Sustaining policy promise: rhetorics of disease elimination and sustainable development

The focus of this paper is the discourse of the ‘endgame’ of disease elimination linked to the 2030 Agenda of Sustainable Development Goals (SDGs). The aim is to explore how policy promise is sustained in the face of faltering progress, such as when targets are missed or appear unreachable. Viewed via Lauren Berlant’s work on the ‘cruel optimism’ of unmet promise, with Ben Anderson’s work on affective attachments, the analysis looks first at the 2030 SDGs and then at disease elimination through the examples of hepatitis C and HIV. The materials for analysis include political declarations, global progress reports and strategy documents. These materials sustain imaginaries of a universal endgame promise as if there cannot be an otherwise. We see how ‘crisis’ is enacted to account for failure as well as to sustain promise. We also see that the threat of failure gives rise to recalibrated promise in what might be described as an emerging ‘elimination otherwise’. Here, the figure of crisis affords increasing attention to disease elimination as a ‘problem of the social’. Discourses of the disease elimination endgame act as sites of potential, even in crisis.