How To “Talk Left and Walk Right” in South Africa: Access to Medicines in the Neoliberal Era

Abstract

One of the modalities of access to medicines in South Africa consists in the paradoxical delegation of regulatory functions to non-state actors — namely, but not only, industry. Drug policies in neoliberal globalized states are characterized by their insertion into a global trade system which promotes a growing commodification of medicines. At the same time, calls for the reform of national drug policies rise significantly. State formation in South Africa has been characterized by continuous negotiations and compromises with business, which at first sight questions the possibility of access policies. Opening the black box of the South African state amounts to demonstrating the state’s ability to roll out a political project which endeavours to have the pharmaceutical industry adopt the notion of universal access in a neoliberal context. This article attempts to shed a light on access mechanisms through the analytical deconstruction of the public market of antiretroviral medicines as a set of intertwined social relations. In South Africa, the role of industry, as heterogeneous as it is, has been deeply ambiguous and often denounced by civil society. Still, its role has been critical to ensure the supply of medicines. As a result, the Department of Health has been broadly dependent on industry, regarding the innovation agenda, the security of supply and industrial policy.