This study took shape amid a measles outbreak. Throughout the outbreak, one question seemed to be everywhere: Why were Somali American parents refusing the MMR vaccine? And it was followed by another question: How can public health departments get Somali American children vaccinated, and quickly? During my time working on this study, I heard many stories about Somali American parents, their medical noncompliance, and their unscientific health beliefs. Most accounts linked low MMR vaccination rates with unscientific fears about autism and its causation. In news media, in public health reports, and in conversations with healthcare providers, social service providers, and community health workers, I encountered frequent explanations for why Somali vaccination rates were low in Minnesota and why fears about autism persisted. Healthcare and social service professionals often proffered theories about Somali American parents'' lack of education and consequential vulnerability to antivaccination appeals. I heard theories about Somali people''s stubborn distrust of medicine and science and their misplaced faith in spiritual and holistic healing. I heard theories about cultural beliefs, mostly accounts of cultural taboo and stigma that attached to disability in Somali and East African cultures. I most often heard that there is not a word for autism in the Somali language.

This anecdote was shorthand to explain that Somalis therefore did not know about autism and were prone to thinking that autism was unique to the US. In short, there were many explanations circulating about why Somali parents were declining vaccines. And in tandem with these explanations, there were many preset solutions, mostly health literacy outreach, mandated vaccination, and barrier removal. These preset solutions all represent important goals, but I also wanted to ask: Why did dominant explanations for Somali American parents'' MMR vaccine refusals focus so wholly on individual beliefs? What logics and histories inform dominant approaches to medical dissent as an irrational but remediable act of individual noncompliance? How has medical dissent been defined and explained elsewhere? And might there be significance to Somali Minnesotans'' dissent? Might there be arguments, stories, histories, and ideas that were being written off because their external packaging was that of noncompliance? Because so many of us were locked into "evidence-based everything" thinking? Was there reason to listen to and follow this dissent, instead of--or in addition to--trying to quickly and permanently reverse it? What is the significance of Somali Minnesotan parents'' expressions of dissent? These questions guided the writing of this book. I began this book by considering the limited ways that medical dissent has been named and explained. Dissent, often approached on a gradient of noncompliance, is typically defined as a wrong but fixable stance. Sometimes there is room for understanding dissent as more than just illogical--for example, steep access barriers to medicine can erode trust, and cultural insensitivity can alienate patients. Always, though, compliance is the right answer, even if medical institutions and their leaders bear some of the responsibility for facilitating trusting, accessible spaces where compliance is logical and actionable.

This medical frame for approaching dissent works within and naturalizes a culture of biomedicine that "is often frustratingly inattentive to the weight history continues to bear on peoples of African descent as they counter and navigate neoliberal policies, mushrooming state-industry partnerships, and their pharmaceutical and technological offerings." Benjamin has referred to the biomedical framing of dissent as a persisting "inexplicable curiosity" as the work of "analytical summersaults" that biomedicine must undertake to avoid acknowledging that noncompliance is an obvious response to racism in medicine, an obvious response to a system wherein the benefits and risks are not evenly distributed. Simply, dissent is logical. In response, Charles and Benjamin and fellow scholars have theorized dissent outside of a biomedical frame and set of premises.