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Q&A with Dr. Nicole Charles

Dr. Charles discusses her work on vaccine hesitancy in Barbados

Dr. Nicole Charles recently delivered a seminar titled, Suspicious Refusals: A Transnational Feminist Remapping of Hesitancy and drew upon seven months of ethnographic research which explored Barbadians’ ambivalence toward the HPV vaccine.
The IGDS: NBU conducted a short interview with Dr. Charles to find out more about her work.

How did you come into this as your chosen topic in general, and studying Barbados in particular?

Barbados was chosen as a field site because when I officially began this project in 2014, it was the most recent Caribbean country to introduce the HPV vaccine through a national program and the vaccine was very much at the forefront of the citizenry’s consciousness. But the seedlings for this research topic were planted over a decade ago when my own mother voiced concerns about the HPV vaccine for me and my sibling.As a health-conscious and proactive parent, her ambivalence surprised me, and I remember challenging her relentlessly about it! I was completing my BA at the time, and she encouraged me to look closer into the vaccine and its merits and write one of my course researchers papers on the topic. It was during that process of inquiry that I first became preoccupied with the contentions that appeared to surround this vaccine worldwide.
Can you share a bit about the study? (ie population studied, data collection methods, length of time it took)
I began this work wanting to know what was at stake not only for parents who were ambivalent about the HPV vaccine, but for the adolescents to whom the vaccine was marketed, and for the medical professionals who were onerously working to deliver the vaccine to the Barbadian public. How did they understand and work to mitigate this hesitancy?  What did adolescents – the targets of this vaccine – have to say about it, and about their parents’ concerns?  Between 2015 and 2018, I engaged these various demographics in in-depth interviews to answer questions such as these. I collected historical accounts of reproductive healthcare in Barbados and the Anglophone Caribbean and followed the multiple local forums and media platforms through which the vaccine was discussed and promoted to better understand the complexities involved in its promotion and refusal.

How do you define vaccine hesitancy in your work?

Vaccine hesitancy, as defined by the World Health Organization refers to both the act of delaying or refusing vaccines in a context in which vaccines are available. As opposed to focusing on the factors that implicate hesitancy in a medical sense, my work engages what I have come to understand as a vernacularized reframing or articulation of hesitancy in Barbados: “suspicion.”
Based on your work thus far, how do you understand suspicious refusal? What does it look like?

This research highlights that we ought to understand “suspicion” beyond the limited confines of resistance due to scientific ignorance or cultural taboos around sex – both of which are widely perceived to drive Barbadian parents’ HPV vaccination refusal. Suspicion instead, I argue, is something more ambiguous and affective. I have a forthcoming article in the journal Feminist Formations that maps this notion of suspicion out in more detail, by speaking to the multiple circles (past and present) in which suspicion travels for Barbadians and gesturing to the productive claims to knowledge that refusals of technologies like the vaccine can offer feminist scholars even amidst their potential negative implications for vaccine compliance.
How can your work help public health practitioners make meaning of hesitancy/suspicion/refusal of the HPV vaccine in particular, as well as other biotechnologies created in the Global North?

As a transnational feminist and technoscience scholar, my work is largely motivated by a desire unsettle normative or easy understandings of ambivalence toward biotechnologies in the Anglophone Caribbean – a region shaped by legacies of slavery and colonialism, in which injurious forms of medical experimentation are an inescapable past, and in which state-multinational-pharmaceutical assemblages and globalized technologies are mushrooming amidst neoliberal globalization. At the same time, Barbados (and much of the Caribbean) has a disproportionately high burden of HPV and sees some of the highest incidences of cervical cancer in the Americas. That said, I also very much value the importance of engaging public health practitioners in the findings of this research so that they might more carefully rethink the ways in which technologies like the HPV vaccine are promoted in light of the specificities and histories of the region. Ultimately, I believe that sustained conversations across scientific and social science researchers, and a concerted engagement of lay communities as active co-researchers across our varying research projects and public health initiatives are crucial to fostering improved health outcomes for the region. This, I would add, is very much in line with the legacies and successful models of self-determination employed by our Caribbean feminist foremothers like Dame Nita Barrow, Andaiye, Peggy Antrobus (to name a few), within the Women in Development Unit’s many health and development projects – including some of the earliest around reproductive tract infections and cervical cancer in the early 90s.

Institute for Gender and Development Studies: Nita Barrow Unit
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