Governing an Ungovernable Foe: Vaccines and Public Health Policy at the National Cancer Institute

• In Event: Innovation Outside Markets: Government and/in Technoscientific Innovation

Abstract

Since the close of WWII, American cancer policy has been managed by the U.S. National Institutes of Health’s (NIH) National Cancer Institute (NCI).The NCI is tasked with a dual organizational mandate: to fund the most promising cancer research, and to reduce the disease’s impact on the American populace. The two sides of this dual mandate often sit in tension with one another, as frequent calls for the NCI to be accountable to its use of taxpayer funds by improving the nation’s health compete with scientists’ insistence that only advances in the fundamental knowledge of disease processes will ultimately eliminate the threat of cancer. Through an analysis of vaccine development efforts at the NCI, I show how considering the institutional, scientific, and organizational environments in which NCI scientists learn how to balance these demands over long periods of trial and error explains the distinctive organizational culture that allows the Institute to connect innovations to public health strategies designed to improve cancer outcomes. Vaccines provide an important case study, as they comprise quintessentially public health innovations and strategies that target cancer control at the level of populations, rather than individual cancer treatments or behavioral interventions. I demonstrate how the NCI’s distinctive mode of health governance has historically imbricated with the cancer vaccine innovation strategies federal scientists pursued, where these scientists’ understandings of the NCI’s role as a federal agency contributed to successful outcomes.

Author

• Natalie Aviles, University of California, San Diego