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

by Nicole Charles, Durham, NC and London: Duke University Press, 2022

Reviewed by Lorane Nunez Carrasco

This book magnificently shows how a simple question can lead to a multi-layered societal analysis with historical depth and global reach. Suspicion focuses on the perceptions, but more so on the doubts, Afro-Caribbean communities in Barbados express towards the introduction and rollout of the papillomavirus vaccines (HPV vaccine). From its title, Suspicion, the book follows a thread connecting history and subjectivity.

The author conducted an extended ethnographic work in Barbados. Originally from Trinidad and Tobago, she undertakes her research assisted by the closeness of her cultural and historical affinity, and initially complicated by existent tensions between these countries. Woven in her conversations with Afro-Caribbean parents of young girls, with medical doctors, and nurses, the book delves into their considerations on whether to vaccinate their children. As they express a range of reasons why they would not vaccinate their adolescent girls, the author unfolds a fascinating thread, tracing suspicion in the political and colonial history of Barbados and the Caribe. These Afro-Caribbean parents voiced their reluctance towards the introduction of HPV vaccines and their disbelief in the promises of care emanating from biomedicine and from the government.

Suspicion is the sediment of history. Suspicion is treated as an epistemic path articulated in historical events in Barbados’ colonial and recent history. Suspicion is the epistemic place of the colonised. As such, it does not have a moment of emergence but several moments which the author reviews and connects with the required synthesis and dynamism. This book skilfully tells a local story connected to global orders and their implications for Afro-communities and their young daughters. For a reader who does not know the history of the Caribbean or of Barbados, this book offers a very good balance in terms of laying the foundations and providing information to follow the threads of a journey that reveals the generative power of suspicion. This book can be read from various angles, the history of medicine, Caribbean history, women’s health, public health, medical anthropology, and health sociology.

Reluctance to adhere to vaccination campaigns is termed vaccine hesitancy, a medical descriptor of a population’s reluctance to adhere to biomedical mandates. The term often conveys misunderstanding, sometimes its usage is accompanied by an underlying criticism towards hesitant individuals and the ‘antivaxxers’. Other times, hesitancy is used accompanied by accusations of ignorance. But what is ultimately the reason for such hesitancy is not well understood. With a focus on the HPV vaccine the book is timely, and its relevance is given by the moment we still live in, marked by the COVID-19 pandemic. Sars-Cov-2 has put pressure on vaccination at a global scale. The book leads to pose the question of whether so-called vaccine hesitancy should not be examined in each context with the depth that this book treats suspicion. In so doing, the generative capacity of such an endeavour may help us to understand why at least in the global South, COVID-19 vaccination can be regarded close to a failure.

Paradoxically, yet entirely understandably, the voices of the adolescent girls are absent. Probably they are not yet aware of what is at stake in the official policy to get them vaccinated. These young women are not aware either of what are the many reasons to want or not want the vaccine. They are not aware of their parents’ fear, of the possibility of unleashing their presumed Caribbean (hyper) sexuality what concerns their parents’ uncanny apprehension towards the HPV vaccine. To gather the voices of the young girls would have been like entering an ethical labyrinth. Yet, it is perplexing that these young girls do not have a say on what is debated about their bodies and future health, and that their views cannot be asked either. One wonders if this is not another generative moment to unfold in the future, where suspicion will be nested in these conversations, in what is said and not said, and the decisions adults make about these young girls and their bodies.

The book is bounded by the historical and geographical parameters defined by colonial powers. Its epicentre is Barbados and its broader border the Anglo-speaking Caribbean region. Yet, an analysis like this could well have been extended to other communities and their responses to biomedical authorities in their postcolonial contexts. Unfortunately, while some references to other cases outside the region are brought into consideration, this is done too sparsely. However, this does not take away its merits, as ultimately, I do believe that a book should always be measured against what it has set out to do, and this is a well-accomplished book that does what it set out to do.