Vaccination as governance: HPV skepticism in the United States and Africa, and the north-south divide

Perhaps more than other medical technologies, vaccines-invasive processes whose benefits emerge through counterfactual reflection on the absence of disease-condense and highlight relationships of trust or skepticism between the state and its citizens and subjects. So it is not surprising that across the globe, wherever the prospect of human papillomavirus vaccination has been raised as a possibility, it has brought to the surface nascent debates about governance and control-about the troublesome relationship between government, big capital, adolescent girls, and the family, and about issues of sexuality and social control. These debates over HPV and the cervical cancer vaccines frame a challenge with multiple ironies. As one American policymaker noted, the vaccine "encapsulates so many issues that are at the core of politics and health policy right now." 1 In what follows we consider the possible introduction of HPV vaccines to compare issues of skepticism and pharmaceutical governance in the United States and various sites in Africa. In contrasting the po liti cal complexities surrounding the potential introduction of a single technology in one region of the largely privileged global North and one region of the largely resource-poor global South, po liti cal economy and epidemiological realities of contemporary.