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Goldsmiths - University of London

On scale work: evidential practices and global health interventions

Ehrenstein, Vera and Neyland, Daniel. 2018. On scale work: evidential practices and global health interventions. Economy and Society, 47(1), pp. 59-82. ISSN 0308-5147 [Article]

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Abstract or Description

Scalability can be understood as the ability to expand without changing. Yet expanding an intervention to a global scale, we suggest, is a significant and difficult accomplishment. In this paper we propose to explore the kind of evidential exigencies that this accomplishment involves. To do so, we focus on the field of global health and examine how child immunisation against the pneumococcus bacterium has been scaled up in low income countries. The paper first attends to initial epidemiological scrutiny that revealed the existence of a large-scale public health problem and the possibility of an expandable solution (vaccination). It then describes the set-up of a funding arrangement using overseas aid to purchase vaccine doses manufactured by pharmaceutical companies, before paying attention to various frictions that affect the widespread use of pneumococcal vaccines. In these different moments through which scalability is accomplished, always partially and temporarily, we show that a dual activity can be witnessed, a pivoting between referential work and forward projection. To conclude, we suggest that scalability is more usefully approached as a form of expansion that is always attentive to the possibilities of change.

Item Type:


Identification Number (DOI):


scale work, scalability, evidential practices, global health, vaccines, markets

Departments, Centres and Research Units:

Sociology > Centre for the Study of Invention and Social Process (CSISP)


1 February 2018Accepted
7 March 2018Published

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Date Deposited:

23 Mar 2018 11:59

Last Modified:

27 Feb 2019 16:58

Peer Reviewed:

Yes, this version has been peer-reviewed.


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