Making Markets for Merit Goods: The Political Economy of Antiretrovirals

This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.HIV/AIDS; ARVs; antiretrovirals; activists; policy entrepreneurs; merit goods; international community; global public health; global public policy; foreign aid

Dividing the spoils - pensions, privatization, and reform in Russia's transition

The authors present a political economy model in which policy is the outcome of an interaction between three actors: government (G), managers and workers (W), and transfer recipients (P). The government's objective is to stay in power, for which it needs the support of either P or W. It can choose slow privatization with little asset stripping and significant taxation, thus protecting the fiscal base out of which it pays pensioners relatively well (as in Poland). Or it can give away assets and tax exemptions to managers and workers, who then bankroll it and deliver the vote, but it thereby loses taxes and pays little to pensioners (as in Russia). The authors apply this model to Russia for the period 1992-96. An empirical analysis of electoral behavior in the 1996 presidential election shows that the likelihood of someone voting for Yeltsin did not depend on that person's socioeconomic group per se. Those who tended to vote for Yeltsin were richer, younger, and better educated and had more favorable expectations for the future. Entrepreneurs, who had more of these characteristics, tended to vote for Yeltsin as a result, while pensioners, who had almost none, tended to vote against Yeltsin. Unlike Poland, Russia failed to create pluralist politics in the early years of the transition, so no effective counterbalance emerged to offset managerial rent-seeking and the state was easily captured by well-organized industrial interests. The political elite were reelected because industrial interests bankrolled their campaign in return for promises that government largesse would continue to flow. Russia shows vividly how political economy affects policymaking, because of how openly and flagrantly government granted favors in return for electoral support. Bur special interests, venal bureaucrats, and the exchange of favors tend to be the rule, not the exemption, elsewhere as well.Public Health Promotion,Banks&Banking Reform,Municipal Financial Management,Economic Theory&Research,Environmental Economics&Policies,Economic Theory&Research,National Governance,Banks&Banking Reform,Municipal Financial Management,Health Monitoring&Evaluation

Economics and Military Power

Writing in 1941, Edward Mead Earle argued that the interrelation of commercial, financial, and industrial strength on the one hand, and political and military strength on the other ... is one of the most critical and absorbing problems of statesmanship. 1 This is the enduring problem that informs the books under review. As did Earle and other writers, the authors have attempted to refine the problem and point toward its policy resolution

Income and Influence: Social Policy in Emerging Market Economies

The authors study the connection between economic reform and social policy, and why such reforms failed to produce the tide needed to lift all boats in the transition economies of eastern and central Europe and of Asia.https://research.upjohn.org/up_press/1048/thumbnail.jp

Social Policy in Emerging Market Economies

The authors study the connection between economic reform and social policy, and why such reforms failed to produce the tide needed to lift all boats in the transition economies of eastern and central Europe and of Asia.https://research.upjohn.org/up_press/1048/thumbnail.jp

Social Movements and International Relations: A Relational Framework

Social movements are increasingly recognized as significant features of contemporary world politics, yet to date their treatment in international relations theory has tended to obfuscate the considerable diversity of these social formations, and the variegated interactions they may establish with state actors and different structures of world order. Highlighting the difficulties conventional liberal and critical approaches have in transcending conceptions of movements as moral entities, the article draws from two under-exploited literatures in the study of social movements in international relations, the English School and Social Systems Theory, to specify a wider range of analytical interactions between different categories of social movements and of world political structures. Moreover, by casting social movement phenomena as communications, the article opens international relations to consideration of the increasingly diverse trajectories and second-order effects produced by social movements as they interact with states, intergovernmental institutions, and transnational actors