Paula Larsson. Review of Charles, Nicole, Suspicion: Vaccines, Hesitancy, and the Affective Politics of Protection in Barbados

BOOK REVIEW

Suspicion:
Vaccines, Hesitancy, and the Affective Politics of Protection in Barbados
by Nicole Charles

Duke University Press
2021. xi + 196 pp. $25.95
(paper) ISBN 978-1-4780-1763-9.

Reviewed by Paula Larsson (University of Oxford)

Suspicion: Vaccines, Hesitancy, and the Affective Politics of Protection in Barbados is a short but gripping ethnographic study exploring the manifestation of suspicion as it relates to the human papillomavirus (HPV) vaccine in Barbados by Toronto-based scholar Nicole Charles. Building on her previous publications and theories about HPV vaccine hesitancy in postcolonial Barbados, she brilliantly captures a picture of vaccine refusal in the country by weaving together the personal stories, suspicions, and concerns of health-care workers, Afro-Barbadian parents, and teens as they experienced the HPV vaccine rollout program between 2014 and 2018.

Charles approaches her research with a careful consideration and openness for the contentiousness of the topic, recognizing the importance of her own positionality in these conversations as a representative of an academic institution and an outsider to Barbados with a Trinidadian background. Using snowballing techniques and public advertising to source her interviewees, she succeeded in finding a number of individuals for her study, while recognizing that the challenges of recruitment led to largely middle-class participants. Her analysis juxtaposes discussions with nurses, who represent the forefront of patient care and serve as mediators of vaccine confidence within the community, alongside conversations with ambivalent parents who wrestled with the decision to allow their daughters to be vaccinated. Whatever the outcome, it is clear from the exchanges she presents that the decision to vaccinate children for HPV is neither easy nor clear-cut in modern Barbados.

Of particular note is the inclusion of the voices of teenagers within this study. Often silenced and overlooked in discussions of vaccination, the opinions and perspectives of teens are treated with great care by Charles, who highlights the differing perceptions between adolescents and their parents regarding the suspicions about the HPV vaccine. She asserts, “Suspicion toward or refusal of this technology appears to be as much about the unsettling, racialized, and gendered hypersexual activity it brings into focus as it is about affective memories and residues of the control, denigration, and hypersexual tropes enforced on Black women under slavery and in postcolonial bio/necropolitical regimes that cannot be let go of” (p. 92).

Charles argues for a recognition of the historical legacy of colonial oppression and slavery in the country as an underlying sieve through which conversations about sex, disease, and young Afro-Barbadian women’s bodies are filtered. The long history of exploitation is additionally layered with more complex and modern histories regulating immigration into the country, economic policies, and the introduction of new biotechnologies by the state. Suspicion is described as an embodied affect that is internalized and transmitted intergenerationally within the country, shaping the variety of responses from the public regarding the HPV vaccine campaign. Charles critically analyzes the marketing techniques employed by the government and health-care professionals when the first rollout of the vaccine occurred, finding that the novelty of its approach and the embedded racial messaging triggered a heightened suspicion across the country.

Charles’s analysis draws on a number of critical feminist theories in its approach, providing a strong critique of biopower and biopolitics by harnessing the analogy of the palimpsest as a metaphor “to frame suspicion and identify how it shifts and intensifies through various itineraries across space” (p. 15). Pulling on critical, Black, and transnational feminist theoretical approaches enables her to convey the nuanced and complex picture of suspicion as a haunting affect that imbues a type of sticky "residue" that is circulated between "social, psychic, and material realms" (p. 14). Refusal has power, she notes, and creates possibilities for recognition in the face of neglectful state-driven policies. One critique is that although Charles is deeply engaged with the literature throughout her analysis, there are moments when the complexity of the philosophical and theoretical jargon risks losing the reader and serves as more of a barrier to comprehension than as an aid to understanding.

The chapters of this study are organized thematically around approaches to the concept of “suspicion.” Shifting from macro explanations of historical events and their general impact, she then presents the words of her interviewees for the narrative power of the actualization of suspicion in various forms. Her first chapter provides context to the wider conversations in the country regarding immigration, health, the use of biomedical technologies, and the HPV vaccination campaign itself as it was rolled out between 2014 and 2018. The subsequent chapters approach the concept of “suspicion” from the standpoint of various perceptions of refusal, weighing narratives of risk, sexuality and respectability, protection, and subjective certainty. Yet there is an underlying optimism within the conversations she presents, a recognition that the care and protection expected by parents in regard to their child’s health is not only possible but also demanded. As one mother queried: “The government and the health officials have the ability to put stuff out there in a better way that we can feel comfortable, [so] why won’t they?” (p. 146).

This book has several strengths. Although numerous studies have been undertaken on vaccine confidence and its social regulators, there has rarely been a work published in this area that provides such depth of feeling to the voiced concerns of a specific community. Charles refuses the traditional framing of biomedical studies, which seeks to discover why people say "no" to vaccination. The unsettling aspect of vaccine hesitancy, she contends, “is the extent to which it contests the hegemony of uncontested scientific and biomedical certainty and truth” (p. 7). Rather than assuming vaccination decisions are limited to a binary with a correct answer, Charles overturns this assumption by exploring the many depths of feeling and embodied identities that mold one’s response to specific vaccine technologies in particular contexts. The result is a beautifully rich understanding of the complexity of human decision-making and a recognition that, at least in the case of Afro-Barbadians, "suspicion" is a far more apt description of collective vaccine response than "hesitancy."

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