Requiring Gardasil for U.S. Immigrants

Well this is effed up.

The federal government is considering making Gardasil vaccination, made by Merk pharmaceuticals, mandatory for female immigrants applying for citizenship. These shots, which vaccinate against certain types of HPV related to potential development of cervical cancer, are not mandatory for U.S. citizens.

I am all for making Gardasil more accessible and affordable. I think there’s a good argument to be made for making it a mandatory vaccine for school-age children — with an easy voluntary opt-out clause — because in many states that’s the only way that low-income families will be able to afford it, since mandatory vaccines are more likely to be covered by Medicaid (I also think there’s a better argument against it, but that’s another post). I think there’s a very good (and obviously widely-accepted) common-sense argument to be made for making certain vaccines mandatory for new immigrants or visitors to the U.S. — and some vaccines for highly communicable and airborne diseases are mandatory. That’s reasonable.

But making the HPV vaccine a requirement? It’s both unnecessary and frightening. It’s also shamelessly xenophobic.

As WOC PhD describes, immigrant women and women of color in the United States have long been used as test subjects for experimental medications and treatments, especially in the reproductive area (head over and read her post — she has great details). When it comes to Gardasil, it’s increasingly clear that Merck is more concerned about their profit margin than health care.

And since it’s no big secret that Republicans are in bed with Big Pharma, we shouldn’t be surprised when that relationship props up other right-wing policies — like keeping certain kinds of immigrants out. Gardasil is expensive, and requiring it means that immigrants of a certain income level will have a much easier time meeting American health requirements than lower-income immigrants. It puts more barriers in the way of women and families seeking to live in the U.S., and has a disproportionately negative impact on immigrants who are coming from difficult financial situations — immigrants who are less “desirable” to the current political administration.

For a lot of feminists and reproductive rights activists, Gardasil is a soft spot. Just a couple of years ago we were fighting to get it on the market, against right-wing ideologues who were convinced that protecting women and girls from cervical cancer would turn them into big sluts — the underlying message being that the threat of death should be a sexual deterrent, and women who don’t abide by the rules don’t deserve to live. The initial narrative was full-throated support of Gardasil, because the political debate over it was another example of social conservatives demonizing female sexuality and going out of their way to punish women who have sex.

But singular narratives rarely work out in the real world, and Gardasil is no exception. Like many forms of birth control — access to which feminists also support, and rightly — Gardasil is not patented and sold solely for the good of womankind. Like birth control, it has side effects and certain risks that individuals should weigh and evaluate. And like many forms of birth control, it’s being tried out on communities of color and incarcerated communities. That’s unconscionable.

You don’t have to be anti-vaccine (or anti-Gardasil) to maintain a healthy skepticism when Big Pharma is pushing a drug with all its might. I love my birth control; once I start getting paid, I will probably be vaccinated against HPV. This isn’t about making blanket judgments about whether Gardasil or other reproductive medications and technologies are good or bad; it’s about recognizing that our goal as reproductive justice advocates should be to give women as many options as possible, and to situate those options in a broader context that takes into account our individual and collective histories within a system that treats us differently based on our race, class, physical ability, and other factors. As WOC PhD says:

I know people who worked on the research that eventually led to the creation of Gardasil. And I believe that they had the best intentions about supporting women’s health and curing cancer in mind. Obviously, they had HSB/IRB approval. I do not mean to disparage their work by questioning this potential legislation. Instead, I’m trying to encourage some introspection on the potential for abuse on the part of the nation and big pharma at the expense of women post-approval, post-official research project(s). I’m trying to track a pattern, however loose it may be, of big pharma getting around HSB and returning to the very kinds of research that we swore would never happen again. When a marginalized population, in this case immigrant women, is singled out for mandated medical procedures that no other population is nationally mandated to undergo, we should be concerned.

It seems to me that we need to pay close attention to the ongoing connection between intentional use or coerced use (which a state or national law requiring use is) of vulnerable populations and medicine with known major side effects. We need to be concerned not only because of what it could say about how human subjects are once again rendered unwitting research subjects without HSB approval but also because of what this pattern says about the state’s growing interference in women’s bodies.

At a time when outcry about reproductive rights is so loud, I find myself wondering where is the similar outcry about medical testing targeting women who are members of vulnerable populations. Gardasil in particular seems to mobilize a feminist discourse to sell its product and the realities of this potential legislation forcing immigrant women to take medicine they may not otherwise take, and which non-immigrant women have not been universally forced to take, is antithetical to feminism which claims women should have sole control over their bodies. It is not about Gardasil, its effectiveness or lack there of (of which there is ample evidence in both directions), it is about women’s rights, women’s health, and women’s bodies. No matter how bad cervical cancer is, and as someone who has lost family members to cervical cancer I can tell you first hand it is bad, we cannot afford to sacrifice a woman’s right to choose what she does with her body based on her legal status, race, class, location, or any other marginalizing identity. Nor should we settle for a product that may not have been studied enough because it is all we have.

Cervical cancer kills thousands of women, many of whom are lower-income women with limited health care access — that’s part of the reason why an affordable and accessible HPV vaccine is so important. And millions of women live with HPV, which can have serious impacts on one’s health even if it never develops into cervical cancer. But every woman deserves the right to decide for herself if the benefits of Gardasil outweigh the risks. And we all need to be vigilant when we see the history of reproductive exploitation of bodies of color repeating itself.


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About Jill

Jill began blogging for Feministe in 2005. She has since written as a weekly columnist for the Guardian newspaper and in April 2014 she was appointed as senior political writer for Cosmopolitan magazine.
This entry was posted in Gender, Immigration, Race & Ethnicity, Reproductive Rights and tagged , . Bookmark the permalink.

44 Responses to Requiring Gardasil for U.S. Immigrants

  1. shah8 says:

    I think this is more an attempt to stop the mass commercial viability of Gardisil than anything else. Turn it into a BrownPeople’s Drug for the control of their sexuality–like Norplant. Then the vaccine turns into a treatment that suggest that their lily-white selves are actually more like those darkies. Thus a means of punishing women for sex continues–as well as the drug testing angle/profits angle outlined in the link.

  2. Whether it’s denying young women access to this vaccine or forcing immigrant women to have it, conservatives simply don’t want women making their own health decisions.

  3. Adrian says:

    From what I read last year, I thought the vaccine was much more effective when given to girls and young women. My doctor was recommending it to patients from 13-25, and giving it to patients from 25-35 if they asked. When I asked about it, she said it would probably not accomplish anything because I was already 40. What proportion of immigrants are over 35? They would be spending the money and taking on whatever risk there the vaccine carries, and not getting the cancer reduction benefit.

  4. selkie says:

    for me, I have not made a decision vis-a-vis gardisel. Here in Ontario, it is avialable free of charge to grade 8 girls – which is no good to my girls who are 15, 19 and 21. Otherwise, it is VERY expensive – around $700-$800 per kid – a percentage of which I could get reimbursed by their father’s drug plan. BUT, I have hesitated becuase it is VERY new drug. The long-term effects are really pretty unknown at this point and frankly, I don’t think I like my girls being used as guinea pigs.

    I’m not sure that I’m against it- but I am holding off at this point until more information comes in on the potential long-term effects.

  5. bleh says:

    Overmedicalization of women – yes, this counts. Over, over-medicalization of WOC -yes, damn it. I agree that women (and girls) need to control what medical procedures they get and do not get. But our culture wants to make girls and women public health gatekeepers.

    We are all still buying the STD line. Over 20% of genital HPV infection comes from vertical (mother to child) and auto-innoculation from hand warts. Very young children have it, even in their genitals, even with no signs of sexual abuse.

    Wanna fix the HPV problem? Vaccinate as infants and vaccinate boys too!

  6. bleh says:

    Oh and wait for the new vaccines that will make Gardasil outdated. Gardasil is multi-valent (4 strains of the virus), but new ones will emerge that protect against most of the 200 strains. Then we might be on to something.

  7. PeggyLuWho says:

    This big ole slut is so happy she got that vaccine, even though she’s an old big ole slut who’s technically out of the approved age range and is probably gonna end up paying for it out of pocket. I’m very much for as many women as possible getting this. I’m also for them developing a male version.

    But no one should be forced to get something against their will unless it’s airborne or something. If it’s not required for everyone, then it shouldn’t be a condition of entry. But they won’t require it for everyone, because that would mean someone would have to pay for it. Someone other than the big old ole sluts.

  8. Erica says:

    It seems like the only reason anyone is remotely concerned about women’s health right now, with gardisel, it protects what my woman Dr. told me–“your baby making parts”–and anything that anything that lets the gals continue to squeeze out the puppies (and return to their original “duties” as women) is somehow, ALL OF A SUDDEN, worth investing in.

  9. Britta says:

    Hmm. I had heard of this new law, but never made the associations you did because my immigrant friend applying for citizenship and who is affected by the law is white and from Northern Europe. When she told me about her ordeal, the big issue seemed to be cost. She had to have a series of three shots, each at around $200 a pop. Even though her home country has universal health care, she still had to pay out of pocket for the shots, and was unable to enter the US without proof of vaccination (not that it would likely be cheaper in the US). It was an annoyance and Yet One More Hurdle to Citizenship to a woman of means from a wealthy European country, but it seems like it could be a major obstacle for citizenship for women who can’t afford to shell out hundreds of dollars for a vaccine. To me, a bigger immediate concern is that the vaccine serves as a screen to eliminate poorer and therefore “undesirable” women from becoming citizens. The racial implications of that are clear, especially as the vaccine may not even be available in many developing countries, and on certain visas (e.g. spouse visa, fiance visa), it’s a requirement for entry.

  10. preying mantis says:

    Wtf? God forbid the virgin daughters of citizens get it lest it cause all manner of sluttiness and adverse reactions, but hey let’s force it on immigrants? I mean, I’m be all for offering it gratis to anyone who wanted it, including immigrants, but making immigrants get it while still caterwauling about how our own schoolchildren shouldn’t is ten different kinds of hosed up.

  11. misanthropic anthropologist says:

    (To PeggyLuWho)
    There is a male version — it’s the same as the female version. The only reason it’s not yet been approved for males is that the FDA did not feel Merck’s data were sufficient. One of the main reasons the data are limited is because of the lack of institutionalized male sexual health practices.

    While I agree that as with most things, Gardasil is not clearly good nor bad, but in a country where there are reliable methods for protecting oneself against developing cervical cancer (though not against HPV), it’s unclear how necessary this expensive and limitedly researched vaccine actually is. Further, as most of us probably know, women’s sexual health care remains pretty primitive (Pap smears, though important, are imprecise, for example), and it’s a bit disappointing that we’re not working to improve and advance more routine measures rather than pin so much hope onto new vaccine technology.

  12. ol cranky says:

    what, are the republicangnants now claiming the bible says that HPV and cervical cancer are caused by the brown menace?

  13. The history is all very interesting, but I’m wary of giving anti-vaccination nuts any fuel. The world is indeed a complex place, and part of that is that making money isn’t necessarily always done through exploitation and evil. Not to defend drug companies as pure, but also let’s consider that modern medicine does us a lot of good and we’d be a lot less happy without it. The answer to right wing glorification of the market isn’t demonizing the market, but admitting complexity.

    The idea of requiring the vaccine is terrible, of course. But Occam’s Razor—the vaccine is expensive, so it’s clearly a quick and dirty way to make sure that immigrants who bring children over that are too young to work are well off.

  14. Also, it’s not factual to suggest that Gardasil was released on the market untested and so that this law would substitute for such testing. Seriously, I’m worried that if people believe that it isn’t tested, they won’t get it for their daughters and then those girls run the risk of death. BTW, death rates for cervical cancers—as well as HPV transmission rates—are much higher in WOC.

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  16. Jill says:

    Amanda, I hear what you’re saying, but in the name of not giving anti-vaccine activists any fuel, do you really think it’s ok to create this kind of explicitly anti-immigrant measure? And one that doesn’t make Gardasil any more accessible or affordable, but simply takes away the voluntary aspect of it?

    I’m not anti-vaccine by a long shot, and as I said in the post I would get Gardasil if I could afford it right now. I am planning on getting it once I start getting paid. But I made that decision based on my own belief system, needs, and health history. Just like I was pissed that anti-vaccine religious nuts were trying to deny me a potentially life-saving vaccine, I’d be pretty pissed if, because of my immigration status and because the country I sought work in didn’t want any more people like me, I had to pay $500 for a vaccine I didn’t want and/or didn’t need. I don’t think we should be forcing this vaccine on people — even if it’s a godsend, even if it has no health risks. And no, it’s not untested, but I think there’s an argument to be made that it is under-tested — and there is certainly a really long history of medications being marketed to women as safe and effective when that wasn’t the case (see: early birth control pills; the Dalkon shield; IUDs; etc etc). Big Pharma isn’t always evil and I’m a big proponent of better living through chemistry, but I don’t blame women for being a little skeptical and not entirely trusting that this time, Big Pharma is looking out for them.

  17. Anna Phor says:

    Is this regulatory within USCIS or is there legislation on the table? Is there a public comment period? Anyone have any info?

  18. Albanya says:

    I work with resettled refugees, and let me tell you, they’re either pissed or confused when they learn about this, and they really struggle to afford the vaccine.

  19. There are a number of other vaccines that are mandatory for immigrants and long term visa holders. Mandatory vaccines for immigration purposes are not ethically problematic. We have mandatory vaccines for people who are born here, and I don’t see a problem with requiring would-be immigrants to get the same battery of vaccines as a native born citizen would be required to get (assuming they are medically appropriate).

    Also, I would support a program that gave free vaccines to new immigrants. It’s not fair to make someone trying to immigrate here for a better life cough up $700 for an HPV vaccine at market rates in addition to every other fee they have to pay to come here. Let ICE use its bargaining power with the pharmaceutical companies to negotiate a favorable bulk rate–it would set a good precedent.

    What’s ridiculous is if the HPV vaccine is considered important enough and valuable enough to be mandatory for immigrants, but not for girls in the USA. Social conservatives can’t have it both ways. Either it’s not worth mandating it for anyone, or everyone in the target population needs to get it–whether they are born here, or arrive from somewhere else.

  20. Amanda, I hear what you’re saying, but in the name of not giving anti-vaccine activists any fuel, do you really think it’s ok to create this kind of explicitly anti-immigrant measure?

    God, of course not. It’s obviously a measure meant to keep immigrants out unless they have $1200 laying around to vaccinate every daughter.

    The problems with the drug are a) it’s expensive and b) it’s being used to demonize non-white people as somehow diseased. Which is laughable.

    My point is that the racism in play here is in the demonizing of immigrants as diseased, and using those fears to keep immigrants out. That’s the more relevant history in my opinion than the history of testing drugs on non-white women, which has gone on.

    We can condemn this policy without suggesting that Gardasil is dangerous or that drug development can be treated as automatically too contaminated by profit motive to ever trust it. Again, if the concern is protecting vulnerable populations, it’s worth remembering that STDs tend to hit communities of color worse than white communities, probably because white people are able to get treatment for contracted diseases faster. HPV tends to fade in and out if you have it, so if you have poorer health, I bet you have HPV more often, which means less access to health care=more HPV. Additionally, women in financially constrained situations aren’t as able to get annual cancer screenings, meaning that they’re in much more danger of dying from cervical cancer.

    All this means that if we’re interested in preserving the health of WOC, we need to advocate for this drug and for it becoming more affordable rather than trucking in discourses that support people who want to refuse to vaccinate children. Anti-vaccination nuts have already managed to resurrect measles. They shouldn’t have inroads on more deadly diseases. Again—the people who suffer most when anti-vaccination nuttery takes hold are non-white people living in poverty, who already live in communities where herd immunity has been compromised by poverty.

    None of this means that the policy is a good idea. It’s a clear instance of preying on immigrant women. But why not argue that the best approach is to mandate vaccinations for all young women already living here first? I also have quarrels with the concept that non-participation in vaccination is “voluntary”. Inevitably, we’re talking about children who have no voice being used by their parents as objects of ideologically minded experimentation of the most nutty sort. Children don’t have the authority to sign onto weakened immune systems.

  21. Re: testing drugs on non-white women. The egregious use of this was in the past in testing drugs before FDA approval. The birth control pill was mainly tested in the Caribbean islands, for instance. But it’s problematic to compare the devil-may-care racist mid-century birth control testing to the highly controlled, extensive Gardasil testing. It also confuses the differences between established vaccination protocols with what was, at the time, an incredibly unique drug.

    Right now, people are being told, no lie, that Gardasil was released without testing. That’s the sort of misinformation we need to be mindful of stomping out, in interest of preserving truth more than anything.

    I do think it would be nice if we could separate drug development from the profit motive. Realistically, though, that would mean more Gardasils and less Viagras.

  22. denelian says:

    waitwaitwaitwaitwait…

    *I* am 31, and my doctor won’t give me Gardasil because i am too old. no one over 28 (although i have heard that some doctors will give it up do 32 or 33, I CAN’T FIND ONE). i keep being told it’s against the uses and regulations created for the vaccine – it might not even WORK, i am too old. so how the fuck are they gonna turn around and require it for EVERY immigrant woman? many of whom are ALSO too old? that’s incredibly stupid.

    how do immigrants afford vaccination NOW, without the added cost of Gardasil? are there programs in place?

  23. Blackamazon says:

    I’m gonnaw rite o n this on my own . but I am appalled .

    Literally apalled.

    Since RIGHT NOW OWC are being given DEPo ant obbscene rates even after it’s been mostly pulled,

    I am amused you can thing that the history of medical testing on WOC is less an important than teh immigration measures.

    And frankly YES if deaths complaints and other issues are going unadressed and it is being used oUTSIDE OF ITS RECOMMENDED DOSAGE ONLY ON IMMIGRANT WOMEN

    It’s being tested

    But please lets have another deep conversation about how we can play fast and loose iwth priorities of WOC health by deciding whats best to promote so as not to influence who really care about the ” right wing”

    and no that woefully vague article doesn’t prove anything.

    And supporting discources that scare people

    You mean listening and talking and focusing on teh people who are affected instead of planning just for this rightw ing you don’t even respect and aren’t even concerned

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  25. Hawise says:

    The biggest issue to me is that it is another way for the government limit access to immigration. I am definitely pro-vaccination, especially if it is required across the board and government sponsored. That is not what this law is intended to do. It is a barrier to poor and middle-class immigrants who may not be able to afford all the vaccinations in a timely manner. Some of the required vaccinations for communicable diseases need to be redone every year that you are living in an affected area. If it takes you several years to be able to afford all the vaccinations required then you have to reapply or at least resend paperwork. Adding an expensive vaccination that is not required for the general American population or does not cover a proven rampant local disease to the list of those required for immigrants is just a means of limiting immigration to the wealthy and connected.

  26. Rachel says:

    Blackamazon, I’m curious – the requirements are for the vaccine “as age-appropriate” – do you have a citation for it being used “outside its recommended dosage” in this population?

  27. NancyP says:

    This is still an “optional” vaccine for school entry in the US. 99.9% of cervical cancer is relatively slow to develop, and we have good screening methods. I for one don’t care if immigrant women get HPV vaccinated or not. It seems more to the point to give them a quick refresher on the importance of safer sex, condoms for HIV.

    I think it is meant as a barrier to entry, as a pool of test subjects, as a possible claim that any later cervical cancer developing was a “pre-existing condition” in order to deny gov’t paid care.

  28. Michele says:

    Just to add one pedantic note, it should be made more clear that this list of vaccinations is NOT part of the citizenship application process; according to the USCIS, this is a list of vaccinations required “to adjust status to legal permanent resident” – that is, in order to apply for a green card.

    Yes, green card holders can later apply for citizenship, but they are 2 different processes & green card holders are not *required* to ever apply for citizenship.

    The US requires medical exams & proof of vaccination from ALL green card applicants, regardless of country of origin.

    The term “permanent resident” is also a mis-nomer. There are 2 types of green cards: those that expire in 2 years (given to aliens who have been married to US Citizens for 2 years or less); and those that expire in 10 years. Upon expiration, the holder of a 2 year green card can, if they qualify, apply for a 10 year green card. When a 10 year green card expires, it is my understanding that it can be renewed for another 10 years. Green cards are not “permanent” (though they may have been at one time).

  29. Michele says:

    “The US requires medical exams & proof of vaccination from ALL green card applicants, regardless of country of origin.”

    This is not to say that I think forcing Gardacil on green card applicants is a good thing – I don’t.

    In my initial post, I just wanted to clarify that even people from Western Europe, Australia, Canada, and Japan – places that are nowhere even close to being “Third World Countries” – are required to do this.

    In fact, the entire immigration process has no regard for the origin of the applicant. Europeans, Australians, and Canadians are treated with just as much suspicion as if they were from an “Axis of Evil” country. To the USCIS, a potential immigrant is “illegal until proven legal”.

    Regardless, I do want to make it clear that I agree that this new requirement is an unfair burden on people from economically disadvantaged countries, especially women and children.

  30. Michele says:

    Oh – one more thing!!

    I’d also like to point out that even applicants who are already in the US and are working jobs from which they receive insurance must pay for these out of pocket — insurance does NOT cover the cost of immigration medical exams or any treatment prescribed as a result of the exam.

    It is EXPENSIVE to immigrate to the US. These vaccination requirements are just one more hurdle used to keep poor people out.

    (Never mind that in the initial stages of the green card application, the applicant is forbidden to work in the US. They must apply for Employment Authorization separately. Once that is granted, then they can work. Before it’s granted, they have to prove that they have sufficient resources to keep them off out of public assistance programs. The whole system is stacked to keep poor people out.)

  31. minna says:

    I won’t lie, I’m still boggling that US women have to pay for it. Aus made it free for women under 25 for a heavily publicised, quite extended period.

  32. Renee says:

    I for one am not surprised by the mandatory vaccination, I am only surprised that it has been made so public. Drug companies have a history of testing medications on poor brown bodies, often lying to them about the purpose of the drug.

  33. Laura J. says:

    Paranoia. Vaccinating immigrants has a lot more to do with preventing further spread of HPV than anything to do with ethnic discrimination. Vaccinating immigrants is actually something we can control and should. You forget that rights of Americans are just that… “of Americans”….when they want to jump through the legal hoops to become rightful citizens they can have the same rights. Nationalism is not evil…..we have just become a spineless “melting pot” of no culture.

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  35. Jill says:

    I am an immigrant. I have been here for 10 years and only just turned 24. This idea is OBSERD! The idea of “testing” this on a select few women is against what it means to be a citizen of America; “created equals!” As committed citizens we pledge to make our communities better places and live up to the standards of a peaceful and United society….where does being a citizen tie into being treated for HPV viruses (only 4, not all 200)!
    The post explained it perfectly, who is the government to determine who should receive this vaccination. I am about to apply for my citizenship at the weekly rising cost of $600 just for the application. Add another $1200 shot to that is definitely class discrimination! Like some other commenter’s noted….why not vaccinate boys? I believe the intentions of the Gardasil makers was good…but for the government to yet again step into our lives and tell us what to do with our bodies is just typical of the right-wing conservatives that have forever held to their anti-woman’s rights!

    All the more reason we need to be done with the politicians stuck in the past. It’s a new world that demands equality for everyone, because it is our RIGHT to life, liberty and Happiness!

  36. Natalia says:

    I’m a naturalized citizen. And yeah, you can add my voice to the “wow, this is seriously wrong” chorus.

  37. T says:

    HPV is not a contagious!!!! There is no reason in the world that this vaccination should be required!!!! Not by US citizens, and not by someone coming into the country!

    How would this be looked at if it were a vaccination being forced on just men?

  38. T says:

    Oops I meant not to or for US citizens, or someone coming into the country.

    I think they should be recommended… but not required!!!!

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  42. Brandi says:

    I have a real problem with Gardasil being required because I believe requiring it (for immigrant women or for girls to attend school) is wrong and ultimately a way to build in a consumer base for the pharmaceutical companies manufacturing the vaccine (and the ones we know are coming in the next few years).

    Many states do not have a philosophical exemption for vaccines, meaning you cannot just sign a piece of paper to say you’re opposed. You have to get it, homeschool, or sue. We’ll face that with the chicken pox vaccine, and I’m not interested in going through it with my pre-adolescent daughter. If she asks for the vaccine when she’s old enough, I’ll be happy to pay for it, but I do not think the government should mandate its use for anyone.

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