Making evidence, making legitimacy : the introduction of HPV (Human Papillomavirus) vaccines in Colombia

Cervical cancer is strongly associated with the persistent and untreated infection with specific types of Human Papillomavirus (HPV). There are currently two vaccines which protect against the HPV types associated with 70% of cervical cancers. In 2013 the Colombian government introduced Gardasil® (Merck’s HPV vaccine) into the Colombian Expanded Programme of Immunisation. Since that year, three million girls have received the vaccine in Colombia. This thesis offers an empirical analysis of the configurations of evidence, efficiency and anticipation that this intervention entails. Based on diverse sources including policy documents, scientific literature, memoranda, minutes and interviews with experts, consultants and members of the National Committee of Immunization Practices, I show how evidence and efficiency are the result of different calculation practices. They constitute modes of ordering heterogeneous sets of objects, data and people. These orderings perform different values, including trust, efficiency, legitimacy, accountability and objectivity. I argue that evidence and efficiency are performed in health policy by means of calculation devices such systematic reviews, cost-effective analysis, statistical modelling and pharmaco-economics, and that these practices are not isolated from the political and cultural practices and discourses that constitute a policy. On the contrary, these elements constantly reshape calculation practices by configuring affective economies in relation to policy objects. Drawing on material semiotics of numbers, valuation studies and political sociology of science, I undertake a detailed analysis of the calculation and the transformation of data, figures and numbers in their movements between documents, technical committees, regulations and media. This exploration shows the contingency and the complexity in any claim regarding evidence and their role in contemporary policy legitimation. A central concern of this thesis is to ask: why do numbers and quantified expressions matter in healthcare policy? This thesis contributes to science and technology studies and sociology by devising methods to research the relationships between policy and calculation. These conceptual and methodological tools allow the practices of producing figures and numbers and their public use and political consequences to be traced and followed. This thesis extends social studies of evidence in healthcare by exploring the Colombian experience in the reception and adaptation of evidence based medicine in vaccination policy. Moreover, it contributes to the social science literature about HPV vaccines by analyzing the process of selection and decision making undertaken in technical committees and the role of calculations in constituting the HPV vaccines as a matter of public interest.

Name dc:type.qualificationname

Ph.D.

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

Lancaster University

Year dc:date.issued

2015

Authors dc:creator

• Maldonado Castañeda, Oscar Javier
• Mort, Maggie
• Roberts, Celia