Unpacking the Role of Metrics in Global Vaccination Governance

Abstract

Recent efforts by intergovernmental actors, such as the World Health Organization (WHO), to foster collaboration on vaccine-preventable diseases stand in stark contrast to the contextually contingent nature of national immunization programs: vaccination schedules and delivery differ greatly, and so do the ways in which these programs are assessed by means of coverage rates—a key metric in global health governance. These divergences, we show, are sidelined and resolved diplomatically in WHO assessment practices: here, seemingly standardized metrics and practices of datafication function to translate political differences into technical discussions about “data quality.” Using a practice-based approach, we conceptualize data practices as a form of health diplomacy and their infrastructures as constitutive of global health governance. Drawing on document analysis and interviews, we examine the WHO’s practices of producing coverage rates provided by member states. We argue that these metrics are performative inasmuch as they help frame vaccination as a global concern and mediate between global norms and local practices. We show how datafication is both an effect of, and a means for, health diplomacy and helps sustain the authority of the WHO. Our research further demonstrates the need to attend to practices of datafication and their political implications.