Pharmaceutical Companies' Role in State Vaccination Policymaking

The Case of Human Papillomavirus Vaccination

Michelle M. Mello, JD, PhD; Sara Abiola, JD, PhD; James Colgrove, PhD


Am J Public Health. 2012;102(5):893-898. 

In This Article


We conducted a series of case studies combining data from key informant interviews with analysis of media reports and archival materials. We selected 6 states for study; the number was driven by available project resources to conduct in-person interviews. We selected states primarily on the basis of their active engagement in debates about HPV immunization policy (Table 1). We used volume of media coverage as a measure of the intensity of policy engagement in a state. From among the 10 states with the highest volume of media coverage in a LexisNexis search of 2128 newspaper articles from 2006 through early 2008, we selected 4 (Texas, Virginia, New York, and Indiana) that had enacted legislation at the time of the search. We then selected an additional 2 states (New Hampshire and California) on the basis of criteria aimed at ensuring that the sample was diverse geographically, politically, and in terms of immunization policies. In addition to geographic region—New England and the western states were not well represented in the sample—we examined each state's ethnic composition, purchasing policies for vaccines generally, and laws concerning vaccination mandates and exemptions. To measure the political environment, we examined data on political ideology, religiosity, political party control of government, proportion of women legislators, and whether the year in which HPV bills were introduced was an election year in the state. The HPV vaccination policies considered and adopted by the sampled states are described in Table 1.

We used purposive sampling to recruit at least 10 key informants in each state. The within-state sample size represented our estimate of the number of interviews required to reach thematic saturation. First, we composed a list of key categories of stakeholder groups based on interviews with public health experts, representatives from 2 national organizations of health policymakers, analysis of news coverage, and our previous work (Table 2). We then identified representatives of each stakeholder group based on consultation with the national organizations, news coverage, analysis of bill sponsors, and Internet research. We identified additional respondents through snowball sampling. We recruited informants by e-mail and telephone.

Two investigators conducted semistructured interviews face to face or by telephone lasting 45 to 60 minutes, using an interview guide that was vetted with the national policymakers' organizations. Interviews were audiorecorded and transcribed. Respondents were asked to supply relevant archival materials, such as legislative testimony.

We analyzed the transcripts by using methods of thematic content analysis. One investigator coded each transcript by using a detailed coding manual and the NVIVO software package, version 8 (QSR International, Doncaster, Victoria, Australia). We incorporated information from media reports and archival materials as background material.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.