Reviewed Book
Suspicion: Vaccines, Hesitancy, and the Affective Politics of Protection in Barbados By Nicole Charles, Durham: Duke University Press. 2022. 196 pp.
Raphaëlle Rabanes
University of Washington
Nicole Charles’s Suspicion: Vaccines, Hesitancy, and the Affective Politics of Protection in Barbados is a highly nuanced examination of the fraught response to HPV vaccination campaigns in the 21st century Caribbean. Rather than turning to the framework of vaccine hesitancy, Charles mobilizes the idiom of suspicion alongside her Barbadian interlocutors. She theorizes suspicion as a “felt response” (17), an embodied affect that connects to practices of refusal and resistance, but centers affective intensity. Building on the long tradition of embodied epistemology in transnational women of color feminism, Black Studies, and Caribbean theory, Charles turns to forms of knowledges shaping the circulation of suspicion in Barbados, as it attaches to debates around HPV vaccination.
The monograph is organized in a series of interlocking chapters, each offering deep insight into the circulation of suspicion. Charles first turns to how Barbadians engage her as a Black Trinidadian researcher: running counter to forms of Afro-Caribbean diasporic connection she had expected, Barbadian interlocuters initially manifest suspicion towards her as part of broader geopolitical forces of extraction. This powerful analysis of her positionality clues her and us as readers into the socio-political landscape that over-determine Barbadian life, “inundated with intra-regional and international corporations, interests, investments, researchers” (26).
Charles alternatively engages health-providers, parents and teenagers and attunes to the tensions that emerge amongst these different groups. Unsettling public health framing of parents as non-compliant or vaccine hesitancy as irrational, complacent, or uneducated, Charles shows how the deep understanding of health inequities and political economy informs their embodied response to vaccination campaigns. She also engages the ambivalence of medical professionals towards vaccination campaigns and pays attention to how teenagers navigate the paradoxical messages they receive. Suspicion thus appears as a palimpsestic affective response that travels in time and connects colonial slavery to forms of neoliberal and biopolitical governance denotated in public health campaigns.
Charles then attends to the contrasting logics around vaccines and sexuality. She offers a genealogy of discourses on risk and sexuality weighing on Black women in forms of biopolitical surveillance and pharmaceutical management, demonstrating how “risk, identity, morality, and care (…) converge” in the HPV vaccine (62). The vaccine is saturated by idioms of sexuality and respectability, as it is deployed in a context where Black women have been surveilled for their “suspicious morals” from colonial times to the post-independence nationalist era (60). On one hand, nurses and teenagers think that parents’ refusal is driven by concerns over their daughter’s sexuality and respectability. On the other, parents themselves push back against this assertion while still expressing concerns about teen sexuality.
“What are we to make of these contradictions and dualities in and around respectability in the Caribbean and in Caribbean scholarship?” (69), Charles asks, offering a deep engagement with research interlocutors while weaving in essential debates in Caribbean and Black feminist scholarship. This reflects the core ethnographic and intellectual quality of Suspicion: the book unsettles discourses in Barbados and in academia and shows the core tensions they reflect. Thanks to this careful genealogical and ethnographic study set against the lasting effects of slavery’ afterlives, parents’ refusal gains much needed depth: In this over-determined context, how to trust a pharmaceutical logic turning the body into a commodity?
Beyond the trope of moral condemnation of either teens’ sexuality or parents’ concerns with it, the author shows how both groups navigate representations of hypersexuality and misbehavior in a context where historical consciousness brings actors to see the body as commodified anew in the pharmaceutical era (80-81). For Charles, parents’ response to vaccination is primarily informed by mistrust of the state and political economic interests. Worries about the long-term effects of the vaccine also reveal a distrust in the future, tying together concerns about futurity, globalization, and the afterlives of slavery as they weigh in on the bodies of teens through HPV vaccination debates.
What does it entail to take seriously a sense of knowing from the body, while not necessarily adhering to its conclusions? In Chapter 4, Charles legitimates the deep sense of mistrust harbored by parents while also critiquing how suspicion got attached to the HPV vaccine. Her deep engagement with the logics of vaccine refusal does not lead her to idealize refusal. While conducting her epistemological study of suspicion as an affect that reveals broader concerns, she highlights its repercussions: “Suspicion is impossibly imperfect” (113), as it leads to loss of protection for those who do not get vaccinated. Listening to the core insight of suspicion, the author problematizes an analysis that would stop at linking HPV vaccine refusal, vaccine hesitancy, fake news, and anti-science rhetoric (Chapter 5). While she traces the influence of fake news (122), she also shows how parents receive accusations of illiteracy and defend their ability to think. Following their call for complexity, she questions forms of biomedical authority that oppose certainty to suspicion. Instead, she invites us to think about the “possible simultaneity, fallibility, and generativity of suspicion and certainty” (129).
COVID vaccine reception looms large while reading Suspicion. Much valuable insight from this study could be put to use in the design and implementation of vaccination campaigns in the Caribbean and beyond. During Charles’ ethnographic study between 2015 and 2018, parents already argued that the internet allowed them to push back against medical power or a discourse of responsibility and certainty (124), voiced their concerns about the lack of information about side effects and put the honesty of doctors into question (129), or insisted on being heard as rational rather than disregarded (132). The author also attunes to medical professionals’ ambivalent response to vaccination campaigns. This book proves to be a precious critique of pharmaceutical and biomedical logics at a time when vaccine refusal has become a central concern.
Charles’ innovative ethnography lays the ground for imagining different forms of care and health promotion. While ethnographic monographs seldom provide implementation strategies, readers are left to wonder how to build the radical care Charles calls forth. Rather than summoning the public to comply with mandates, could forms of care that center community knowledge lead to different practices? What can be gained by decentering a logic of certainty and authority in public health campaigns and health care provision? And more fundamentally, following ethnographic witnessing, what forms of action can be devised amidst the conditions of transnational neoliberal racial capitalism?
Suspicion is an extremely generative book that furthers a collective reckoning with forms of biomedical authority. Vitally, Charles invites us to expand the scope of intervention to promote community health and radical care rather than accept logics of pharmaceutical compliance. Charles also makes a valuable intervention in scholarship about social movements: While suspicion connects with forms of refusal, frameworks of refusal and resistance are most often discussed as practices. In contrast, Charles foregrounds “embodied affective intensity” (13) circulating beyond the conscious level. Charles’ attunement to affective lives and their socio-historical roots invites readers to move beyond dichotomy and think with nuance and complexity about the messy afterlives of colonialism in biomedical intervention, but also in people’s palimpsestic responses to them.
Both the style and urgent questions of Suspicion will speak to students trying to mobilize anthropology and public health for social justice. This text would be a precious read in undergraduate and graduate courses spanning from gender and sexuality studies, to Caribbean and African diaspora studies, to medical, psychological, and socio-cultural anthropology. Finally, it would be relevant for public health practitioners, health care actors, and community health advocates.