Abstract: Controversy, Backlash and a Magic Dose: The Social Representation of the HPV Vaccine among Jamaican Women.
Jamaican women have higher human papillomavirus (HPV) prevalence than similar Caribbean nations, certain minority populations in the United States and other at risk populations in Europe (Lewis-Bell, 2018). Without regular screening, HPV can develop into cervical cancer; almost half of the Jamaican women who are annually diagnosed with cervical cancer die from it. Despite the comparatively high prevalence rates of HPV and burden of cervical cancer, Jamaican women are neither participating in routine pap smear screening, nor consenting to having their daughters vaccinated for HPV. Only 22% of the targeted population received the full dosage of the vaccine in the first year it was administered in high schools in October 2017 (Wilson-Harris, 2018). We utilize Social Representation Theory (SRT) to attempt to understand this underwhelming response, since the framework explains the process of formation of a shared meaning making about a novel event such as a new vaccine being introduced to communities. SRT examines the interaction of individual cognition, media impact and interpersonal influences, which forms a “popular cognitive representation” or social representation (Sommer, 1998, p. 186). Social representation can be so influential that it even overrides personal experience with the event (Moscovici, 1988). To carry out the study, we first analysed newspaper articles published since the announcement by the government in May 2017 and up to June 2018. We searched for “HPV vaccine” in the title or in text three most popular newspapers in Jamaica: Gleaner, Observer, Star. We included hard news content, feature stories, letters to the editor and “editor’s forum” into our coding sheet. To understand the valence and quantity of news articles, a combination of inductive and deductive coding was employed, using nVivo qualitative software to conduct the thematic analysis. We found a predominance of negative framing, particularly during the months surrounding implementation of the vaccine (September to October 2017), including the use of inflammatory language like “magic pill”, “controversial vaccine” and associations with HIV (related to the introduction of PREP). Then, we recorded conversations among Jamaican women in 8 focus groups in Kingston in June 2018. In the group discussions, women expressed vaccine resistance narratives themes such as skepticism of vaccine safety, references to traditional treatment and prevention strategies, expressions of HPV and cervical cancer stigma, and defensive avoidance messages. Regarding the HPV vaccine, many women suggested that their first knowledge of HPV only came at the introduction of the vaccine in high schools in the island. According to Participant 29 (FG 6):“They were talking about it but we didn’t really… they never explain about it. We said to ourselves it would probably prevent early pregnancy in the girls”. The communication attempts by the government did not effectively dispel misconceptions about the HPV vaccine that are prevalent in communities. We found that media stories were congruent with the lack of knowledge, and negative attitudes and opinions of the women. We suggest that the media must directly address misconceptions in simple language and acknowledging the sociocultural context to effect greater change HPV vaccine uptake.