Lessons we can learn from suspicion in health care
Though vaccine hesitancy is a discussion taking place currently in several circles around the globe, Professor Nicole Charles has been interested in this area ever since she began studying the human papillomavirus (HPV) vaccine in Canada while she was still an undergraduate.
She has continued to focus on reluctance related to HPV immunization, and now as an assistant professor of Women and Gender Studies in the Department of Historical Studies at UTM, her book Suspicion: Vaccines, Hesitancy and the Affective Politics of Protection in Barbados is set to come out in December 2021.
“In this book, I'm contextualizing Black Barbadians’ hesitancy, which is vernacularized as “suspicion” in Barbados within a much longer economic, cultural and socio-political history to really explore what is generative about suspicion,” said Charles in a recent interview on VIEW to the U podcast.
“This is in contrast to how we often approach the topic of hesitancy in terms of what we can do to circumvent it. I'm really interested in what suspicion can teach us about public health, about care, about the promotion of biotechnologies to Black Caribbean communities, and in asking how might these really location-specific and vaccine-specific learnings not be bound to that place, but engender a critical dialogue and change within public health throughout, for example, the Black diaspora.”
Charles first got interested in this area of research with some encouragement from her mother, who felt unsure about the HPV vaccine being administered to young women, particularly her daughters, when it was first introduced in 2006.
Charles went on to study the promotion of the HPV vaccine in Canada, in the medical anthropology seminar she was enrolled in at the time in Montreal at McGill University.
She says she has expanded on the topic over the last 15 years, also factoring in other considerations such as gender, race, biotechnologies, and care, with a focus on the Caribbean where Charles grew up. Barbados became the particular site for her study because the HPV vaccine was introduced through a national program there in 2014 when Charles started to do the research for her dissertation.
It is important here to make the distinction between vaccine hesitancy and anti-vaccination/anti-vaxx ideology which refers to outright opposition to vaccines. The anti vaccination movement has become more widespread in recent years, fuelled by a fraudulent study published in 1998 by former British physician Andrew Wakefield which falsely linked the measles, mumps and rubella (MMR) vaccine with autism.
“With the term vaccine hesitancy, we're thinking of a spectrum between complete refusal to acceptance amid ambivalence,” says Charles.
Charles says reasons for hesitancy can range from distrust in medical systems and pharmaceutical agendas, to religious concerns, or in the case of HPV in Barbados, “tropes around hypersexuality.”
The title of Charles’s forthcoming book Suspicion took on particular resonance for her: while conducting the study in Barbados she was confounded by her research participants’ suspicion for her and her motives, which she aimed to assure them was to better address public concern about vaccines and to improve public health promotion efforts.
While Charles says it is difficult to comment on vaccine hesitancy as it relates to the coronavirus because hesitation can be so vaccine specific, COVID-19 and its immunization issues have illuminated other areas of interest.
“We are well aware of the disproportionate devastation that this pandemic has had on Black, Indigenous, and people of colour, which directly speaks to the endemic racism that persists within the Canadian and American healthcare systems,” says Charles.
“We need to have these conversations about the ways that public health agencies, service providers, and our governments absolutely have more to do to challenge the racism and racist biases that underlie our medical systems, and, crucially, to build the trust of those who are most marginalized, which … includes protecting essential workers, so doing things like banning evictions to stop the spread of COVID, and really engaging with rather than dismissing a community's concerns about the vaccine, and seeking to overcome these concerns through accountability.”
Go to SoundCloud to hear the full VIEW to the U interview with Professor Charles.