Pharmaceutical governance in Brazil : globalization, institutions and AIDS

The Acquired Immune Deficiency Syndrome (AIDS) caused by the human immunodeficiency virus (HIV) represents one of the biggest challenges facing today's globalized world. Meanwhile, transnational drug companies have strengthened their market positions in developing countries as a result of the Agreement on Trade-Related Aspects of Intellectual Property (or TRIPS). Patent protection provided by TRIPS has led to higher prices and reduced access to essential medicines. Low- and middle-income countries are under increased pressure to provide expensive life-saving medicines to their citizens. Brazil's AIDS program is deemed successful in reducing morbidity and mortality rates through universal provision of free AIDS medicines. The program's sustainability came under threat as the result of TRIPS, pressures by transnational corporations, and trade threats by the US government. The research question that drove my dissertation centered on the impact of these threats on policy space available to Brazilian government to sustain its universal social program. How has the incorporation of patent protections for drugs affected the ability of local firms to develop pharmaceutical technology and challenged states like Brazil to fulfill social democratic obligations? Under what conditions can a developing country challenge the interests of transnational drug companies? I employed mixed methods for gathering and analyzing data. These included ethnographic field techniques, content analysis, and archival research. My findings are threefold. First, TRIPS has increased the power of foreign firms to secure monopoly positions in Brazil’s drug markets and weakened Brazil's labs to quickly make generic copies of essential medicines. Second, policy space, though curtailed due to external pressures and treaty obligations, expanded through the development of symbolic power, or what I call "reputational dividends," based on a successful social program. Third, by adroitly marketing its banner AIDS program by employing human rights principles, health officials constructed a triple alliance between the state, local private drug manufacturers, and domestic activists tied into transnational advocacy networks. I employ institutional and power analyses to examine the changing sources of power for transnational capital, social movements, and state actors, as well as analyze the impact patent protection has on the ability of Brazilian firms to produce medicines locally. I posit that globalization results in the formation of strong domestic coalitions who are capable of exploiting the "reputational dividends" of a successful social program in order to contest transnational corporate power. This symbolic form of power appears particularly well-disposed for "middle-income" countries that lack the material forms of power held by a global hegemon or transnational corporations.