Prevention is better than cure

The ongoing struggle to reduce the cost of vaccines in developing countries like Ghana.

 

Monday saw me in Committee room 1 in Westminster amongst Parliamentarians and health and development activists at the start of World Immunisation Week. Now I am in Ghana where more than 50 years ago I was inoculated against polio. This has now been eradicated in Ghana by the sort of mass immunisation campaign that I am privileged to see launched here this week.

Today, in Ghana the target is two of the biggest child killers in the world pneumonia and diarrhoea. These two diseases account for an estimated 20 per cent of all under 5 deaths in the country, but are largely preventable through the introduction of the pneumococcal and rotavirus vaccines. In the UK we take for granted the access and availability of these vaccines and we have little experience of the fatal impact of these diseases. But pneumonia and diarrhoea each kill roughly 500,000 children under 5 every year and 85 per cent of the diarrhoea deaths caused by rotavirus are in the developing world. In Ghana the fatal impact of these diseases is very real.

I am travelling to Ghana with the GAVI Alliance. This unique partnership between governments, North and South, civil society, and private sector philanthropists and businesses has revolutionised the market in and delivery of vaccines globally and saved the lives of millions. The origins of GAVI's funding lie in the very special coming together of activists and government that led to the UK’s historic commitments to the UN 0.7 per cent of GDP target for development. This is an enduring achievement of the last Labour government. The good news is that this saw the advent of a new national consensus. The consequence of which is that David Cameron and Andrew Mitchell, who hosted the last funding conference for GAVI, have committed a further £814 million pounds to the cause. This recognises not simply the need I see so clearly demonstrated in Ghana and indeed throughout my work in Africa but also of the effectiveness of GAVI and its unique model. This builds local ownership whilst intervening in world markets to reduce the cost of vaccines to developing nations through innovative funding mechanisms. The IFFIm on which I worked with Gordon Brown during our time at the Treasury was the first of these. Designed and championed by a very special partnership between the treasury, the city, and civil society including the Vatican, it proved to be a groundbreaking approach to securing sustainable funding for development. I am now seeing first hand in Ghana the product of a next generation initiative, the Advanced Market Commitment (AMC), which is delivering life saving pneumococcal vaccines to the poorest countries at a 90 per cent price reduction compared to the cost in the US and EU. And it has accelerated the pace of delivery so that by 2015 an additional 700,000 lives ought to be saved.

The child that I saw my self struggling for breath in the arms of her father, whilst a weeping mother looked on at the Princess Marie Louise Hospital in central Accra ought not to be joined by countless others. Politics and the budget process that protects DFID’s spending are too often disparaged by so many in the sadly cynical and disillusioned country that we have become. Not least by so many young people who have been turned off completely by the whole process. We all need reminding from time to time why politics and the contest of ideas and values matter so desperately. And why we need to restore and revitalise our own politics.

One of GAVI’s strengths, as I see it, is that GAVI builds and supports local ownership and participation. A traditional leader in rural Ghana told us through his linguist, the original version of our own Number 10 spokesperson, why he had called together the village community to get vaccinated. Ghanaian health professionals had proudly outlined the “cold chain”, the logistical triumph that will ensure that children in the remotest parts of Ghana will still get access to the vaccine in good time and at maximum effectiveness. The Health Minister rightly outlined the Ghanaian taxpayers’ contribution to the funding of the whole process supported by GAVI. This is best practice in international development. Britain’s contribution ensures that somewhere in the world every 2 seconds a child is being vaccinated and a life is saved every 2 minutes from diseases that no child in the UK ever dies. On my way back from the medical field unit so similar to the one my mum took me all those years ago now, I saw a “Tro-Tro”, Ghana’s ubiquitous minivan taxi system. They are famed for the proverbs emblazoned on them with great colour and decorative flourish. This one simply said, “Prevention is better than cure". 

Paul Boateng is a former chief secretary to the Treasury, ex-High Commissioner in South Africa and a Labour peer

Paul Boateng, a former British high commissioner to South Africa, MP, cabinet minister and civil rights lawyer, is a member of the House of Lords and a trustee of the Planet Earth Institute

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Stop saying identity politics caused Trump

It's a wildly unsophisticated analysis that ignores the fact that all politics is inflected by identity.

Look, I don't mean to be funny, but is there something in the water supply? When Mark Lilla wrote his jeremiad against "identity liberalism" in the New York Times, it was comprehensively picked over and rebutted. But this zombie take has risen again. In the last 24 hours, all these tweets have drifted across my timeline:

And then this (now deleted, I think, probably because I was mean about it on Twitter).

And finally, for the hat-trick . . .

Isn't it beautiful to see a Blairite, a Liberal Leaver and a Corbynite come together like this? Maybe there is a future for cross-spectrum, consensual politics in this country.

These are all versions of a criticism which has swilled around since Bernie Sanders entered the US presidential race, and ran on a platform of economic populism. They have been turbocharged by Sanders' criticisms since the result, where he blamed Clinton's loss on her attempt to carve up the electorate into narrow groups. And they are now repeated ad nauseam by anyone wanting to sound profound: what if, like, Black Lives Matter are the real racists, yeah? Because they talk about race all the time.

This glib analysis has the logical endpoint that if only people didn't point out racism or sexism or homophobia, those things would be less of a problem. Talking about them is counterproductive, because it puts people's backs up (for a given definition of "people"). She who smelt it, dealt it.

Now, I have strong criticisms of what I would call Pure Identity Politics, unmoored from economics or structural concerns. I have trouble with the idea of Caitlyn Jenner as an "LGBT icon", given her longstanding opposition to gay marriage and her support for an administration whose vice-president appears to think you can electrocute the gay out of people. I celebrate female leaders even if I don't agree with their politics, because there shouldn't be an additional Goodness Test which women have to pass to be deemed worthy of the same opportunities as men. But I don't think feminism's job is done when there are simply a few more female CEOs or political leaders, particularly if (as is now the case) those women are more likely than their male peers to be childless. Role models only get you so far. Structures are important too.

I also think there are fair criticisms to be made of the Clinton campaign, which was brave - or foolish, depending on your taste - to associate her so explicitly with progressive causes. Stephen Bush and I have talked on the podcast about how hard Barack Obama worked to reassure White America that he wasn't threatening, earning himself the ire of the likes of Cornel West. Hillary Clinton was less mindful of the feelings of both White America and Male America, running an advert explicitly addressed to African-Americans, and using (as James Morris pointed out to me on Twitter) the slogan "I'm With Her". 

Watching back old Barack Obama clips (look, everyone needs a hobby), it's notable how many times he stressed the "united" in "united states of America". It felt as though he was trying to usher in a post-racial age by the sheer force of his rhetoric. 

As Obama told Ta-Nehisi Coates during his last days in office, he thought deeply about how to appeal to all races: 

"How do I pull all these different strains together: Kenya and Hawaii and Kansas, and white and black and Asian—how does that fit? And through action, through work, I suddenly see myself as part of the bigger process for, yes, delivering justice for the [African American community] and specifically the South Side community, the low-income people—justice on behalf of the African American community. But also thereby promoting my ideas of justice and equality and empathy that my mother taught me were universal. So I’m in a position to understand those essential parts of me not as separate and apart from any particular community but connected to every community."

Clinton's mistake was perhaps that she thought this caution was no longer needed.

So there are criticisms of "identity politics" that I accept, even as I wearily feel that - like "neoliberalism" - it has become a bogeyman, a dumpster for anything that people don't like but don't care to articulate more fully.

But there are caveats, and very good reasons why anyone pretending to a sophisticated analysis of politics shouldn't say that "identity politics caused Trump".

The first is that if you have an identity that any way marks you out from the norm, you can't change that. Hillary Clinton couldn't not be the first woman candidate from a major party running for the US presidency. She either had to embrace it, or downplay it. Donald Trump faced no such decision. 

The second is that, actually, Clinton didn't run an explicitly identity-focused campaign on the ground, at least not in terms of her being a woman. Through the prism of the press, and because of the rubbernecker's dream that is misogyny on social media, her gender inevitably loomed large. But as Rebecca Solnit wrote in the LRB:

"The Vox journalist David Roberts did a word-frequency analysis on Clinton’s campaign speeches and concluded that she mostly talked about workers, jobs, education and the economy, exactly the things she was berated for neglecting. She mentioned jobs almost 600 times, racism, women’s rights and abortion a few dozen times each. But she was assumed to be talking about her gender all the time, though it was everyone else who couldn’t shut up about it."

My final problem with the "identity politics caused Trump" argument is that it assumes that explicit appeals to whiteness and masculinity are not identity politics. That calling Mexicans "rapists" and promising to build a wall to keep them out is not identity politics. That promising to "make America great again" at the expense of the Chinese or other trading partners is not identity politics. That selling a candidate as an unreconstructed alpha male is not identity politics. When you put it that way, I do accept that identity politics caused Trump. But I'm guessing that's not what people mean when they criticise identity politics. 

Let's be clear: America is a country built on identity politics. The "all men" who were created equal notably excluded a huge number of Americans. Jim Crow laws were nothing if not identity politics. The electoral college was instituted to benefit southern slave-owners. This year's voting restrictions disproportionately affected populations which lean Democrat. There is no way to fight this without prompting a backlash: that's what happens when you demand that the privileged give up some of their perks. 

I don't know what the "identity politics caused Trump" guys want gay rights campaigners, anti-racism activists or feminists to do. Those on the left, like Richard Burgon, seem to want a "no war but the class war" approach, which would be all very well if race and gender didn't intersect with economics (the majority of unpaid care falls squarely on women; in the US, black households have far fewer assets than white ones.)

Those on the right, like Daniel Hannan, seem to just want people banging on about racism and homophobia to shut up because he, personally, finds it boring. Perhaps they don't know any old English poetry with which to delight their followers instead. (Actually, I think Hannan might have hit on an important psychological factor in some of these critiques: when conversations centre on anti-racism, feminism and other identity movements, white men don't benefit from their usual unearned assumption of expertise in the subject at hand. No wonder they find discussion of them boring.)

Both of these criticisms end up in the same place. Pipe down, ladies. By complaining, you're only making it worse. Hush now, Black Lives Matter: white people find your message alienating. We'll sort out police racism... well, eventually. Probably. Just hold tight and see how it goes. Look, gay people, could you be a trifle... less gay? It's distracting.

I'm here all day for a discussion about the best tactics for progressive campaigners to use. I'm sympathetic to the argument that furious tweets, and even marches, have limited effect compared with other types of resistance.

But I can't stand by while a candidate wins on an identity-based platform, in a political system shaped by identity, and it's apparently the fault of the other side for talking too much about identity.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.