their way to convince medical professionals who would be administering this new wonder drug that any medical conditions experienced by the recipients after HPV vaccines were most likely psychosomatic or coincidental. Was this protecting the public health, or psychological manipulation?

Consider this quote from the UK MHRA drug safety update on Cervarix dated 1 October 2009:

As part of the Cervarix pharmacovigilance strategy, at the start of the immunisation programme we wrote to healthcare professionals involved to encourage use of the Yellow Card Scheme to report suspected side effects. Psychogenic events include vasovagal syncope, faints, panic attacks, and associated symptoms. These can occur with any injection procedure, not only vaccination, and can be common in adolescents. Such events can be associated with a wide range of temporary signs and symptoms, including: loss of consciousness; vision disturbance; injury; limb jerking (often misinterpreted as a seizure or convulsion); limb numbness or tingling; and difficulty in breathing or hyperventilation. These are due to fear or anticipation of the needle injection and are not side effects of Cervarix vaccine as such.

Here is another example but more blatant. Let’s examine part of a 2013 teleconference held by Israel’s Advisory Committee on Infectious Diseases and Inoculations as a case in point. One of the topics scheduled for discussion at this meeting was the proposed introduction of HPV vaccines into Israel’s school inoculation program targeting 14 year-old girls.

Dr. Ron Dagan was Professor of Pediatrics and Infectious Diseases at the Ben-Gurion University of the Negev in Beer-Sheva, Israel, and Director of the Pediatric Infectious Disease Unit at the Soroka University Medical Center, also in Beer-Sheva at the time. His expert advice to Israel’s Advisory Committee regarding HPV vaccine implementation was as follows (translation provided-emphasis added):

We are dealing with injections, some of which are given in 3 [separate] doses, which are delivered to teenage girls. Many side effects are to be expected. During the week following the delivery of the injections many serious events which are not related to the vaccination are expected: fainting, deaths and convulsions/fits. This needs to be taken into account. Even if it is not rational, if these events happen in class they may damage the general reputation of vaccinations. This is happening all over the world all the time. We have already dealt with a similar issue in relation to the delivery of MMR with TD and Polio and we have accepted the nurse’s proposal to split these between grades 1 and 2. The nurses are suitable to make recommendations to the committee in relation to this issue. In relation to the side effects, we need to be prepared in advance and not simply react after the fact. I propose we consult with the English representatives as to how they’ve gone about this.

Not sure this qualifies as psychological manipulation?

Take a look at the following excerpt from an article published in The Australian Journal of Pharmacy by Ben Basger, lecturer and tutor in pharmacy practice, Faculty of Pharmacy at the University of Sydney. This article addresses what pharmacists can do to increase vaccine uptake among ‘vaccine-hesitant’ families.

Vaccine communication strategies that build rapport and trust need to be incorporated into healthcare encounters. Unfortunately, attempts to persuade carers using graphic narratives (that is, frightening people) or by simply providing more information often fail or backfire. Vaccine discussions with healthcare providers should occur early, as studies have shown that the vaccine decision making process begins prenatally. And so we turn to a behavioural “stages of change” model. You may be familiar with the ‘pre-contemplator’, ‘contemplator’ model.

What is the Stages of Change Model?

The “Stages of Change Model” was developed over the last 35 years as a result of over $80 million worth of grants to a single organization from agencies like the CDC, the National Institute of Mental Health, and the National Cancer Institute to name a few. Who knows how many other organizations have been working on similar projects.

Nevertheless, this model is currently in use by professionals around the world.

The model provides suggested strategies for public health interventions to address people at various stages of the decision-making process allowing public health officials to create specific, effective programs, messages and interventions that are tailored for each target population’s level of knowledge and motivation.

According to the Boston University School of Public Health’s document on behavioral changes, the Stages of Change (or Transtheoretical Model/TMM) operates on the assumption that people do not change behaviors quickly and decisively. Rather, changes in behavior occur continuously through a cyclical process. For each of the six Stages of Change in the diagram above, different intervention strategies have been found to be most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.

Ten of these Processes of Change (POC) have been identified as strategies to help people move through the Stages of Change to result in the desired behavior or decision. They are as follows:

Consciousness Raising – Increasing awareness about the healthy behavior. Dramatic Relief – Emotional arousal about the health behavior, whether positive or negative arousal. Self-Reevaluation – Self reappraisal to realize the healthy behavior is part of who they want to be. Environmental Reevaluation – Social reappraisal to realize how their unhealthy behavior affects others. Social Liberation – Environmental opportunities that exist to show society is supportive of the healthy behavior. Self-Liberation – Commitment to change behavior based on the belief that achievement of the healthy behavior is possible. Helping Relationships – Finding supportive relationships that encourage the desired change. Counter-Conditioning – Substituting healthy behaviors and thoughts for unhealthy behaviors and thoughts. Reinforcement Management – Rewarding the positive behavior and reducing the rewards that come from negative behavior. Stimulus Control – Re-engineering the environment to have reminders and cues that support and encourage the healthy behavior and remove those that encourage the unhealthy behavior.

Now, go back and read through the processes of change (POC) inserting the words ‘HPV vaccines’ in place of ‘the healthy behavior’. Think about everything you have ever seen or heard about HPV vaccines from an ‘official’ source.

How much of what you recall fits nicely into one or more of these categories?

Still not convinced society is the victim of psychological manipulation?

The Cancer Prevention Research Center Faculty at the University of Rhode Island has summed it all up in a paper entitled, Disease Prevention without Relapse: Processes of Change for HPV Vaccination. According to the abstract:

Although the HPV vaccine appears in the US immunization schedule during adolescence, a large percentage of women reach adulthood without being vaccinated. The Transtheoretical Model’s (TTM) Processes of Change (POC) construct provides an assessment of participants’ experiences with HPV vaccination and is a central component of computer-tailored interventions designed to increase compliance with medical recommendations, such as vaccination. This study describes development and validation of a POC measure for increasing HPV vaccination among young adult women.

Everyone who is or might be considering submitting to or administering HPV vaccines needs to read the entire paper. But, one should pay particular attention to Figure 1 HPV vaccine acquisition processes of change structural mode on page 306 of the Open Journal of Preventive Medicine (3, 301-309. doi: 10.4236/ ojpm.2013.33041). ach

The figure referenced above clearly states what the subject should be thinking at each stage of the ’processes of change.” Let’s go through them one at a time in the order listed above.

This is what you are supposed to do after exposure to each ’process of change’

AFTER EXPOSURE TO: YOU ARE SUPPOSED TO: Consciousness Raising: Recall seeing advertisements for HPV vaccines; seek out facts about HPV vaccines; pay attention to stories about the benefits of receiving HPV vaccines; and think about the information you have seen about HPV vaccines Dramatic Relief: Be scared you could get cervical cancer from HPV; be disturbed knowing you could get HPV; be scared you could get genital warts from HPV; and be scared that people can spread HPV without knowing it. Environmental Reevaluation: Think about how getting vaccinated makes your social environment safer; think about how getting vaccinated reduces the spread of HPV; think about how getting vaccinated makes your sexual relationship(s) safer; and consider the healthy example you are setting for others by getting vaccinated. Self Reevaluation: Feel empowered knowing you can protect yourself from HPV; feel you would be doing something good for yourself by getting the HPV vaccine; feel you would be more comfortable sexually if you got the HPV vaccine; and think about how getting the HPV vaccine makes you healthier. Social Liberation: Feel that society has made the HPV vaccine readily available; recognize that people support you getting the vaccine; believe society is making HPV vaccination a priority; and notice that many people your age have chosen to be vaccinated. Counter Conditioning: When having second thoughts about getting vaccinated, remind yourself that you will be helping to stop the spread of HPV; find ways to feel good when others question your decision to get vaccinated; remind yourself of the benefits of HPV vaccines when you are having second thoughts about your decision; and remind yourself that vaccination is safe when you are afraid of being vaccinated. Stimulus Control: Keep information around you to remind you of the reasons to be vaccinated; use reminders in your calendar or planner so you remember to get the shots; make efforts to schedule appointments to get your shots at a convenient time; and arrange to receive reminders from your provider for your HPV vaccination appointments. Helping Relationships: Talk to your healthcare provider about the HPV vaccine; have a person in your life you can count on to discuss HPV vaccination with; have at least one person you can be open with about your decision to get the vaccine; and seek out others who support your decision to get the HPV vaccine. Reinforcement Management: Feel personally rewarded for getting the vaccine; remind yourself that HPV cancer prevention is a big reward for getting vaccinated; reward yourself when you take steps towards getting vaccinated; and have people in your life who make you feel good about getting vaccinated. Self Liberation: Feel you have control over getting the full series of vaccinations; remind yourself that getting vaccinated is YOUR choice; feel committed to keeping yourself healthy by getting vaccinated; and tell yourself you can follow-up with your commitment to get all three shots.

How many of these statements have crossed your mind, or your daughter’s mind? Think about all of the information about HPV vaccines you were exposed to before you had these thoughts. How much of your HPV vaccine decision was a result of planned psychological manipulation?

Whether HPV vaccines are a good health choice or not appears to be irrelevant to those promoting their use. The only goal seems to be HPV vaccine compliance! Apparently those promoting HPV vaccines will utilize whatever means necessary to achieve that goal.

One question remains – If HPV vaccines are so great, why are such extensive psychological manipulations necessary?

Think about it – if HPV vaccines were actually Safe, Affordable, Necessary and Effective – there would be no need to ‘create’ a demand for them!