The Biopolitics of Reproductive Technologies beyond the Clinic: Localizing HPV Vaccines in India

Abstract

The human papillomavirus (HPV) vaccine research and marketing in India exemplifies the privatization of public sectors and global assemblages of novel actors and public-private partnerships in service delivery and pharmaceutical marketing. Drawing on ethnographic research, in this article I examine how the molecularized conception of cervical cancer and the simultaneous global rise of the HPV vaccine is redefining the meaning of prevention, the role of the state, and blurring the relationship between health care and health research in India. In 2009, two Indian states began “demonstration projects” to vaccinate 30,000 girls. The subsequent deaths of a number of girls exposed inherent problems with the projects. For many health activists, the vaccine has potentially grave consequences for India's public health system. This case demonstrates how biopolitical actors, and the drive for biocapital, can create a public health campaign that might in the end place women's health and the public health system at a greater risk.

Keywords:

• biocapital
• biopolitics
• cervical cancer
• epigenetics
• HPV vaccine

ACKNOWLEDGMENTS

I am grateful to the individuals in India for their time and insights. I particularly would like to thank Amar Jesani for his time and introducing me to all the relevant people in India. The research and writing of this article would not have been possible without the support of Shalini Randeria and the fellowship of Swiss Network for Mobility Studies (MOVE), Universities of Zurich and Neuchatel. Many people provided thoughtful comments including Lawrence Cohen, Judith Farquhar, Carlo Caduff, Tobias Rees, Kalindi Vora, and Nancy Chen. I also thank Vinh-Kim Nguyen and Sean Brotherton for organizing and inviting me to contribute to this special journal issue in honor of Margaret Lock. Their critical comments along with that of the four anonymous reviewers, and Lenore Manderson's fabulous editorship were crucial in enabling the publication of this article.

Notes

See the US vaccine adverse event reporting system and the European Medicine Agency for records of deaths associated with Cervarix and Gardasil.

Postgenomics refers to a network of epistemologies, practices, and technologies and to focus on gene functions and expressions that has emerged as the next phase of molecular biological work (Abu El-Haj 2007:284).

Epigenetics science explores gene-environment interaction and how environmental influences impact and modify genes, and further how transformations in genes can be passed on to next generations. That is, environmental variables can alter complex cellular processes predisposing individuals to risks of diseases independently of their DNA (Lock and Nguyen 2010:337).

Under the ‘conflict of interest statement’ Castellsagué (2008) noted his research is supported with grants from GSK, Merck Sharp & Dohme, and Sanofi Pasteur MSD. He also served on Speakers’ Bureaus for these pharmaceutical companies.

GSK-India is the fourth largest pharmaceutical company and leading prescription drug supplier in India. It is a 51% subsidiary of GSK Plc (UK), which is the largest foreign company in India's pharmaceutical market. Many of the world's leading pharmaceutical companies have subsidiaries or other operations in India. Approximately 34 foreign pharmaceutical companies, among them 15 of the world's 20 largest companies, are engaged in India's pharmaceutical market (Greene 2007).

In 2005–2006, multinational companies invested more than $172 million in India's pharmaceutical industry (Greene 2007).

See Sama: Resource Group for Women and Health (samawomenshealth.wordpress.com).

See Harvey (2006) on the political and economic implications of privatization of social sectors and the constraints placed on the state due to global neoliberal economic policies.

Conversation with Anant Phadke of SATHI-CEHAT, Pune, India.

Additional information

Notes on contributors

Fouzieyha Towghi

Fouzieyha Towghi is Medical Anthropologist and Research Fellow at the Department of Social and Cultural Anthropology, University of Zurich. Her scholarship focuses on the politics of reproduction, medicine, science, and technologies and their implication on women's corporeal and social bodies in South Asia. Her current research explores the global circulation of molecular biology and the diagnostic and therapeutic norms of reproductive cancers and their impact on public health policy and women's health in India.