Sticks and Pills: Governance Patterns of HIV/AIDS Medication in India and Brazil

Abstract

Even more than industrialised countries, developing states are confronted with the epidemic spread of HIV/AIDS. Due to a lack of sufficient financial resources, they depend critically on regulatory policies to rise to that challenge. Evidence shows, however, that varying approaches have emerged to cope with the humanitarian, social, and economic consequences of the disease. In our contribution, we focus on two competing governance models that provide for the HIV/AIDS medication in India and Brazil. Within the framework of its recent patent reforms, the Indian government has paved the way for a market-driven innovation process in the field of pharmaceutical research. The Indian generics industry has entered into numerous cooperation agreements with Western research-based corporations. Decisions on the development and production of new prescription drugs are taken in a self-regulatory private network, where the Indian state refrains from direct intervention. In Brazil, however, the government is deeply involved with the research and production of HIV/AIDS drugs. New or modified formulas are imported or developed by public laboratories, and the production is organised by public private partnerships. If Brazilian or foreign corporations refuse to cooperate with the government, they are threatened with compulsory licensing of their formulas, i.e. a suspension of monopoly rights.

In our research paper, we argue that a credible threat of governmental intervention is essential for shaping societal actors’ orientations towards the fulfillment of collective goals. We draw our evidence from the availability of affordable HIV/AIDS drugs in India and Brazil. Although both countries possess sufficient industrial infrastructure to cope with the epidemic, Indian authorities cannot provide an adequate pharmaceutical treatment for the poorer population, whereas the Brazilian health care system has caught up with the standards of industrialized countries. Differences in the policy output can be largely explained by direct governmental intervention in Brazil and its absence in India.