High Modernist Hubris and its Subversion in South Africa’s Covid–19 Vaccination Roll-Out

Abstract

The South African government presented its strategy for rolling out vaccinations against Covid–19 in 2021 as a comprehensive plan designed by technocratic experts working with the country’s leading scientists. This imagery built on the government’s prior claims that its responses to Covid over the previous year ‘followed the science’. In 2021, as in 2020, this framing functioned ideologically to justify projects of expanded government control over the economy and the health sector. This article shows how the objective of the vaccination roll-out ‘plan’ was not simply to vaccinate people, but to build key foundations of the proposed ‘national health insurance’ system, including patient registration and procedures for channelling patients (and corresponding financial flows) between public and private health care providers. But the imagery of planned efficiency projected through PowerPoint presentations masked the reality that there was no detailed plan and most of the proposed roll-out scheme was unworkable. We contend, following James Scott, that this was an example of high modernist hubris and aesthetics that confused visual imagery with operational order. Almost every aspect of the supposed vaccination ‘plan’ was subverted, as scientists excluded from government advisory structures disputed aspects of vaccine procurement and use, people ‘walked in’ to vaccination sites where health care workers implemented informal systems to manage them, provincial governments failed to conform with national instructions, and special interest groups lobbied for privileges. The result was that a somewhat disorderly but more effective vaccination roll-out replaced the dysfunctional, overly ordered system set out by government planners.