Multiple Interfaces of Big Pharma and the Change of Global Health Governance in the Face of HIV/AIDS

By using a game theoretical approach and the notion of “forum” or “regime shifting” this paper examines the multiple interfaces of the multinational pharmaceutical corporations (MNPCs) with their major counterparts at home and abroad, including the governments of the North and South, the international organizations and increasingly with national and international NGOs in the context of the spreading HIV/AIDS crisis. It shows how the execution of the MNPCs’ strategies led to significant reactions from other actors, which led to further moves and countermoves in a strategic battle between representatives of the North and the South in the global health arena.Multinational Pharmaceutical Corporations (MNPCs), HIV/AIDS, global health governance, pricing of ARVs;

AIDS, Access to Medicines, and the Different Roles of the Brazilian and South African Governments in Global Health Governance

The present article illustrates how the main actors in global health governance (GHG)— governments, nongovernmental organizations (NGOs), intergovernmental organizations (IOs), and transnational pharmaceutical companies (TNPCs)—have been interacting and, as a result, modifying the global health architecture in general and AIDS treatment in particular. Using the concept of “power types” (Keohane/Martin) and “interfaces” (Norman Long), the authors examine the conflicts among major GHG actors that have arisen surrounding the limited access to medicines for fighting HIV/AIDS basically as a result of the Agreement on Trade Related Intellectual Property Rights (TRIPS), in force since 1995. They then analyze the efforts of Brazil and South Africa to obtain fast and low-cost access to antiretroviral medication against AIDS. They conclude that while policy makers in the two countries have used different approaches to tackle the AIDS problem, they have been able, with the support of NGOs, to modify TRIPS and change some WTO rules at the global level along legal interfaces. At the national level the results of the fight against AIDS have been encouraging for Brazil, but not for South Africa, where authorities denied the challenge for a prolonged period of time. The authors see the different outcomes as a consequence of Brazil’s ability to combine discoursive, legal, administrative, and resource-based interfaces.Dieser Aufsatz zeigt, wie die Hauptakteure von global health governance – Regierungen, Nichtregierungsorganisationen (NGOs), intergouvernementale Organisationen (IOs) und die transnationalen pharmazeutischen Unternehmen (TNPCs) – durch intensive Interaktionen die globalen Regelungen zum Gesundheitswesen im Allgemeinen und zur Behandlung von AIDS im Besonderen entscheidend modifiziert haben. Ausgehend vom Begriff der verschiedenen Machtformen (Keohane/Martin) und Schnittstellen (interfaces, Norman Long), untersuchen die Autoren die Konflikte zwischen den genannten Akteuren, entstanden aus dem beschränkten Zugang zu den teuren antiretroviralen HIV/AIDS-Medikamenten – u.a. eine Folge des 1995 in Kraft getretenen Agreement on Trade Related Intellectual Property Rights (TRIPs). Sie gehen sodann auf die unterschiedlichen Politiken der AIDSBekämpfung in Brasilien und Südafrika ein und kommen zu dem Schluss, dass diese Länder es zwar gemeinsam mit anderen Ländern und den NGOs geschafft haben, einige WTO-Regeln auf globaler Ebene zu verändern, dass die Ergebnisse auf nationaler Ebene jedoch auseinanderklaffen – enttäuschend für Südafrika, wo das Problem lange Zeit ignoriert wurde, und ermutigend für Brasilien, dank einer gelungenen Kombination der diskursiven, legalen, organisatorischen und ressourcenbezogenen interfaces

From import substitution to export diversification in Colombia

The recent surge of industrial exports from some Latin American countries has prompted a number of studies which have examined the new outward-looking strategies of a few nations such as Brazil, Mexico and Argentina. There are, however, at least two characteristics which do not apply to most other countries of the Southern Hemisphere of the Americas. First, export diversification in the large nation states began only after import substitution had run its course and seemed to be exhausted. Secondly, in spite of their importance for the balance of payments, exports contribute a relatively small part to the formation of the gross national products in these countries. Hence industrialization will depend on the expansion of domestic markets. This situation is already quite different in the Andean countries, where import substitution industrialization was not only hampered by small and fragmented markets but also by lower per capita income and more widespread poverty. To overcome this handicap Chile, Bolivia, Peru, Ecuador, Colombia and later Venezuela have joined in the Andean Common Market. Simultaneously they have promoted industrial exports the results of which have been modest except in the case of Colombia. Unless one includes Peru's fishmeal into industrial exports, only Chile and Colombia have been able to raise the share of manufactured goods in total exports beyond 10 %. But whereas industrial exports' share has been falling considerably in Chile in the last few years, Colombia was able to raise that share from less than 2 % in 1960 to over 15 % in 1973.

The EU's Blue Card: will it attract Asia's highly skilled?

As of this year, the EU Council will implement Directive No. 2009/50/EC of 25 May 2009, which is meant to coordinate and simplify the immigration of highly skilled migrants (HSMs) from third countries. It is expected that the new system, providing HSMs with "blue cards", will not only help Europe overcome current shortages of skilled labour but also contribute to alleviating the continent's ageing problem. We argue that this action is overdue, but we maintain that the impact of the measures will be rather small in this decade. Those countries from which a growing inflow of HSMs is expected are increasingly demanding highly qualified personnel themselves or are eager to lure them back. Thus, the EU will need to make additional efforts in order to create a win-win situation for host and home countries as well as for the HSMs themselves. The overdue blue card initiative provides a common starting point for HSMs to jointly consider the majority of European countries as potential host locations. It is doubtful, however, that the blue card will have a significant impact on the pattern of immigration to the European countries before 2020. Past attempts to open up immigration for the highly skilled have been less than successful. A 'green card' initiative by the German government in 2004, which aimed to attract IT personnel from India, provides a useful case study about a rather limited response from Asian HSMs to move to Europe. In addition to the traditional immigration countries’ hunt for HSMs, strong economic growth and dynamic restructuring in emerging economies – particularly China and India - have intensified the global war for talents. They have introduced a reverse brain drain policy, trying to attract highly qualified foreign personnel. Along with the United States and other traditional immigration countries like Canada and Australia, China, in particular, is going to become an important competitor on the international market for the highly skilled

AIDS, Access to Medicines, and the Different Roles of the Brazilian and South African Governments in Global Health Governance

The present article illustrates how the main actors in global health governance (GHG)— governments, nongovernmental organizations (NGOs), intergovernmental organizations (IOs), and transnational pharmaceutical companies (TNPCs)—have been interacting and, as a result, modifying the global health architecture in general and AIDS treatment in particular. Using the concept of “power types” (Keohane/Martin) and “interfaces” (Norman Long), the authors examine the conflicts among major GHG actors that have arisen surrounding the limited access to medicines for fighting HIV/AIDS basically as a result of the Agreement on Trade Related Intellectual Property Rights (TRIPS), in force since 1995. They then analyze the efforts of Brazil and South Africa to obtain fast and low-cost access to antiretroviral medication against AIDS. They conclude that while policy makers in the two countries have used different approaches to tackle the AIDS problem, they have been able, with the support of NGOs, to modify TRIPS and change some WTO rules at the global level along legal interfaces. At the national level the results of the fight against AIDS have been encouraging for Brazil, but not for South Africa, where authorities denied the challenge for a prolonged period of time. The authors see the different outcomes as a consequence of Brazil’s ability to combine discoursive, legal, administrative, and resource-based interfaces.global health governance; HIV/AIDS in Brazil and South Africa; discoursive, legal, organizational and resource-based interfaces; WTO; transnational pharmaceutical companies; NGOs

Global booms and busts: how is Brazil's middle class faring?

Brazil's Post War economic history has been marked by inflationary booms and busts, which kept large parts of the population poor, as income distribution remained highly skewed, and most governments failed to put enough efforts and resources into education and health. That seems to have changed recently, as an increasing number of studies have shown considerable advances in the incomes of the lower and the middle classes. This essay examines those findings and puts them into a historical perspective, discussing earlier attempts and hopes of Brazilian policy makers to advance the welfare of the population. It concludes that while the last fifteen years have been remarkable for the country to achieve macroeconomic stability and while the increasing efforts of supporting the poor seemed to have been moving income distribution slowly towards a more equal level, there is still a long way to go. The 2008 world financial crisis also hit Brazil hard, but the recovery has been smoother and faster than in any OECD country. The impact of the current crisis may provide a good test as to the robustness of the previous trends to further the wellbeing of the poor and the middle clas