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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Is love necessary? Laurie Penny in conversation with Moira Weigel

The author of radical Marxist feminist text Labor of Love on emotional labour, finding freedom in relationships, and love's connection to work.

Laurie Penny: So Moira, your book, Labor of Love, is a radical Marxist feminist tract disguised as a salmon-pink self-help book, and it’s doing incredibly well. Nice work. You must be knackered.

Moira Weigel:  I’ve been overwhelmed by the response – surprised, frankly, and also grateful and encouraged that there is this kind of appetite for history and theory. It affirms my sense that the world is more ready for radical Marxist feminism than it might have thought. As an academic and writer, I am used to spending much of my time alone – it’s electrifying to be able to have conversations with other humans about this topic I obsessed about for so long. But it's also tiring: these past few weeks I have written and talked so much that I have decided I need to get a dog as soon as this book tour is over. I just want to stare into the eyes of a wordless creature for a while, and I may be too insecure to love a cat.

LP: I endorse this attitude. If I want to live with something that will judge me all day, interrupt my deadlines and expect me to work for its affection, I’ll get a boyfriend.

So anyway, I love your book, but I’ll start with my one real nitpick. As a British reader, I found Labor of Love to be an extremely American text  more specifically, a New York text. This makes sense as so many of the world’s ideas about romance are leached from American culture, but I’ve always felt New York to be a particular arcane circle of dating hell whose rules and customs are quite opaque even to those of us who’ve seen Sex and The City. This is a general complaint, rather than a complaint about your book, but New York forgets that it isn't the whole world, which is a problem when the entire American literary world lives there. In Britain, you know, we don’t really even date. We do a little bit now, because of the internet, but it’s still largely a formalised version of “get hammered, get laid, and see if you have anything in common in the morning”.

MW: Yes, I hear this! I tried, in the book, to talk about other cities in America, but I did not get to talk about other countries - though I’ve written about Chinese dating elsewhere. I think that dating was invented in America because it is basically an expression of a particular form of consumer capitalist logic applied to love – and America invented that logic, and New York maybe its capital. Its rise also has a lot to do with mass immigration and the working class immigrant cultures in American cities, historically speaking.

LP: New York is the zenith of a particularly mercenary love culture that I found, and continue to find, utterly terrifying. Intimacy is negotiated with the formality of a merger. But at the same time New York lives in the global imagination as one of the most romantic places on earth. Which, in the classical sense, it is.

Anyway, question two. Your book deals brilliantly with the way that the burden of planning romance, marriage and fertility falls to women, and the real emotional and practical labour involved in that. The discourse of emotional labour is suddenly everywhere in contemporary feminist writing. Why do you think that is?

MW: Emotional labour does seem to be trending, doesn’t it? I have noticed that more and more folks seem to be using that term, specifically – “emotional labour,” coined by the brilliant feminist sociologist Arlie Hochschild, instead of the Hardt/Negri terms “affective” or “immaterial labour,” which describe related phenomena and seemed to come up more often in left academic discourse until recently.

I have two interrelated ideas about why this might be. Firstly, I believe that there is a growing interest in emotional labour now because the permeation of every corner of our lives by the Internet, mobile phones, and social media, not to mention contemporary forms of economic precarity, mean that it's less and less clear what work is and is not  what production is and consumption and reproduction are. And in an age where we have to brand ourselves constantly for mobility, flexibility, etc, I think many people in developed countries are just doing MORE of it. 

Maybe it's that the kinds of folks who write and edit think pieces are finally having to do it, feeling exhausted. It seems to me that automation and globalisation were evjsceraring the American working class all through the 1970s and 1980s and the newspapers weren't that angry but now that the AIs are coming for the parallegals, financial analysts and journalists, we are seeing all these books and articles taking notice. 

Maybe it's like that: Flight attendants and call center debt collectors, the subjects of Hochschild’s book first exploring this phenomenon, The Managed Heart, were dealing with this shit when she was doing her fieldwork in the early Eighties. But now that media folks and tech folks are having to win over everyone on Twitter, they're realizing that service with a smile is a grind.

Secondly, I think there's been a resurgence of socialist feminism since around the time of Occupy, thanks to the Internet and new social movements. It seems to me that more and more young people are discovering the tradition that talked about the unwaged labour of women and its centrality to the economy despite being neglected by both classical liberal and Marxist economics. I'm thinking of Silvia Federici, Mariarosa dalla Costa and the Italian autonomist feminists, of course, as well as great American feminists like Angela Davis and bell hooks. Thanks to little magazines like N plus One and the New Inquiry, that intellectual recovery is disseminating those ideas to a very broad audience. And they're receptive because it's true. I sometimes joke that every woman is a socialist feminist whether she realizes it or not. And that's rad. If I have l one ambition for this book, it's to stealth-radicalise mums who had no idea they had the joy of so much just rage in them.

LP: That expansion of work theory is the great taboo the idea that labour itself extends beyond what is measured by the wage relation. Romantic love can be work, and so can domestic work, childcare, all of it – and the fact that we call so much of it "love" makes the that work invisible. There’s a resurgence of anti-work theory on the left, but even so, it’s amazing how many leftist men get incredibly uncomfortable when you start to apply ideas of labour and exploitation to gender relations. Particularly if it requires them to take a look at their own relationships.

Relatedly, I’ve noticed that a lot of the articles and discussions around your book specifically mention the fact that you’re married, and happily so. That must be frustrating. A lot of big political books that are coming out by women right now follow a certain trajectory which weaves in the ‘happy ever after’ ending – even Kate Bolock’s recent book Spinster, which is supposed to be all about the power of singleness. On the other hand, since your books is partly personal and all about love, it would have felt dishonest not to mention it. Do you think that the focus would have been different if you were a man?

MW: I do often feel pressure to talk about my own relationship. Not that I mind talking about it, exactly. It’s just… I would hope that my having spent years researching and writing on the subject seems like a more interesting qualification to talk about dating than my happening to be a partnered person. I don't think that would happen to a man nearly as much.

Nobody has asked me about the section of my afterword that deals with intense and loving female friendship. In fact, one or two reviewers have criticised the book by saying that it has a “marriage plot” – because it happened that I fell in love with the person I'm now married to while I was working on it, and there are a few – four, I just counted – sentences on the final page where I mention that. Immediately before those sentences there's a longer paragraph where I talk about the deep love and gratitude I feel for my dear friend Mal Ahern. Labor of Love grew directly out of several essays she and I collaborated on together and was deeply shaped by our relationship. The book is dedicated to both of them.

I do believe disagreement among feminist writers is healthy, and I'm eager to have many folks come into conversation with this book, so I hope I don't sound petulant. Still, it felt a little discouraging to see other women write Mal out.

LP: It’s almost as if we’ve internalised the idea that platonic friendship can’t ever be as important as romantic partnership. In terms of your own marriage, though, you shouldn’t have to apologise for being happy! Everyone deserves what you have, if that’s what they want, but the fact is the odds are against everyone getting it. One of the things that romantic orthodoxy prevents us from talking about honestly is that there just aren't enough men out there who both see women as real human beings and  are actively committed to being in equal partnerships with one of them. We’re supposed to fight for the relationship model at all costs, or die alone. We're encouraged to see those who don’t have a partner as somehow abject, instead of working on other models of human and particularly female fulfilment.

MW: A point I’m very keen to make is that I think the emphasis placed on monogamous romantic relationships in our culture is destructive to happiness – even the happiness of the people in such partnerships. The tremendous emphasis placed on having "A Relationship" with a capital R -- and "Defining the Relationship" – sometimes seems to lead people to devalue all other kinds of intimate connection, and lovers to treat one another worse than necessary. I like to think that all human interactions put us into relations with one another. And all relationships end – even if they last until death. That does not make them “a waste."

The cultural script that says that life, particularly female life, is still defined by a search for "The One" encourages us to devalue relationships that are crucial to our thriving – friendships and other forms of intimate connection. You see this in romantic movies and all kinds of pop culture representations – where, for example, your friends are a focus group you can dissolve once you have a mate. I'm encouraged that shows like Girls and Broad City and Orange Is The New Black  whatever their flaws  or Elena Ferrante's Neopolitan novels show a growing appetite for alternative narrative configurations. Where the end point is not always, only monogamous coupledom.

LP: In my last book, and in the one I’m working on now, I’ve felt pressure to provide that sort of story when talking about the labour of love – to offer a trajectory that tells readers that actually, the world of heterosexuality is still fraught and frustrating, but it’s still possible to find liveable partnership. In the end, the Love chapter of Unspeakable Things came out of two painful breakups, and was informed by a growing sense that alternative narratives to the standard fairytale had to be permissible. There was a lot of outrage in there that the women I knew seemed to be suffering so much in and out of relationships  and that got a huge response. In the years since, there have been more and more feminist writers opening up about the fact that, you know, maybe it’s okay to be skeptical about monogamous partnership and the bourgeois family, and that’s a brilliant thing in my view - that’s why your book is so important, and so radical. That skepticism has been missing from public feminism for so long, as the focus has been drawn back to helping middle-class white women achieve "work-life balance"  essentially ceding the ground to a politics that sees endless emotional and domestic labour as women’s lot, forever.

MW: On the other hand, if we go down the road of believing that capitalism is so fundamentally and profoundly corrupting that there is no way to have a relationship within it… I don't know that I believe that. I want to believe sexual desire and love offer lines of flight. Sometimes I have even felt embarrassed by my optimism, my faith that ultimately our sexualities and our desires are a source of tremendous freedom. I believe it is more than fine not to be an optimist about love – if by that we mean finding one partner to settle down with forever and have babies with. But if someone wants to give up on the enormous power that each of us gets at birth, free of charge by being desiring beings drawn to each other in infinite ways, I think I’d try to convince her not to.

LP: Agreed. I try to set my own cynicism against the fact that I want to fall in love again and again. I just don’t want to get married, or settle down. I want to fall in love with friends, partners, housemates, strangers. At the moment I’m getting to live a version of that dream, as I’ve been polyamorous for years and live in a functioning collective. Part of me always suspected, in my early twenties, that this was a phase I was going through, that eventually I’d settle down and couple up, because that was what it meant to be an adult  but as I approach my thirties I’ve come to realise that no, this is what I’m committed to, and it’s going to be a long-term thing for me. I’m very interested in the notion of "casual love" – love and intimacy that gets to be as free and easy as casual sex, without necessarily obviating commitment... Romance, unlike human labour, is an infinitely renewable resource.

MW: That's interesting. It's the one actual infinite resource. Unlike nature, unlike women's labour which we treat that way.

LP: They say we’re an important natural resource. You know what they do to natural resources these days? All of this is, on a fundamental level, about social reproduction. We have to remember that the work that is done within love and family scenarios, mainly by women, is work that has real, measurable value, work without which capitalism could not continue to exist. And the historical marginalisation of women has been about managing and ensuring the unstinting supply of that work, for free, for a long time. Changing the labour of love will involve changing those conditions – and it will take a lot of imaginative work.

MW: Yes, and work best done among more than two people – among friends and communities as well as individual lovers. Transforming those conditions requires expanding the idea of love beyond the narrow couple form,where it's a prize you get for following The Rules successfully. Not to be too reductive, but the ways that the labour of love has manifested have often been shitty – but they don't have to be. I am ultimately an optimist.

LP: On that note, the world needs to know, by which I mean I want to know, about this puppy you’re going to get.

MW: I am so glad you asked, because this is a matter about which I would like to seek some self-help. The puppy is a source of conflict for me and within my relationship. I won’t name names but one of us thinks it’s basically unconscionable to do anything other than adopt a dog. The other accepts the self-evident truth of that claim, but feels a deep and passionate attraction to purebred French bulldogs. The heart wants what it wants. If anyone in the world would like to give up a French bulldog for adoption please get in touch @moiragweigel.

Laurie Penny is a contributing editor to the New Statesman. She is the author of five books, most recently Unspeakable Things.