by Carsten Horn
Vienna is beautiful, not only because of the historic buildings or the many parks and green spots in the middle of the city (and many other things could be mentioned). One particular aspect that lends the city its special atmosphere for me is the abundance of theaters. On any given day you can go out to see tragedies or comedies, classical or modern plays, amateurs, or professionals on the “boards that mean the world” (to imperfectly translate Schiller’s phrase into English). So, what better thing to do after a long day of racking one’s brains about STS than to go out, attend a play and get the mind off heavy STS stuff.
Thus, one Saturday evening I find myself in line at the entrance of one of the many theaters. Now, in Austria, given the implementation of a vaccination mandate and the so-called “2G-Rules” (stating you either have to be vaccinated (“geimpft”) or recovered (“genesen”), one has to present a certificate to prove that one meets the access requirements. Much could be said about the logic of this way of controlling access (Deleuze, 1992) not only to theaters but also restaurants, bars and museums, but remember, at least initially, the goal of this visit to the theater was to get my mind off STS. Conveniently, the Austrian Ministry for Social Affairs, Health, Care and Consumer Protection has introduced the so-called “Green Pass App,” a digital app that stores all your Covid-19-related certificates on your smartphone so you don’t have to carry them around in the paper format that is issued at the vaccination centers (or at pharmacies, but more of that later) or find a pocket large enough to fit the rather unwieldy, yellow vaccination pass, mine issued by the World Health Organization (WHO). As the line moves ahead, I collect what I need to be able to enter: the personalized ticket, my ID card to prove that I am indeed the person the ticket has been issued to and that I am indeed the person whose name is stated on the vaccination certificate I am about to present, and my Green Pass App-equipped smartphone. Opening the Green Pass App, I am not greeted by the familiar green checkmarks underneath the QR-code which signal that, yes, I may access museums, theaters or bars and restaurants. Instead, I see two bright red boxes: My vaccination certificate has been invalidated. In disbelief I scroll down on the screen — after all, I was vaccinated for the third time only little more than a month ago and even with the rapidly changing regulation there surely shouldn’t be any problem, right? But there it is, in black on white: My Green Pass App claims I have only been vaccinated twice, the last time in the summer of 2021, thus the invalidation. All my pleas to the theater employees that my app is clearly lying and that there must have been some type of technical error because I have been vaccinated three times are, rightfully, to no avail — and thus I find myself, contrary to the intention of attending the play, thrown right back into the midst of current debates in STS.
Of seams and cyborgs
Given the contemporary proliferation of digital infrastructures, “seamlessness” has become a virtue. The multiple, (not only digital) infrastructures we are constantly attached to need to fit one another so that, for instance, we can easily and almost automatically link the results of our latest run in the park, self-tracked by one of the many apps that exist just for this purpose, to our social media feeds for our digital social networks to, literally, cheer us on or to link our sensing devices to our smartphones and the corresponding apps (Williams et al., 2020). Janet Vertesi (2014) has shown that this is a more or less tedious task of what she calls “aligining,” that is, finding more or less creative ways of making heterogeneous infrastructures compatible. Nevertheless, especially in digital infrastructures, seamlessness, thanks to technologies such as Application Interface Programming (API), may seem rather easy to accomplish and at times may even be invisible to the user of such infrastructures. In this sense, what is at stake in the denied theater visit portrayed above is twofold. On the one hand, in the rather classical STS move to look for controversies or situations of breakdowns, Vertesi (2014, p. 276) argues that “[m]oments when actors fail to interweave their many systems successfully can be analytically useful for revealing otherwise invisible infrastructural components essential to the task at hand and surfacing sociotechnical orders and tacit social relations to analytic view.” On the other hand, there seems to be more at stake than just the alignment of however heterogeneous technical infrastructures — in this case, among others, the infrastructures that make the vaccination campaign of the City of Vienna possible and the digital infrastructure involved in the certification of the vaccinations. Perhaps even more pervasively, alignment here concerns the relationship between the digital world and the real world, especially salient in the times of the pandemic (Coeckelberg, 2020). To successfully enter the theater, I should have been a “cyborg” (Haraway, 1985), which in this situation comes to mean the entanglement of a vaccinated bodymind and a digital app. Only this entanglement of the real and the digital world would have made me “vaccinated” in terms of the official 2G-Rules. Because the latter component — the functioning app — was missing, I might have been a vaccinated bodymind but this was insufficient to grant me the desired access (thus the hopelessness of my pleas to the employees). In turn, this makes visible an often taken-for-granted dimension of the cyborg as the interweaving of organism and technologies: the seams “between embodied consciousness and socio-material fields, flesh and machines and body and society” (Freund, 2004, p. 277).
The work to make digital health work
As Vertesi (2014) points out, breakdowns of interconnected infrastructures as a methodological point of departure unveil the social relations that are obscured as long as these infrastructures hold together seamlessly, including the work of (re-)aligning them. This is an especially salient insight for the contemporary efforts of digitalizing healthcare systems ongoing in many countries. These efforts often have the alignment of digital infrastructures as their core. They entail questions such as how the socio-technical alignment is possible, who makes alignments work and who is responsible for failures and the corresponding repair of seamlessness. Such sociocultural questions need to be considered carefully to get a fuller picture of digitalized healthcare. Existing research into telemedicine, as one particular form of digital health, shows that it indeed goes along with a redistribution of work. Work that may subsequently become invisible in formal accounts of medical practice but is crucial for the workings of telemedicine (Nicolini, 2006; Oudshoorn, 2008).
How did things work out or, rather, had to be made to work out in my case? The recovery of the seamlessness between the digital and the real world took a detour: I had to align the medical infrastructure of the City of Vienna, with the built infrastructure of the city, the small alleyways of Vienna’s Inner City, and the infrastructure provided by the Global Positioning System (GPS) to guide me the way to an emergency pharmacy that was still open on a Saturday evening. There, a pharmacist could luckily print out my vaccination certification. This was made possible by the alignments between the technical infrastructure of the pharmacy and the Austrian electronic health record that the pharmacist thankfully created by using my insurance card. This impromptu printout, at last, granted me access to the theater. The solution disclosed an alternative pathway and a corresponding different configuration of the digital and the real world: The moment of breakdown and the distributed efforts to find a resolution make visible a vast analog and digital infrastructure that exists in parallel with the Green Pass App. This infrastructure and the types of work it implies tend to remain hidden in the seemingly inconspicuous analog sheet of paper that I was then able to present to the employees at the theater (although the QR-code printed on top of the certificate provides a trace of the digital world as a constant companion). In turn, this also shows that for me, in this situation the interconnectedness of infrastructures has been boon and bane at the same time: disruptive when it failed at the theater entrance, enabling in the concerted effort to repair the situation and save the day after all. Dealing with these ambivalence(s) of seamlessness will likely be one of the major challenges in the digitalization of healthcare systems in the near future. The play, an adaption of a recent French movie, turned out great in the end, by the way; I only missed the first couple of minutes.
References:
Coeckelbergh, M. (2020). The Postdigital in Pandemic Times: A Comment on the Covid-19 Crisis and its Political Epistemologies. Postdigital Science Education, 2, 547–550.
Deleuze, G. (1992). Postscript on the Societies of Control. October, 59, 3–7.
Freund, P. (2004). Civilised Bodies Redux: Seams in the Cyborg. Social Theory & Health, 2(3), 273–289.
Haraway, D. (1985). Manifesto for Cyborgs: Science, Technology, and Socialist Feminism in the Late Twentieth Century. Socialist Review, 15(2), 65–107.
Nicolini, D. (2006). The work to make telemedicine work: A social and articulative view. Social Science & Medicine, 62(11), 2754-2767.
Oudshoorn, N. (2007). Diagnosis at a distance: the invisible work of patients and healthcare professionals in cardiac telemonitoring technology. Sociology of Health & Illness, 30(2), 272-288
Vertesi, J. (2014). Seamful Spaces: Heterogeneous Infrastructures in Interaction. Science, Technology, & Human Values, 39(2), 264–284.
Williams, R., Will, C., Weiner, K., & Henwood, F. (2020). Navigating standards, encouraging interconnections: infrastructuring digital health platforms, Information. Communication & Society, 23(8,) 1170-1186.
Carsten Horn is a second-year master’s student at the Department for Science and Technology Studies. He also works as a researcher in the research project “ICU4Covid” at Department. His research interests are situated at the intersection of STS, sociology and philosophy. Currently, he is writing his master’s thesis on the regulation of digital health technologies.