The sun was setting over the historic city of Dijon, in eastern France. A group of people milled around the courtyard of a conference center on the edge of town, drinking kir cocktails. The occasion was the annual meeting of the Association Liberté Information Santé, an organization that campaigns for what it terms “medical liberty” – or the right to refuse vaccines. This year, one topic dominated the agenda: the human papillomavirus injection, given to girls at puberty to protect them from a leading cause of cervical cancer.
“They’re virgins, they’re sacrificial virgins,” Robert Lidon, the gathering’s organizer, told me. He was using a favorite trope of the anti-HPV vaccine movement: painting girls either as innocent victims of a cynical and exploitative pharmaceutical industry or in danger of succumbing to the promiscuity that they believe inoculation against HPV encourages. This thread of old-fashioned sexual morality runs through many of the movement’s constituent parts, from Christian conservative groups to secular activists like Lidon.
Regardless of religious conviction or other motivations, anti-vaccine campaigners sit on a spectrum. Some falsely believe that immunization programs pose serious mental and physical health risks, while others go much further, subscribing to conspiracies that they are part of a shadowy population control project.
On my second night in Dijon — while many attendees adjourned to a nearby, but more expensive cafe — I had dinner with a 30-year-old woman, who I found sitting alone in the conference center’s canteen.
Celeste Bonnard asked to be referred to under an assumed name, for fear that talking about her beliefs would have consequences for her family. She was eight months pregnant and saving every cent she could for the arrival of her first child — a girl. She was adamant that she would not vaccinate her daughter against anything at all.
“What are they trying to do? It’s poison,” she said. “Some people have a theory. The population is at eight billion. At the beginning of the 19th century, it was one billion. I think they just try to kill people.”
To be an anti-vaxxer is to live in a terrifying, isolating world. Bonnard spends much of her days on Facebook scrolling through anti-vaccine conspiracy theories. She’s planning to reorganize her entire life when her child arrives.
Allowing unvaccinated children into schools risks outbreaks of preventable diseases, especially among peers who cannot be inoculated for medical reasons, such as compromised immune systems or allergies. Accordingly, in 2018, France’s then-health minister Agnès Buzyn brought in a new policy — no vaccines, no access to state education.
Ahead of Bonnard lie years of homeschooling and hardship. She will give up full-time work and, as a single mother, be forced to rely on her family for financial support. All because she refuses to vaccinate her daughter.
“I don’t want my little girl to lose her smile, or become paralyzed,” she told me. “I will never vaccinate my child. I’ve lost all trust in my government.”
Then Bonnard stopped talking. “What’s your opinion of it all?” she asked.
The risks of refusal
As a teenager growing up in the UK, I was one of the first girls to get the HPV vaccine after its nationwide rollout in 2008. My older sister, who had left school by then, was too old to be eligible. Two years ago, after a routine pap smear, her doctor informed her she had HPV, which had developed into lesions on her cervix. If left untreated, they could progress into cancer.
“I remember the doctor saying the word “cancer” and not really hearing anything else after that,” my sister told me recently.
Removing the lesions required an operation under general anesthetic. My sister’s experience, though without complications, was painful and stressful. And, had she been born two years later, it would have been entirely preventable.
HPV vaccine programs have been relatively successful in high-income countries like Australia and the UK, which have recorded dramatic drops in precancerous lesions in young women. In 2019, a major study by the Lancet, looking at 66 million young people, found that uptake of the HPV vaccine also protects unvaccinated people, because it makes the virus circulate less widely. Now that the vaccine is given to boys as well as girls in a growing number of countries, doctors and scientists anticipate that rates of cervical, head, neck and penile cancers will fall sharply in the next few years.
But in other nations, moral and religious opposition to the HPV vaccine has seriously affected levels of vaccine uptake. In Colombia, where there is a lack of both access to and education on the importance of regular pap smears, cervical cancer is one of the top killers of women. In 2012, the nationwide introduction of the HPV vaccine was initially hailed as a huge accomplishment, with 95% of teenage girls receiving the injection.
Carlos Castro, medical director of the Colombian League Against Cancer, fought hard to get the government to fund the HPV vaccine for all young women. He told me that when the program was launched, he felt that Colombia had a chance to slash its cervical cancer rates. “Then,” he said, “the nightmare began.”
In May 2014, in a small village named Carmen de Bolivar, in the north of the country, a group of schoolgirls began to have mysterious fainting spells.
Doctors could not explain it. When someone pointed out that the girls had all received HPV vaccinations at different points in the previous year, the country’s media linked their symptoms to the injection. Camera crews descended on Carmen de Bolivar, and local politicians began to use the events there to further their own agendas.
“I think they decided that this was an excellent motif to blame the government and the things they were doing wrong,” Castro said.
The HPV vaccine was denounced by conservative political movements such as Catholic vote Colombia, which argued that the treatment was both harming young girls and encouraging sexual promiscuity.
The effect was devastating. Hundreds of girls began having copycat fainting spells and Castro watched in horror as vaccination rates plummeted to below 5%. He described how lawyers and anti-vax campaigners fell upon the village, offering to help the families of the girls to sue the government and pharmaceutical companies.
“In a matter of weeks, there were not only 15 girls with symptoms, there were more than 500,” Castro said.
Doctors later diagnosed the situation as a case of mass hysteria.
Japan’s introduction of the HPV vaccine in April 2013 followed a similar pattern. After an initially successful launch, a nationwide epidemic of hysteria occurred, in which girls began to report involuntary movements, muscle weakness, and increased sensitivity to light and sound. Extensive media coverage pushed the government to withdraw its recommendation of the vaccine. National uptake plunged to below 1%.
An investigation conducted by Japan’s Ministry of Health found that the symptoms were unrelated to the vaccine, but the damage was done. The World Health Organization, which commissioned a review that found no link between the vaccine and any serious adverse effects, has continually called for Japan to reverse its decision not to endorse the treatment.
A study published in the Lancet in February found that if the government does not change its position, almost 11,000 Japanese women will die of cervical cancer over the next 50 years.
A disaster for science
When it comes to vaccines, France is the most skeptical country in the world. According to a 2018 Wellcome Monitor survey, one in three French citizens believe them to be unsafe.
The anti-vax movement is also widespread across the rest of Europe and the U.S., where it has reversed decades of scientific achievement. After announcing that measles had been eliminated from the country in 2000, the U.S. Center of Disease Control has reported the highest rates of infection in 25 years. Meanwhile, several countries in Europe have also lost their measles-free status. Around the world, 140,000 people died of the disease in 2018 — most babies and young children.
Back in Dijon, Lidon told me there has been a surge of interest in his group since 2018, when President Emmanuel Macron brought in a new law that made 11 key vaccines mandatory for all French children born after that time. The HPV vaccine is recommended rather than obligatory, and uptake in France is very low: just 19% of 16-year-old girls received the shot in 2016, a figure that experts believe is thanks to disinformation circulated by the anti-vaccination lobby.
On the opening night of the conference, a British documentary titled “Sacrificial Virgins” was screened. “The Greeks sacrificed young girls to appease their Gods. The Incas of Peru drugged and buried young girls in the farthest corner of their Empire,” the voiceover ran. Then the audience was introduced to two teenage girls who, the film alleged, were paralyzed as a result of receiving the HPV vaccine.
Dr. David Gorski, a surgical oncologist at the Barbara Ann Karmanos Cancer Institute in Michigan, has devoted his career to fighting pseudoscience and health misinformation. He has examined a number of these claims and faced the difficult task of trying to explain to parents that their child’s illness has no link to the HPV vaccine.
“There is no evidence that in general vaccination correlates with this sort of thing,” Gorski said. He added that tragic events are often “cynically exploited” by anti-vaxxers. Whenever a teenage girl dies unexpectedly within a few months of being inoculated, he said, they “come out of the woodwork and try to attribute it to the vaccine.”
“We can’t stand a tragedy that’s unexplained and finding a cause – even if it’s the wrong cause – often gives these parents a purpose in life,” Gorski told me. “It’s a horrible thing, because the consequence is that they blame themselves for their suffering or death, because they gave them permission to have the vaccine.”
Narratives about helpless virgins have accompanied discussion of the HPV vaccine, even before it first became available. “Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a license to engage in premarital sex,” Bridget Maher of the Family Research Council, a conservative Christian activist group, told New Scientist magazine back in 2005.
After Ireland launched its HPV vaccination program in 2010, prominent religious figures lined up to say that it would encourage young women to have more sex. In 2015, a lobby group named Regret was set up, claiming young Irish women were “vaccine injured” – a phrase favored by anti-vaxxers who believe their children have been paralysed or left chronically ill after receiving the injection.
By its own admission, Regret could not produce evidence that any of its members had been harmed by the vaccine. That did not stop several Irish politicians, such as cabinet minister Finian McGrath, to campaign for its withdrawal. In 2016, uptake rates for the HPV vaccine plunged from 90% to 50%. The following year, McGrath admitted he had got it devastatingly wrong: “I cocked up,” he said, offering his “unequivocal support” to the vaccine’s rollout.
In 2017, the Roman Catholic Bishop Phonsie Cullinan told the Irish Times: “I wonder could the large amount of money being spent on this vaccine be better spent on programmes which encourage our young people to live clean and chaste lives.”
According to a 2018 Harvard study, there is no evidence that promotion of the vaccine has any effect on how much teenagers have sex. Nevertheless, the promiscuity line is a powerful one.
David Robert Grimes, an Irish cancer researcher at the University of Oxford, has campaigned for the HPV vaccine in Ireland for the past five years. He describes the opposition campaign as closely tied to religious identity and charged with emotion.
“I’ve had situations where people have found my address,” he told me. “I’ve had to go to the police. People can be very violent.”
For Grimes, this is a personal matter as well as a scientific one. Last March, his close friend and campaigning partner Laura Brennan died of cervical cancer at 26 years old. She had been a powerful advocate for the HPV vaccine.
As a teenager, Brennan had been too old to receive the vaccine when it was first introduced in Irish schools. In a speech delivered alongside Irish health minister Simon Harris in September 2018, she reflected on this fact, saying, “the HPV vaccine saves lives. It could have saved mine, but it can save yours.”
Despite her illness, Brennan received huge amounts of hate mail from anti-vaxxers around the world – calling her “brainwashed” and even blaming her for her cancer, suggesting it was a result of promiscuity. “You should be ashamed of yourself; you got what you deserved; God’s judgement is just,” one message read.
In February, Ireland’s health service said that it expected HPV vaccine uptake to hit 80% in 2020. In County Clare, where Brennan was from, the figure stands at 90%. This rapid recovery is her legacy. But, as long as unsubstantiated claims, threaded through with proscriptive views of sexual morality, are spread around the world, similar outcomes elsewhere will remain challenging.
“I will always owe her a huge debt of gratitude,” Grimes said of Brennan. “But no one should have had to know her name. Ideally we get to a point where nobody is dying of these cancers, because we can prevent that.”