The introduction presents the concept of the para-state and its relation to science and medicine. It links the current para-state of medical science to the preceding decades of the long 1980s, including economic and political neoliberalization, and to the older historical figure of contrast of the African developmental nation-state, colonial and postcolonial, of the mid-twentieth-century. Acknowledging the ruptures that transformed the bond between science and state, and between medicine and nation, over the past half century, the introduction draws attention to the multiple ways in which the state remains central, such as in the millions of state-employed health care staff across the continent, in state standards and policies, national educational institutions and certificates, in civic memories and visions, paper trails and archives, in built forms and material circulations, habits and language. This persistence of the state, its practices and protagonists, does not falsify the observations in much recent social scholarship of radically new biopolitical forms—new, ephemeral citizenships and sovereignties, nongovernmentalization and projectification, and new forms of legitimate domination by way of pharmaceuticals, disease control interventions, humanitarianism, clinical trials, or experimental social projects. But it qualifies claims to radical novelty and historiographic closure, and it sharpens the eye to elements that are both an imprints of past forms and foreshadowing future states.