The Political Economy of AIDS Treatment: Intellectual Property and the Transformation of Generic Supply


  • Author’s note: I presented earlier versions of this paper at the First Global International Studies Conference at Bilgi University (Istanbul, Turkey) in August 2005, and the conference on “Frontiers of Regulation: Assessing Scholarly Debates and Policy Challenges” at the University of Bath (UK), in September 2006. I wish to thank the following people for sharing their insights and providing helpful comments and suggestions on earlier drafts: Brook Baker, Tony Barnett, Shamnad Basheer, Jim Bjorkman, Catherine Boone, Angela Burger, Nick Corby, Graham Dutfield, Tim Dyson, Kevin Gallagher, Christopher Garrison, Padmashree Gehl Sampath, John Gerring, Cheri Grace, Homi Katrak, Marcus Kurtz, Evan Lieberman, Susan Martin, Duncan Matthews, Christopher May, Andrew Schrank, Hakan Seckinelgin, and Susan Sell. I am also grateful to ISQ’s editor and the three anonymous reviewers for their encouraging and constructive feedback.


This article examines the relationship between intellectual property (IP) and public health, with a focus on the extension of AIDS treatment in the developing world. While most of the literature on IP and health examines the conditions affecting poor countries’ capacities to acquire essential medicines, I show the distinct—and more complicated—political economy of production and supply. IP regulations alter the structure of generic pharmaceutical sectors in the countries capable of supplying essential medicines, and changes in market structure affect actors’ economic and political interests and capacities. These new constellations of interests and capacities have profound implications for the creation and maintenance of political coalitions in support of on-going drug supply. The result is that the global AIDS treatment campaign becomes marked by mismatches of interests and capacities: those actors capable of taking the economic, legal, and political steps necessary to increase the supply and availability of essential drugs have diminished interest in doing so, and those actors with an interest in expanding treatment may lack the capacities to address the problem of undersupply. By focusing centrally on actors’ interests in and capacities for economic and political action, the article restores political economy to analysis of an issue-area that has been dominated by attention to international law. And by examining the fragility of the coalitions supporting the production and supply of generic drugs, the article points to the limits of transnational activist networks as enduring agents of change.