In the early 1990s, James Ferguson published a groundbreaking book in the field of development studies titled the anti-politics machine. The book argued that the global development enterprise, as it relates to the Global South, often has the effect of “lifting politics out of poverty” by masking relations of inequality and entrenching state power.
He illustrated his argument by referring to World Bank rural development projects in Lesotho that had failed but were continuously financed during the 1970s and 1980s.
Ferguson argued that the development was like the prison system, which remained in place despite the failure to reform criminals. He argued that the reasons for the continued financial support of Lesotho’s projects had less to do with their success than with how the “development apparatus” – funded by donor capital – was depoliticizing rural poverty and the power of society. the state.
In some ways, the World Health Organization’s global vaccination campaign could be designed the same way. Certainly, the promise of protection against Covid-19 deaths through Western biomedical vaccines has proven considerably more successful, for example, than the World Bank’s failed commercial agricultural projects in rural Lesotho. But the effects or what Ferguson called the “unintended consequences” of the campaign were remarkably similar.
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Globally, death rates from Covid-19 are three to five times higher in poor communities than in middle class ones. Inequalities in wealth and access to medical services have also had a profound effect on both the spread of the disease and the distribution of deaths from the virus. It is therefore not surprising that there is generally more hesitancy and resistance to vaccination in poor communities than in wealthier communities, in part because of low levels of trust in government services and their top-down management of the pandemic.
But, with the support of external funding, innovative government outreach programs and their community engagement strategies have pushed back the resistance. In the rural Eastern Cape region of South Africa, for example, which has been devastated by the pandemic, a recent survey showed that while more than 60% of rural adults were hesitant to get vaccinated, a rural awareness campaign massive and generously funded had driven up vaccination rates. up to 65% in some rural areas – 25% above the initial acceptance threshold.
The huge investment in rural immunization has also led to increased levels of satisfaction with government health services, which had virtually collapsed in parts of the Eastern Cape during the first two waves of contagion.
The “anti-political machine” of development, as Ferguson called it, gathered momentum as local bureaucrats, elites and traditional leaders, who had deserted and ignored the rural poor as they died in large numbers , were now gaining favor and credibility through their association with special government grants, donor programs, a government-created solidarity fund with private sector support, and private donations. This new money bought vaccines, nurses, pop-up clinics, free T-shirts and vouchers, and paid the salaries of local community advocates and activists.
The rural vaccination machine piloted by Prime Minister Oscar Mabuyane and his team in the Eastern Cape, like the World Bank’s development projects in Lesotho, generated a kind of false hope among the desperate, who now had better chances to starve than Covid-19. The renewal of the Covid-19 relief grants in April 2022, for the third time since their introduction in May 2020, has given new impetus to the spirit of hope, especially among unemployed young people who wish to register on the social assistance list. Over the past two years, the South African government has added 10 million new grant recipients to its monthly payroll.
Despite the difficulty of accessing the subsidy in rural areas, the provision of social assistance subsidies has eroded the anti-vaccination politics and created a wave of political unrest around issues of inequality related to the Covid-19 and vaccination. At the heart of this transition is the rise of what might be called a shift to “transactional vaccination”.
In the early stages of the vaccination campaign in South Africa and rural parts of the Eastern Cape, which had the highest recorded virus death rate on the continent, fear of death led to vaccination, in particularly in the elderly. But when acceptance thresholds were reached at about 40% of the population in the second half of 2021, the provincial government increasingly encouraged transactional vaccination by offering service providers, including nongovernmental organizations and community organizations, cash incentives to increase the numbers. , while encouraging vaccination in other ways, such as the distribution of gifts and vouchers.
At the same time, local politicians and public health nurses have emphasized vaccine compliance as the basis for securing grants and jobs. They said there was no guarantee that people would receive basic government services, including health care, if they weren’t vaccinated. And Mabuyane stressed that he saw no reason why all citizens of the province should not be vaccinated.
These strategies gained momentum as rural adoption rates declined. In effect, the previous ethos of free will based on steady supply and public education has been replaced by the politics of compliance, persuasion and coercion.
By emphasizing the transactional nature of the vaccine as a prerequisite for citizenship, defined by access to the labor market, subsidies and basic services, the state has inadvertently provoked new politics, especially among young people who fear least the impact of Covid-19. They now claim that access to their body must be based on a measurable return, such as receiving a grant, gift or benefit. In this context, the use of vaccination has left the domain of individual free will and the dynamics of supply and demand to enter the space of exchange.
In this policy that the State has promoted with its threats, its conditionalities and its money, vaccination is no longer seen as a matter of choice but as a tradable good, embedded in requirements of reciprocity, reinforced citizenship and dependence. desired.
The introduction of the new social assistance grant, now restricted to those under 35, offers the possibility of long-term access to assistance for young people and the unemployed, who have been marginalized in rural areas in because of their dependence on old age pensioners for money and help. The new subsidy scheme also encourages the return to rural areas for young people who cannot find jobs in the cities and potentially creates a new basis for youth policy in rural areas.
Another interesting aspect of the new grant is that the application requires the ID numbers and contact details of parents and partners, which requires young people applying for these grants to inform their families of their request. This imposes certain obligations on them to devote their extra income to collective consumption rather than to individual priorities, which may include alcohol, socializing and travel.
Could subsidies promote greater rural family unity? And, if they were to grow, would they provide a much-needed return to family business and agrarian production?
What seems clear is that old vaccination theories and practices based on public education and free will may have fallen on hard times as vaccination is increasingly conceived as a form of transactional capital by the largest category of unvaccinated individuals in South Africa – the young. . DM
Professor Leslie Bank is Deputy Executive Director of HSRC’s Inclusive Economic Development Unit in Cape Town and leads a project on vaccine hesitancy in rural Eastern Cape. Her new book, with Nelly Vuyokazi Sharpley, Covid and custom in rural South Africawas recently published by Hurst Publishers, London.