"Vaccination" against pregnancy the politics of contraceptive research

Ecologist

Volumn 26, Issue 2, 1996, Pages 53-60

  Richter, Judith ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

BIRTH CONTROL; CONTRACEPTIVE RESEARCH; HEALTH RISK; POPULATION CONTROL; POPULATION FERTILITY; SOCIAL POLICY;

EID: 0029837524     PISSN: 02613131     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (49)

1. Stevens, V.C., "Current status of antifertility vaccines using gonadotropin immunogens ", Immunology Today, Vol. 7, No. 12, 1986, p.374.
2. Dukes, G.N., letter to the author, 24 January 1995.
3. I refer to these birth control methods under development as "immuno-contraceptives" rather than "vaccines ", as the research community calls them, because they differ in significant ways from vaccines against diseases. However, Indian women's rights activists Swatija Paranjape and Chayanika Shah have said that they would "continue to call it the 'anti-fertility vaccine' . . . We feel that the basic assumption behind the development of this contraceptive is an understanding of fertility as a disease - a communicable one at that! It is considered to be an epidemic in the context of the poor marginalized women all over the world. The name that [the researchers] have given highlights their mentality in producing it."
4. See Katsh, S., "Immunology, fertility and infertility: A historical survey", American Journal of Obstetrics and Gynecology, Vol. 77, No.5, 1959, p.947.
5. Jones, W.R., Immunological Fertility Regulation, Blackwell Scientific Publications, Oxford, 1982, p.9.
6. See ibid and Clarke, A., Disciplining Reproduction: Modernity, American Life Sciences and the Problem of Sex, University of California (forthcoming)
7. The research at WHO is coordinated by the Special Programme or Research, Development and Research Training in Human Reproduction (HRP). Funders include the World Bank, the United Nations Fund for Population Activities (UNFPA), the United Nations Development Programme (UNDP), the Rockefeller Foundation, the US Agency for International Development (USAID), the International Development and Research Center (IDRC, Canada) and the governments of Germany, Britain, India, Norway, Sweden and the US. Immuno-contraceptives are also being researched by several smaller research teams at the Indian Institute for Science in Bangalore; the Reproductive Biology Unit at the University of Edinburgh, Scotland; and Institut Gustave Roussy, France.
8. World Health Organization, "First human trial of birth control vaccine begins in Australia ", WHO press release, Geneva, 17 February 1986.
9. Mitchison, N.A., "Lessons learned and future needs ", in Alexander, N.J. et al., Gamete Interaction: Prospects for Immuno-Contraception, Wiley-Lyss, New York, 1990, p.607.
10. In fact, the immune system's functioning and interactions with other body systems are not fully understood. I use a simplified, mechanistic model of the immune system to describe how immuno-contraceptives are designed to work. The mechanistic, molecular model is, however, just one way of describing the immune system. For critiques of this model, see Haraway, D.J, "The biopolitics of postmodern bodies; constitutions of self in immune system discourse" in Haraway, D.J., Simians, Cyborgs and Women: The Reinvention of Nature, Free Association Books, London, 1991 and Martin, E., Flexible Bodies: Tracking Immunity in American Culture - From the Days of Polio to the Age of AIDS, Beacon Press, Boston, 1994.
11. In fact, the immune system's functioning and interactions with other body systems are not fully understood. I use a simplified, mechanistic model of the immune system to describe how immuno-contraceptives are designed to work. The mechanistic, molecular model is, however, just one way of describing the immune system. For critiques of this model, see Haraway, D.J, "The biopolitics of postmodern bodies; constitutions of self in immune system discourse" in Haraway, D.J., Simians, Cyborgs and Women: The Reinvention of Nature, Free Association Books, London, 1991 and Martin, E., Flexible Bodies: Tracking Immunity in American Culture - From the Days of Polio to the Age of AIDS, Beacon Press, Boston, 1994.
12. Auto-immune diseases tend to be more frequent and more severe in women than in men. See Playfair, J.H.L., Immunology at a Glance. Blackwell Scientific Publications, Oxford, 1989 (4th edition), p.33.
13. In some people, however, the immune system does react against hormones, cells or other body secretions indispensable for human reproduction. Immune factors are thought to play a role in many early miscarriages. Some women and men also generate spontaneous antibodies to sperm.
14. A toxoid is a version of a disease-causing toxin which has been altered so that when a person is vaccinated with it, the toxoid stimulates the immune response against the toxin but does not cause the disease. If a person subsequently encounters the disease-causing toxin, the primed immune system reacts quickly and vigorously to it.
15. Existing reversible methods of birth control fall into three main classes: barrier methods (male and female condoms, diaphragm); intra-uterine devices (IUDs); and hormonal contraceptives (Pill, injectables, implants). In contrast to hormonal contraceptives, the active principle of immuno-contraceptives is not what is injected into the body but what is produced by the body in response to the administered substance.
16. Spieler, J., "Development of immunological methods for fertility regulation", Bulletin of the World Health Organization, Vol. 65, 1987, p.779. The effectiveness of anti-disease vaccines depends not only on the vaccine's action in an individual but also on the proportion of people in a given population who are immunized. If a vaccine induces an immune response in the majority of people, those who have not been vaccinated or who have weaker immune responses are still protected because it is harder for the disease to gain a foothold in the population and thus such people are less likely to be exposed to the disease. Thus it has never been necessary to develop anti-disease vaccines which are 100 per cent effective (or nearly so) in an individual.
17. Griffin, p.D. & Jones, W.R., "The preliminary clinical evaluation of the safety and efficacy of a fertility regulating vaccine ", Statistics in Medicine, Vol. 10, 1991, p.188.
18. The hormone hCG and the related FSH, LH and TSH hormones are composed of two sub-units: a short alpha unit and a longer beta unit. The alpha sub-unit is virtually identical in all four hormones, but hCG's beta sub-unit is similar only to the beta sub-unit of LH. In addition, the hCG beta sub-unit has a small end section of 37 amino acids - a carboxyterminal peptide (CTP) - which is not found on the other hormones. WHO's anti-hCG immuno-contraceptive research has been directed at this small end peptide, the most unique and distinct part of the hormone molecule, to avoid the risk of potential cross reactions with other hormones. The Population Council and the National Institute of Immunology, however, opted for the whole hCG beta sub-unit because they considered the peptide too small a target antigen for the immuno-contraceptive to be effective as a contraceptive. They hoped that any immune reactions generated against LH with its similar beta sub-unit would not be unduly problematic; however, some of these, such as damage to the ovaries or pituitary gland, may only manifest themselves after years of repeated immunization. Despite the larger target antigen, the prototypes of both the Population Council and the NII still fall far short of inducing an immune reaction of one to two years in the majority of women immunized. Meanwhile, because of the anticipated low immune reactions to the peptide, the WHO research programme added a strong adjuvant (a substance which stimulates the immune reaction to the antigen with which it is mixed). The adjuvant, muramyl dipeptide (which has not been approved for use in antidisease vaccines) seems to have been the cause of muscle and joint pain and fever in several participants in the product's safety trials which took place in Australia and its efficacy trials which took place in Sweden. In June 1994, the Swedish trials were suspended after most of the seven participants developed one or more of these symptoms.
19. Talwar, G.P. et al., "A vaccine that prevents pregnancy in women ", Proc. Natl. Acad. Sci, Vol. 91, August 1994, pp.8535, 8533.
20. It has, as yet, been tested only as a product against prostate cancer. But depending on trial results, there are plans to test it as a male contraceptive.
21. At the outset of research in the 1970s, researchers agreed not to target any substance whose neutralization could interfere with other functions besides reproduction. Although hCG is considered by many researchers to be the most "promising" antigen because it is produced only by the early embryo and would need to be neutralized once a month at most, research has now established that the pituitary gland and certain types of lung cancer may also secrete hCG. As the WHO research team states, "It is not known whether there are other elements in the body which also secrete hCG." See HRP, "Fertility regulating vaccines: report of a meeting between women's health advocates and scientists to review the current status of the development of fertility regulating vaccines ", World Health Organization, Geneva, (Doc. WHO/HRP/WHO/93.1)1993, p.17.
22. See Griffin, p.D., Jones, W. and Stevens, V., "Antifertility vaccines: current status and implications for family planning programmes ", Reproductive Health Matters, No. 3, 1994, pp.108-13.
23. Cited in Alexander, N.J. et al., op. cit. 9, p.615.
24. Staines, N., Brostoff, J. and James, K., Introducing Immunology, Mosby, St Louis and London, 1993, (2nd edn) p.5.
25. There should be no difference between what is often termed a "user perspective" of a contraceptive and a "researcher's perspective". The research community and women's health or consumers' advocates should try to put themselves in the position of all anticipated users and assess the technology from their various perspectives with their differing views and in their differing contexts. Even though two immuno-contraceptives are being designed for use in men, most of my assessment centres on prospective women users for three reasons. Most research has been carried out into ones which act in women's bodies. Theoretical and practical criteria by which to assess a contraceptive from the perspective of a man are lacking, partly because the condom is still the only reversible means of contraception for men but also because of power differences in most societies between women and men. It has been and still is harder for women to prevent outside control over their bodies.
26. The duration of the initial lag phase will depend on the type of contraceptive and on the woman's immune system. The current formula of the Human Reproduction Programme of the World Health Organization acting against hCG takes around five to six weeks to build up to this level while that of the NII in India takes about three to four months. The shortest possible duration is unlikely to be less than two to three weeks. For WHO, see Jones, W.R. et al., "Phase 1 clinical trial of a World Health Organization birth control vaccine", The Lancet, 11 June 1988, pp.1,295-8; for NII, see Talwar, G.P. et al., "Vaccines for control of fertility ", paper presented at the HRP meeting between women's health advocates and scientists to review the current status of the development of fertility regulating vaccines, Geneva, 17-18 August 1992 and the 8th International Congress in Immunology, Budapest, 23-26 August 1992, p.5; for shortest duration, see Stevens, V.C., "Future perspectives in vaccine development ", Scandinavian Journal of Immunology, No. 36, Supplement 11, 1992, p.139.
27. The duration of the initial lag phase will depend on the type of contraceptive and on the woman's immune system. The current formula of the Human Reproduction Programme of the World Health Organization acting against hCG takes around five to six weeks to build up to this level while that of the NII in India takes about three to four months. The shortest possible duration is unlikely to be less than two to three weeks. For WHO, see Jones, W.R. et al., "Phase 1 clinical trial of a World Health Organization birth control vaccine", The Lancet, 11 June 1988, pp.1,295-8; for NII, see Talwar, G.P. et al., "Vaccines for control of fertility ", paper presented at the HRP meeting between women's health advocates and scientists to review the current status of the development of fertility regulating vaccines, Geneva, 17-18 August 1992 and the 8th International Congress in Immunology, Budapest, 23-26 August 1992, p.5; for shortest duration, see Stevens, V.C., "Future perspectives in vaccine development ", Scandinavian Journal of Immunology, No. 36, Supplement 11, 1992, p.139.
28. The duration of the initial lag phase will depend on the type of contraceptive and on the woman's immune system. The current formula of the Human Reproduction Programme of the World Health Organization acting against hCG takes around five to six weeks to build up to this level while that of the NII in India takes about three to four months. The shortest possible duration is unlikely to be less than two to three weeks. For WHO, see Jones, W.R. et al., "Phase 1 clinical trial of a World Health Organization birth control vaccine", The Lancet, 11 June 1988, pp.1,295-8; for NII, see Talwar, G.P. et al., "Vaccines for control of fertility ", paper presented at the HRP meeting between women's health advocates and scientists to review the current status of the development of fertility regulating vaccines, Geneva, 17-18 August 1992 and the 8th International Congress in Immunology, Budapest, 23-26 August 1992, p.5; for shortest duration, see Stevens, V.C., "Future perspectives in vaccine development ", Scandinavian Journal of Immunology, No. 36, Supplement 11, 1992, p.139.
29. Report of the Symposium, "Points to consider in the assessment of the safety and efficacy of vaccines to regulate fertility ", in Ada, G.L. and Griffin, p.D., (eds.) Vaccines for Fertility Regulation: The Assessment of Their Safety and Efficacy, World Health Organization, Cambridge University Press, Cambridge, 1991, p.289. Some commentators maintain that if a woman becomes pregnant, she can simply have an abortion because presumably she was taking the contraceptive because she did not want to have a child. Such a comment does not consider whether a woman has access to safe, legal abortion, nor does it recognize that the wish not to have a child when one is not pregnant does not automatically translate into a wish not to have a child when one is pregnant. I am in favour of abortion as a woman's right, but oppose it as a duty.
30. Quoted in Guymer, L., "Anti-hCG vaccine: Contraception for women or a tool for population control?" (mss), Deakin University, Geelong, p.33.
31. Anderson, D.J. and Alexander, N.J., "A new look at amifertility vaccines", Fertility and Sterility, Vol. 40, No.5, 1983, p.567; Schrater, F.A., "Immunization to regulate fertility: biological and cultural frameworks ", Social Science and Medicine, Vol. 41, No, 5, p.661.
32. Anderson, D.J. and Alexander, N.J., "A new look at amifertility vaccines", Fertility and Sterility, Vol. 40, No.5, 1983, p.567; Schrater, F.A., "Immunization to regulate fertility: biological and cultural frameworks ", Social Science and Medicine, Vol. 41, No, 5, p.661.
33. Jones, W.R., op. cit. 5, p.16; Thau, R. et al., "Advances in the development of antifertility vaccines" in Mettler, L. and Billington, W.D. (eds.) Reproductive Immunology, Elsevier, Amsterdam, 1990, pp.237-44.
34. Jones, W.R., op. cit. 5, p.16; Thau, R. et al., "Advances in the development of antifertility vaccines" in Mettler, L. and Billington, W.D. (eds.) Reproductive Immunology, Elsevier, Amsterdam, 1990, pp.237-44.
35. Report, op. cit. 26, pp.289-290; Nossal, G.J.V., "Life, death and the immune system ", Scientific American, Vol. XX special issue, September 1993, p.30.
36. Report, op. cit. 26, pp.289-290; Nossal, G.J.V., "Life, death and the immune system ", Scientific American, Vol. XX special issue, September 1993, p.30.
37. An effectiveness rate of 95 per cent is no higher than that recorded for contraceptives often considered by family planners to be relatively ineffective - condoms, diaphragms and some "natural" methods such as ovulation monitoring and breastfeeding on demand.
38. Ada, G.L. and Griffin, p.D., "The process of reproduction in humans: antigens for vaccine development ", in Ada, G.L. and Griffin, p.D. op. cit. 26, p. 18.
39. Basten, A., "Birth control vaccines ", Ballière's Clinical Immunology and Allergy, Vol. 2, No. 3, 1988, p.771.
40. See Duden, B., "Population" in Sachs, W., (eds.) The Development Dictionary, Zed Books, London, 1992, pp.146-157.
41. Filmed in "Antibodies Against Pregnancy: The Dream of the Perfect Birth From the Laboratory ", a film by U. Schaz with I. Schneider, 1991.
42. Ibid.
43. Shearman, R. P., foreword to Jones, W.R., op. cit. 5, p.vii.
44. Griffin, p.D., "A birth control vaccine". World Health, November 1987, p.25.
45. Mauck, C.P. and Thau, R.B., "Safety of antifertility vaccines ", Current Opinion in Immunology, No. 2, 1990, p.731. Early on in immuno-contraceptive development, researchers stressed that "immunization as a prophylactic measure is now so widely accepted that . . . one method of fertility control which would have wide appeal as well as a great ease of service delivery would be an anti-fertility vaccine". See HRP Task Force on Immunological Methods for Fertility Regulation, "Evaluating the safety and efficacy of placental antigen vaccines for fertility regulation ", Clinical and Experimental Immunology, Vol. 33, 1978, p.360.
46. Mauck, C.P. and Thau, R.B., "Safety of antifertility vaccines ", Current Opinion in Immunology, No. 2, 1990, p.731. Early on in immuno-contraceptive development, researchers stressed that "immunization as a prophylactic measure is now so widely accepted that . . . one method of fertility control which would have wide appeal as well as a great ease of service delivery would be an anti-fertility vaccine". See HRP Task Force on Immunological Methods for Fertility Regulation, "Evaluating the safety and efficacy of placental antigen vaccines for fertility regulation ", Clinical and Experimental Immunology, Vol. 33, 1978, p.360.
47. For instance, the Rockefeller Foundation's senior adviser for biomedical health research, Mahmoud Fatallah, maintains that "respecting women and responding to their needs is one of the best strategies for saving the planet. The demographic impact will not be diminished but enhanced". See Fatallah, M., "Fertility control technology: a women-centred approach to research" in Sen. G., et al., Population Policies Reconsidered: Health, Empowerment and Rights, Harvard University Press, Boston, 1994, p.229. WHO's David Griffin, meanwhile, acknowledges that the anti-fertility "vaccine" was originally developed in a "demographic-driven, science-led" framework, but thinks public debate should now focus on whether it could enhance women's choices (Personal communication, June 1993).
48. Hartmann, B., Reproductive Rights and Wrongs: The Global Politics of Population Control, South End Press, Boston, 1995, p.154.
49. Avrion Mitchison summarizing the opinion of a number of participants at a WHO seminar on immuno-contraceptives. See Mitchison, N.A., "Chairman's summary: present status and future prospects of antifertility vaccines" in Ada, G.L. and Griffin, p.D. (eds.) op. cit. 26, p.249.