Structural Barriers to Cervical Cancer Prevention: How NIH Policy and Vaccine Design Exclude Indigenous Health Priorities

Human Papillomavirus (HPV) is one of the most prevalent sexually transmitted infections worldwide and remains one of the leading causes of cervical cancer in the United States (US). Over 200 distinct genotypes of HPV have been identified and are circulating worldwide. Despite the availability of highly effective vaccines such as Gardasil 9, which protects against nine of the most clinically significant HPV strains, current vaccines cover only a limited subset of oncogenic HPV types. The study aims to address structural determinants of inequity by integrating vaccine accessibility with the sociopolitical framework governing research funding and research language. Emerging research indicates that some of the less common oncogenic strains, also uncovered by the vaccines, disproportionately affect Indigenous populations in the US who face significant barriers to healthcare access, cancer screening, and vaccination. With a growing health disparity, gaps in research, and inequitable healthcare for Indigenous women, the Trump administration issued Executive Order 14151 in 2025, instructing federal agencies, including the National Institutes of Health (NIH) and the National Science Foundation (NSF), to dismantle Diversity, Equity, and Inclusion (DEI) programs, grants, contracts, and equity action plans. To address these issues, this research aims to interrogate the structural determinants of vaccine inequity, focusing not only on practical barriers to vaccine access but also on the sociopolitical context that guides research agendas, allocates funding, and shapes the language of scientific knowledge production.