What's a jackalope.

What's a jackalope.

A jackalope is a mythological creature, a sort of iconic to the American West. It's a combination of a jack rabbit and a prong horn antelope. So it's a jack rabbit that has antlers or horns, and it exists richly in the imagination of Americans, especially in the West. But it is a mythological creature.

A jackalope is a mythological creature, a sort of iconic to the American West. It's a combination of a jack rabbit and a prong horn antelope. So it's a jack rabbit that has antlers or horns, and it exists richly in the imagination of Americans, especially in the West. But it is a mythological creature.

This is Michael Branch, a man who loves the jackalope so much that he wrote a book about it. It's called On the Trail of the Jackalope. Is that a jackalope on your shirt? Or am I mistaken?

This is Michael Branch, a man who loves the jackalope so much that he wrote a book about it. It's called On the Trail of the Jackalope. Is that a jackalope on your shirt? Or am I mistaken?

Yeah, that's a jacalobe. Of course. Jacoalobe kitch is a huge part of the phenomenon. And so you know, if you've ever seen a jacalobe bumper stick or t shirt, shot glass, taxidermy mount, you're part of the hoax. You're in on the joke.

Yeah, that's a jacalobe. Of course. Jacoalobe kitch is a huge part of the phenomenon. And so you know, if you've ever seen a jacalobe bumper stick or t shirt, shot glass, taxidermy mount, you're part of the hoax. You're in on the joke.

The jackalope is a myth, but there are in fact, real horned rabbits. Is an expert on these two, and those horned rabbits led to a key breakthrough in understanding how viruses cause disease. Today on the show Horned rabbits, human papilloma virus AKAHPV, and a vaccine backlash. This is incubation. I'm Jacob Goldstein. So there's this myth of the jackalope in the US. There are mythological horned rabbits, and in fact, there are real horned rabbits in the world. Right, we've been talking only of myth. But tell me about tell me about real horned rabbits.

The jackalope is a myth, but there are in fact, real horned rabbits. Is an expert on these two, and those horned rabbits led to a key breakthrough in understanding how viruses cause disease. Today on the show Horned rabbits, human papilloma virus AKAHPV, and a vaccine backlash. This is incubation. I'm Jacob Goldstein. So there's this myth of the jackalope in the US. There are mythological horned rabbits, and in fact, there are real horned rabbits in the world. Right, we've been talking only of myth. But tell me about tell me about real horned rabbits.

So called horned rabbits are actually various species of rabbits that develop these weird, grotesque growths on their heads, sometimes on their faces, and they're produced by a papilloma virus. And both hunters and common people and also naturalists have noticed these forever without having any idea what caused them.

So called horned rabbits are actually various species of rabbits that develop these weird, grotesque growths on their heads, sometimes on their faces, and they're produced by a papilloma virus. And both hunters and common people and also naturalists have noticed these forever without having any idea what caused them.

And what does it look like.

And what does it look like.

Let me put it this way. When the slide of an actual horn rabbit comes up when I'm doing book talks, you can hear a collective groan from the audience. I mean, it is quite grotesque. And if you can just imagine bumpy, wordy, caratinous black growths all over the face or head of an animal, that's what it looks like.

Let me put it this way. When the slide of an actual horn rabbit comes up when I'm doing book talks, you can hear a collective groan from the audience. I mean, it is quite grotesque. And if you can just imagine bumpy, wordy, caratinous black growths all over the face or head of an animal, that's what it looks like.

So you mentioned that that these horns, these growths are caused by a papolloma virus, which turns out to be important in the history of understanding viruses and ultimately in the history of human health.

So you mentioned that that these horns, these growths are caused by a papolloma virus, which turns out to be important in the history of understanding viruses and ultimately in the history of human health.

Right yeah, And it involves a guy named Richard shop who had actually been involved in trying to figure out what had caused the global pandemic of nineteen eighteen. By the time he got interested in horn rabbits, he was already a well known virologist. This would have been the late nineteen twenties early nineteen thirties, and he had come from his home in Iowa to Princeton to take up this research position as a medical researcher. And he heard stories from his friends back in Iowa and Kansas who said, hey, you know, sometimes when we're out rabbit hunting, we kill these rabbits that have these weird growths on them. And of course, you know, being a scientific researcher guy interested in viruses, you know, he immediately wanted to see one of these rabbits. In fact, he wanted to see him so badly that he made a special trip back to Iowa with a hunter who had claimed to have shot a number of these rabbits, and Shope himself hunted specifically to try to get one of these rabbits with the strange growths. After four days, he was unsuccessful and he had to go back to Princeton. There was a young young kid who had been hunting with them, and he told that kid, Hey, I'm going to leave you a five dollar bill and a bottle of glycerol solution, and if you can find one of these rabbits, cut off its horns, put him in the solution, mail them to me, and I'll give you another five dollars. He could see from the very beginning that if he could demonstrate a link between viruses and cancer in a mammal that he would be opening the way to research that might ultimately address that question in human beings.

Right yeah, And it involves a guy named Richard shop who had actually been involved in trying to figure out what had caused the global pandemic of nineteen eighteen. By the time he got interested in horn rabbits, he was already a well known virologist. This would have been the late nineteen twenties early nineteen thirties, and he had come from his home in Iowa to Princeton to take up this research position as a medical researcher. And he heard stories from his friends back in Iowa and Kansas who said, hey, you know, sometimes when we're out rabbit hunting, we kill these rabbits that have these weird growths on them. And of course, you know, being a scientific researcher guy interested in viruses, you know, he immediately wanted to see one of these rabbits. In fact, he wanted to see him so badly that he made a special trip back to Iowa with a hunter who had claimed to have shot a number of these rabbits, and Shope himself hunted specifically to try to get one of these rabbits with the strange growths. After four days, he was unsuccessful and he had to go back to Princeton. There was a young young kid who had been hunting with them, and he told that kid, Hey, I'm going to leave you a five dollar bill and a bottle of glycerol solution, and if you can find one of these rabbits, cut off its horns, put him in the solution, mail them to me, and I'll give you another five dollars. He could see from the very beginning that if he could demonstrate a link between viruses and cancer in a mammal that he would be opening the way to research that might ultimately address that question in human beings.

Ah. So he wants to find out whether a virus is causing these growths, these horns to grow out of the heads of rabbits exactly.

Ah. So he wants to find out whether a virus is causing these growths, these horns to grow out of the heads of rabbits exactly.

And soon as Chope left Iowa, this kid just made it his mission to get one of these rabbits, and he did so. He mailed Shope the horns in the glyceral solution. He got his other five dollars, and after that the word get out among the communities of hunters in Kansas and Iowa, and people began to literally mail specimens of horn rabbits to shop in Princeton.

And soon as Chope left Iowa, this kid just made it his mission to get one of these rabbits, and he did so. He mailed Shope the horns in the glyceral solution. He got his other five dollars, and after that the word get out among the communities of hunters in Kansas and Iowa, and people began to literally mail specimens of horn rabbits to shop in Princeton.

So he's there in Princeton and he goes down and gets his like whatever, his insurance bill, and then a box with a dead rabbit in it, exactly.

So he's there in Princeton and he goes down and gets his like whatever, his insurance bill, and then a box with a dead rabbit in it, exactly.

And he started working on horn rabbits there at the Rockefeller Inns Institute in nineteen thirty two with the goal of understanding what caused those odd growths. He is especially interested in viruses, and he is doing his work at a time when the consensus in the scientific community is that it is impossible that a virus could cause cancer, especially in a mammal. And at the time, you know, nobody knew what caused these weird growths, and he wanted to find out what caused them, but he suspected that it was a virus, and so he set out to sort of test that hypothesis through his own experimental method.

And he started working on horn rabbits there at the Rockefeller Inns Institute in nineteen thirty two with the goal of understanding what caused those odd growths. He is especially interested in viruses, and he is doing his work at a time when the consensus in the scientific community is that it is impossible that a virus could cause cancer, especially in a mammal. And at the time, you know, nobody knew what caused these weird growths, and he wanted to find out what caused them, but he suspected that it was a virus, and so he set out to sort of test that hypothesis through his own experimental method.

So when you say his own experimental method, what do you mean, what do you do?

So when you say his own experimental method, what do you mean, what do you do?

Well? First, he samples these weird growths on the rabbit's heads, and he takes those samples and pulverizes them, adds them to a saline solution and then runs them through a centrifuge. And then he takes the fluid that has been produced by that process and then does what is really the most important thing. That is, he takes that fluid and puts it through a filter. Now, back in the nineteen thirties, in the kind of pioneering era of viral research, these porcelain filters were very important because they could filter out bacteria and other larger things. The only thing small enough to go through these filters was a virus. Huh.

Well? First, he samples these weird growths on the rabbit's heads, and he takes those samples and pulverizes them, adds them to a saline solution and then runs them through a centrifuge. And then he takes the fluid that has been produced by that process and then does what is really the most important thing. That is, he takes that fluid and puts it through a filter. Now, back in the nineteen thirties, in the kind of pioneering era of viral research, these porcelain filters were very important because they could filter out bacteria and other larger things. The only thing small enough to go through these filters was a virus. Huh.

It's interesting, right, because that it seems sort of primitive to us on a certain level, but also kind of ingenious, right, Like, they know not that much about viruses at the time, but they know they're way smaller than bacteria and that those are the two main kind of disease causing pathogens, right, And so they're like, Okay, let's just make a filter that will take out bacteria and anything else that can cause a disease, but that will allow viruses to pass through that we know that that's the only pathogen that could be left in here.

It's interesting, right, because that it seems sort of primitive to us on a certain level, but also kind of ingenious, right, Like, they know not that much about viruses at the time, but they know they're way smaller than bacteria and that those are the two main kind of disease causing pathogens, right, And so they're like, Okay, let's just make a filter that will take out bacteria and anything else that can cause a disease, but that will allow viruses to pass through that we know that that's the only pathogen that could be left in here.

Exactly exactly the fact that he uses this technique to make sure that the only thing that can come through that porcelain filter. Is a virus is kind of a key moment.

Exactly exactly the fact that he uses this technique to make sure that the only thing that can come through that porcelain filter. Is a virus is kind of a key moment.

Okay. So now he has his whatever, his gou his solution that we know has no bacteria in it that he's going to do something with. What's he do with it?

Okay. So now he has his whatever, his gou his solution that we know has no bacteria in it that he's going to do something with. What's he do with it?

Okay? So he takes live rabbits that are healthy. He shaves a little bit of their fur off and then scarifies their skin, just roughs it up just a little bit with some sandpaper, and then he takes that fluid that has gone through the filter and applies it to that little spot on the rabbits. And the idea is right that since this fluid has been taken from the horns of disease rabbits, and since it's been filtered to make sure the only thing that can be in it is viruses, he has essentially applied a fluid to these healthy rabbits. So the whole idea is to wait and see. Having no idea if virus is the cause, or if it is what the incubation period might be, he applies this to these patches on his test rabbits, and sure enough, after about ten days, all of the rabbits that he has inoculated with this fluid begin to develop exactly the same kinds of growth that were present on the diseased rabbit. And that's sort of the Eureka moment in the story, because that's the moment at which Shope has essentially proven that the growths on horned rabbits are in fact caused by a virus.

Okay? So he takes live rabbits that are healthy. He shaves a little bit of their fur off and then scarifies their skin, just roughs it up just a little bit with some sandpaper, and then he takes that fluid that has gone through the filter and applies it to that little spot on the rabbits. And the idea is right that since this fluid has been taken from the horns of disease rabbits, and since it's been filtered to make sure the only thing that can be in it is viruses, he has essentially applied a fluid to these healthy rabbits. So the whole idea is to wait and see. Having no idea if virus is the cause, or if it is what the incubation period might be, he applies this to these patches on his test rabbits, and sure enough, after about ten days, all of the rabbits that he has inoculated with this fluid begin to develop exactly the same kinds of growth that were present on the diseased rabbit. And that's sort of the Eureka moment in the story, because that's the moment at which Shope has essentially proven that the growths on horned rabbits are in fact caused by a virus.

Does he publish the results? How does this finding land?

Does he publish the results? How does this finding land?

He publishes his work the following year, which is nineteen thirty three, in a watershed article in the Journal of Experimental Medicine, and you know, outside of fellow researchers in the virology community, it really doesn't go far at all, even though it's a huge breakthrough.

He publishes his work the following year, which is nineteen thirty three, in a watershed article in the Journal of Experimental Medicine, and you know, outside of fellow researchers in the virology community, it really doesn't go far at all, even though it's a huge breakthrough.

After his paper comes out, do people recognize that viruses can cause cancer in mammals?

After his paper comes out, do people recognize that viruses can cause cancer in mammals?

They do, but it takes a while, you know. I think that the scientific community was so thoroughly resistant to this idea that it wasn't as if everyone realized right away what the implications of the work were. That's going to be left to other researchers, most importantly a guy named peyton Us who was a colleague of Shops at the Rockefeller Institute. Peyton Russ will go on to do the extended studies that will prove the hunch that showpad all along, which is that some of those growths can become cancerous.

They do, but it takes a while, you know. I think that the scientific community was so thoroughly resistant to this idea that it wasn't as if everyone realized right away what the implications of the work were. That's going to be left to other researchers, most importantly a guy named peyton Us who was a colleague of Shops at the Rockefeller Institute. Peyton Russ will go on to do the extended studies that will prove the hunch that showpad all along, which is that some of those growths can become cancerous.

Aha. So that's ultimately showing Shope's work and the work of his colleague shows that in fact, a virus is causing cancer in a mammal.

Aha. So that's ultimately showing Shope's work and the work of his colleague shows that in fact, a virus is causing cancer in a mammal.

That's the kind of big breakthrough exactly. And so that's sort of the first step toward working on viruses as cancer causing agents in human beings. It's going to take several generations of scientists to explore the implications fully.

That's the kind of big breakthrough exactly. And so that's sort of the first step toward working on viruses as cancer causing agents in human beings. It's going to take several generations of scientists to explore the implications fully.

In the decades after Shope did his studies on rabbits, scientists kept studying papillomaviruses. They discovered a human version of the papaloma virus, which reasonably enough, they called the human papalomavirus or HPV, and in work that wound up winning a Nobel Prize, another researcher definitively HPV to cervical cancer. Eventually, we learned that over ninety percent of cervical cancer cases are caused by HPV, and that HPV is also a common cause of throat cancer. Despite all that, when a new vaccine promised to prevent HPV, infection. Not everybody was excited. That's after the break the first HPV vaccine was rolled out nearly twenty years ago. People in the vaccine world, in the public health world, and the cancer world were very excited. This was a vaccine that could prevent cancer or at least some kinds of cancer, and HPV vaccines are in fact used around the world today. As it turned out, though back when the vaccine was first approved, many people were not excited.

In the decades after Shope did his studies on rabbits, scientists kept studying papillomaviruses. They discovered a human version of the papaloma virus, which reasonably enough, they called the human papalomavirus or HPV, and in work that wound up winning a Nobel Prize, another researcher definitively HPV to cervical cancer. Eventually, we learned that over ninety percent of cervical cancer cases are caused by HPV, and that HPV is also a common cause of throat cancer. Despite all that, when a new vaccine promised to prevent HPV, infection. Not everybody was excited. That's after the break the first HPV vaccine was rolled out nearly twenty years ago. People in the vaccine world, in the public health world, and the cancer world were very excited. This was a vaccine that could prevent cancer or at least some kinds of cancer, and HPV vaccines are in fact used around the world today. As it turned out, though back when the vaccine was first approved, many people were not excited.

Support was coming from everywhere, but backlash was coming from everywhere too, like all over the political spectrum. Exaggeration to say it's a total mess.

Support was coming from everywhere, but backlash was coming from everywhere too, like all over the political spectrum. Exaggeration to say it's a total mess.

This is Elena Konis. She wrote a book called Vaccine Nation, America's Changing Relationship with Immunization, and she told me that the controversy over the HPV vaccine was really part of this much bigger story. She said, it was the culmination of this deep seated conflict that had been building for decades.

This is Elena Konis. She wrote a book called Vaccine Nation, America's Changing Relationship with Immunization, and she told me that the controversy over the HPV vaccine was really part of this much bigger story. She said, it was the culmination of this deep seated conflict that had been building for decades.

In my view, you really can't understand what happens with the HPV vaccine in the early two thousands unless you rewind the clock back to the nineteen fifties actually, and that was because that was a decade when we got a new vaccine, the polio vaccine that was desperately hoped for the entire public. Really in some level was invested, and when that vaccine was developed and rolled out to the public in nineteen fifty five, it ushered in a new era of vaccination in the US. We started vaccinating kids, especially against a wide range of diseases. We started ensuring that they were vaccinated by making vaccines required for kids to enroll in school. We made them required by passing laws and regulations at the state level, and we did all of this with a lot of federal support. Polio, smallpox, measles, mumps, rubella. What's important about this list of diseases is that they were really different in kind. Polio and smallpox were widely feared dreaded diseases. The policies that we developed for polio ended up being applied to these other vaccines.

In my view, you really can't understand what happens with the HPV vaccine in the early two thousands unless you rewind the clock back to the nineteen fifties actually, and that was because that was a decade when we got a new vaccine, the polio vaccine that was desperately hoped for the entire public. Really in some level was invested, and when that vaccine was developed and rolled out to the public in nineteen fifty five, it ushered in a new era of vaccination in the US. We started vaccinating kids, especially against a wide range of diseases. We started ensuring that they were vaccinated by making vaccines required for kids to enroll in school. We made them required by passing laws and regulations at the state level, and we did all of this with a lot of federal support. Polio, smallpox, measles, mumps, rubella. What's important about this list of diseases is that they were really different in kind. Polio and smallpox were widely feared dreaded diseases. The policies that we developed for polio ended up being applied to these other vaccines.

Policies meaning state laws requiring them for kids to go to school, and the federal government supporting and even subsidizing those laws.

Policies meaning state laws requiring them for kids to go to school, and the federal government supporting and even subsidizing those laws.

Yes, and this is happening in the nineteen sixties. It's coinciding with the rise of all of the social movements of that decade that are encouraging young people in particular to question authority and to ask for more information and to push back against institutions.

Yes, and this is happening in the nineteen sixties. It's coinciding with the rise of all of the social movements of that decade that are encouraging young people in particular to question authority and to ask for more information and to push back against institutions.

I mean, very broadly, more distrust of authority. Right plainly, Yes, Certainly in the nineteen seventies, if not before, people in many domains began to trust institutions and authority less, and that persons.

I mean, very broadly, more distrust of authority. Right plainly, Yes, Certainly in the nineteen seventies, if not before, people in many domains began to trust institutions and authority less, and that persons.

Absolutely, And that actually leads into a kind of ironic moment in this late twentieth century history of vaccination, because by the nineteen eighties we have an organized vaccine safety movement, and I should say this is how they describe themselves. They don't call themselves anti vaccinationists. They lobbied for and ultimately succeeded in getting a change in federal legislation. In nineteen eighty six, Reagan signs a new law to provide compensation to individuals and families who have suffered injuries from mandated vaccines, and also creates the infrastructure for a nationwide system to monitor the public for vaccine injuries. So we get to the end of the eighties with the very organized and very successful national movement, and in the meantime, a handful of other childhood vaccines come out in the background. However, this organized self described vaccine safety movement has not stopped.

Absolutely, And that actually leads into a kind of ironic moment in this late twentieth century history of vaccination, because by the nineteen eighties we have an organized vaccine safety movement, and I should say this is how they describe themselves. They don't call themselves anti vaccinationists. They lobbied for and ultimately succeeded in getting a change in federal legislation. In nineteen eighty six, Reagan signs a new law to provide compensation to individuals and families who have suffered injuries from mandated vaccines, and also creates the infrastructure for a nationwide system to monitor the public for vaccine injuries. So we get to the end of the eighties with the very organized and very successful national movement, and in the meantime, a handful of other childhood vaccines come out in the background. However, this organized self described vaccine safety movement has not stopped.

So tell me the story of the HPV vaccine and it's rollout.

So tell me the story of the HPV vaccine and it's rollout.

So the HPV vaccine is so interesting in the history of vaccination because it comes out in the early two thousands and its rollout really represents a turning point. And when I talk about the HPV vaccine, initially, I'm talking about Merk vaccine Gardasil.

So the HPV vaccine is so interesting in the history of vaccination because it comes out in the early two thousands and its rollout really represents a turning point. And when I talk about the HPV vaccine, initially, I'm talking about Merk vaccine Gardasil.

That was the first HPV vaccine approved in the US.

That was the first HPV vaccine approved in the US.

Yes, that was the first one approved for use in the US. It protected against four strains of HPV, and scientists knew very well that those four strains were linked to a very high proportion of cases of cervical cancer in the US. So there's multiple ways of getting cervical cancer, but one really important way is infection with HPV, and this vaccine protected against four strains known to be linked to cervical cancer. Mirke was excited about this. Reproductive health advocates and providers were excited about this, but Mirk knew that it faced a problem. HPV was not a virus that the public knew much about at all. In fact, they had hardly even heard of it, and that meant that they really didn't know about the link between HPV and cervical cancer. So before the HPV vaccine was approved, Merk ran an ad campaign, and the ad campaign specifically targeted women and told them that there was a virus called HPV and that it was linked to cervical cancer.

Yes, that was the first one approved for use in the US. It protected against four strains of HPV, and scientists knew very well that those four strains were linked to a very high proportion of cases of cervical cancer in the US. So there's multiple ways of getting cervical cancer, but one really important way is infection with HPV, and this vaccine protected against four strains known to be linked to cervical cancer. Mirke was excited about this. Reproductive health advocates and providers were excited about this, but Mirk knew that it faced a problem. HPV was not a virus that the public knew much about at all. In fact, they had hardly even heard of it, and that meant that they really didn't know about the link between HPV and cervical cancer. So before the HPV vaccine was approved, Merk ran an ad campaign, and the ad campaign specifically targeted women and told them that there was a virus called HPV and that it was linked to cervical cancer.

I don't know why people don't know about this.

I don't know why people don't know about this.

I don't know why I didn't know.

I don't know why I didn't know.

I've never heard of this. I'm just shocked. I just found out that cervical cancer is caused by certain types of a common virus, HPV.

I've never heard of this. I'm just shocked. I just found out that cervical cancer is caused by certain types of a common virus, HPV.

Merk knows that without awareness of this virus or its link to cancer, it's not going to get anywhere in the marketplace. So it makes sense why they do this. Reproductive advocates are thinking, hey, here is a vaccine that is not only a new tool against reproductive cancer, but a way of eliminating disparities in who gets cancer. In other words, there at the time were racial and income disparities in cervical cancer rates, and so the thinking on the part of reproductive health advocates were use a vaccine, administer it alongside other vaccines, and then people will be protected against cervical cancer, regardless of wealth, or race or ethnicity. Everybody's excited. Everybody's expecting a seamless rollout of this vaccine. So FDA approves guard to CEL, and the CDC Advisory Committee concludes that since the vaccine was tested in women, it should be administered only to females, and because HPV is sexually transmitted, it should ideally be administered to females as young as say sixth grade.

Merk knows that without awareness of this virus or its link to cancer, it's not going to get anywhere in the marketplace. So it makes sense why they do this. Reproductive advocates are thinking, hey, here is a vaccine that is not only a new tool against reproductive cancer, but a way of eliminating disparities in who gets cancer. In other words, there at the time were racial and income disparities in cervical cancer rates, and so the thinking on the part of reproductive health advocates were use a vaccine, administer it alongside other vaccines, and then people will be protected against cervical cancer, regardless of wealth, or race or ethnicity. Everybody's excited. Everybody's expecting a seamless rollout of this vaccine. So FDA approves guard to CEL, and the CDC Advisory Committee concludes that since the vaccine was tested in women, it should be administered only to females, and because HPV is sexually transmitted, it should ideally be administered to females as young as say sixth grade.

So, just to be clear, the idea is to vaccinate people before they have sex and are therefore exposed to the.

So, just to be clear, the idea is to vaccinate people before they have sex and are therefore exposed to the.

Virus exactly exactly, yeap, catch them before they're sexually active, so that there is little to no chance that they would have encountered this virus otherwise.

Virus exactly exactly, yeap, catch them before they're sexually active, so that there is little to no chance that they would have encountered this virus otherwise.

And then, as I understand it, right, there was this like sample legislation that was drafted to encourage states to mandate the vaccine. And this is essentially the playbook of how vaccines had been rolled out for decades at this point.

And then, as I understand it, right, there was this like sample legislation that was drafted to encourage states to mandate the vaccine. And this is essentially the playbook of how vaccines had been rolled out for decades at this point.

Right, absolutely, absolutely, The only change really is that this is a very new vaccine targeting and infection that the public really wasn't aware of yet, and that they were targeting only girls.

Right, absolutely, absolutely, The only change really is that this is a very new vaccine targeting and infection that the public really wasn't aware of yet, and that they were targeting only girls.

Well.

Well.

As soon as lawmakers introduced these bills, debates erupted in state houses and what happened was the anti pharma backlashed, combined with a conservative trend in sexual education, combined with the advent of kind of religious conservatism, meant that there was pushback coming from a handful of different spheres, all of whom had their own reasons for arguing against these HPV vaccination mandates. They said, vaccines are for children to protect them against diseases that are spread in the school environment. HPV is not. Let's leave it out of it. The best protection against sexually transmitted infections anyway, they said, was abstinence, not vaccines, and were probably quote unquote encouraging promiscuity if we use this vaccine. It made some people, especially a bunch of people who self identified as feminists and women's rights activists, say, hold on, why should it be women's or girls sole responsibility to prevent the spread of a sexually transmitted infection. That's sexist and unfair. And so what this did was it contributed another argument to the backlash, and it's another part of why the HPV story is so interesting because support was coming from everywhere, but backlash was coming from everywhere too, like all over the political spectrum.

As soon as lawmakers introduced these bills, debates erupted in state houses and what happened was the anti pharma backlashed, combined with a conservative trend in sexual education, combined with the advent of kind of religious conservatism, meant that there was pushback coming from a handful of different spheres, all of whom had their own reasons for arguing against these HPV vaccination mandates. They said, vaccines are for children to protect them against diseases that are spread in the school environment. HPV is not. Let's leave it out of it. The best protection against sexually transmitted infections anyway, they said, was abstinence, not vaccines, and were probably quote unquote encouraging promiscuity if we use this vaccine. It made some people, especially a bunch of people who self identified as feminists and women's rights activists, say, hold on, why should it be women's or girls sole responsibility to prevent the spread of a sexually transmitted infection. That's sexist and unfair. And so what this did was it contributed another argument to the backlash, and it's another part of why the HPV story is so interesting because support was coming from everywhere, but backlash was coming from everywhere too, like all over the political spectrum.

And clearly there are a lot of particular things, things that are particular to this vaccine. But when you zoom out and you think about the bigger historical arc, why is this an important moment beyond this one vaccine.

And clearly there are a lot of particular things, things that are particular to this vaccine. But when you zoom out and you think about the bigger historical arc, why is this an important moment beyond this one vaccine.

It's an important moment for this reason. About two dozen states considered laws or regulations to make HPV mandatory for young girls, and this was between two thousand and six and two thousand and eight, and only one of them succeeded.

It's an important moment for this reason. About two dozen states considered laws or regulations to make HPV mandatory for young girls, and this was between two thousand and six and two thousand and eight, and only one of them succeeded.

So was that the first time that this decade's old sort of playbook of a new vaccine comes out and it's mandated in state after state? Was it the first time that had failed?

So was that the first time that this decade's old sort of playbook of a new vaccine comes out and it's mandated in state after state? Was it the first time that had failed?

Yes? What happened was all these lawmakers in these states and then others that were watching, they rolled back and they took the mandates off the table. So it's a really important moment because we see the public being really successful in pushing back against this era of child vaccination mandates.

Yes? What happened was all these lawmakers in these states and then others that were watching, they rolled back and they took the mandates off the table. So it's a really important moment because we see the public being really successful in pushing back against this era of child vaccination mandates.

So the rollout does not go as planned. The HPV vaccine does not join all the other childhood vaccines that are mandated in many states.

So the rollout does not go as planned. The HPV vaccine does not join all the other childhood vaccines that are mandated in many states.

What happens, Yeah, So what happens next is really interesting. Epidemiologists who weren't studying HPV before started to say, hmm, this is interesting. Does it make sense to only vaccinate girls? What about boys? What about other forms of cancer other types of Researchers too, start asking questions about it. In other words, the existence of the vaccine invites further scientific study and scrutiny of its target infection. What we learn with HPV is that, yes, there's a link to cervical cancer, but males get infected with HPV two, and it can cause forms of reproductive cancers in males, and it can cause cancers in other parts of the body as well. So what's interesting about what happens next is that slowly we change HPV's reputation and we change or start to change public understanding and scientific understanding first of HPV's relationship to cancer generally, males are eventually added. Another HPV vaccine is approved for market, and there are more and more efforts promoting education and an awareness of both HPV and the vaccine for males and females. After a decade on the market, there is way more knowledge about the vaccine's safety profile. HPV becomes normalized. For about the first ten years of the HPV vaccine's existence, we were stuck at below fifty percent, like around forty percent uptake of this vaccine, and a lot of lawmakers and a lot of parents just kind of unwilling to touch it or talk about it. But the trajectory is pretty steadily upward, and in fact, it's continued upward since then. By the early twenty twenties, uptake is over sixty percent across young teens male and female in the US.

What happens, Yeah, So what happens next is really interesting. Epidemiologists who weren't studying HPV before started to say, hmm, this is interesting. Does it make sense to only vaccinate girls? What about boys? What about other forms of cancer other types of Researchers too, start asking questions about it. In other words, the existence of the vaccine invites further scientific study and scrutiny of its target infection. What we learn with HPV is that, yes, there's a link to cervical cancer, but males get infected with HPV two, and it can cause forms of reproductive cancers in males, and it can cause cancers in other parts of the body as well. So what's interesting about what happens next is that slowly we change HPV's reputation and we change or start to change public understanding and scientific understanding first of HPV's relationship to cancer generally, males are eventually added. Another HPV vaccine is approved for market, and there are more and more efforts promoting education and an awareness of both HPV and the vaccine for males and females. After a decade on the market, there is way more knowledge about the vaccine's safety profile. HPV becomes normalized. For about the first ten years of the HPV vaccine's existence, we were stuck at below fifty percent, like around forty percent uptake of this vaccine, and a lot of lawmakers and a lot of parents just kind of unwilling to touch it or talk about it. But the trajectory is pretty steadily upward, and in fact, it's continued upward since then. By the early twenty twenties, uptake is over sixty percent across young teens male and female in the US.

So most teenagers now, even in the absence of mandates, largely are getting vaccinated against HPV.

So most teenagers now, even in the absence of mandates, largely are getting vaccinated against HPV.

Yeah, most teenagers, and in fact, I think that in the last couple of years the numbers have continued to march upwards.

Yeah, most teenagers, and in fact, I think that in the last couple of years the numbers have continued to march upwards.

If we sort of think here about you know, what's happened with the HPV vaccine and this longer history of vaccine mandates in general, what do you think at this point about state mandates for vaccines.

If we sort of think here about you know, what's happened with the HPV vaccine and this longer history of vaccine mandates in general, what do you think at this point about state mandates for vaccines.

This is one of those things where this is so politicized that I want to be very careful about what I say. Mandates are political tools, and in this country, since the era of mandates began at the turn of the twentieth centuries, we have included exemptions to those mandates. Three kinds of exemptions historically a medical exemption, a religious exemption, and a philosophical exemption or a belief based exemption. Those exemptions are to me an indication of how political a tool vaccine mandates are. We knew from the outset that mandates were the best way of ensuring the broad and widespread use of a vaccine, But we also knew that there was going to be resistance because this is a country that was founded on enlightened principles of individual liberty and autonomy, and these ideas about individual rights were in an inherent conflict with the idea of a state mandated vaccination program. The exemptions reconciled those two things. So my feeling is that mandates are an incredibly powerful tool, and that when you have a disease as horrifying as smallpox was in its earliest forms, they are a really important way of stopping this of those diseases. When I, as a historian of medicine, think about the history of disease, I look at COVID. It's a horrible, horrible disease, and then I think about things like smallpox and yellow fever, kinds of diseases we can't even imagine in this country today because of the depth of suffering.

This is one of those things where this is so politicized that I want to be very careful about what I say. Mandates are political tools, and in this country, since the era of mandates began at the turn of the twentieth centuries, we have included exemptions to those mandates. Three kinds of exemptions historically a medical exemption, a religious exemption, and a philosophical exemption or a belief based exemption. Those exemptions are to me an indication of how political a tool vaccine mandates are. We knew from the outset that mandates were the best way of ensuring the broad and widespread use of a vaccine, But we also knew that there was going to be resistance because this is a country that was founded on enlightened principles of individual liberty and autonomy, and these ideas about individual rights were in an inherent conflict with the idea of a state mandated vaccination program. The exemptions reconciled those two things. So my feeling is that mandates are an incredibly powerful tool, and that when you have a disease as horrifying as smallpox was in its earliest forms, they are a really important way of stopping this of those diseases. When I, as a historian of medicine, think about the history of disease, I look at COVID. It's a horrible, horrible disease, and then I think about things like smallpox and yellow fever, kinds of diseases we can't even imagine in this country today because of the depth of suffering.

Way worse than COVID, just to way.

Way worse than COVID, just to way.

Worse than COVID. Bodies disfigure from internal bleeding, reeking skins sloughing off like left in the street to die. And this is what I see in the past. This is what we were trying to prevent with vaccination. That is what we were trying to prevent with mandatory vaccination. So this is a really, really sticky question, and it's not a question that, in my view, any one individual can come to. It's about a community or a nation state deciding how do we want to balance our values in the pursuit of public health.

Worse than COVID. Bodies disfigure from internal bleeding, reeking skins sloughing off like left in the street to die. And this is what I see in the past. This is what we were trying to prevent with vaccination. That is what we were trying to prevent with mandatory vaccination. So this is a really, really sticky question, and it's not a question that, in my view, any one individual can come to. It's about a community or a nation state deciding how do we want to balance our values in the pursuit of public health.

Thanks to my guest today, Michael Branch and Elena Konis. Next week another show, another virus HSV aka Herpes.

Thanks to my guest today, Michael Branch and Elena Konis. Next week another show, another virus HSV aka Herpes.

When I was diagnosed with herpes, I was like, am I going to have an outbreak forever?

When I was diagnosed with herpes, I was like, am I going to have an outbreak forever?

And no?

And no?

Viruses are weird and they don't behave the way you expect.

Viruses are weird and they don't behave the way you expect.

Incubation is a co production of Pushkin Industries and Ruby Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz, and Amy Gaines McQuaid. Our editors are Julia Barton, and Karen Chakerjie mastering by Anne Pope, fact checking by Joseph Friedman. Our executive producers are Katherine Girardeau and Matt Romano. Special thanks to Ian Fraser. I'm Jacob Goldstein. Thanks for listening.

Incubation is a co production of Pushkin Industries and Ruby Studio at iHeartMedia. It's produced by Gabriel Hunter Chang, Ariela Markowitz, and Amy Gaines McQuaid. Our editors are Julia Barton, and Karen Chakerjie mastering by Anne Pope, fact checking by Joseph Friedman. Our executive producers are Katherine Girardeau and Matt Romano. Special thanks to Ian Fraser. I'm Jacob Goldstein. Thanks for listening.