Improving Access to Essential Medicines: International Law and Normative Change

Abstract

This paper seeks to gain insights into the struggle to improve access to essential medicines from the empirical and conceptual contributions to the study of normative change in international law and international relations scholarships. When considering the way in which the debate over increased access to essential medicines has unfolded so far, it becomes evident that the forces behind the significant normative shifts have not been only states but networks of non-state actors as well. The paper aims to locate this involvement in the broader context of international normative change and suggest what the way forward should be. Section II begins by examining studies which aim to predict under what conditions international normative change is likely to take place, and focuses on two of the propositions that this body of work has generated. The first proposition is that value-laden, contested international norms often emerge as a result of concerted efforts of norm entrepreneurs who advance their agenda and succeed in mobilizing support around it. Their power often lies in their moral authority rather than military or economic might, yet they successfully engage other international actors in an attempt to either convince or coerce them to accept the new normative standard. Section III shows that this hypothesis is largely confirmed by the case under study. Faced with a sustained campaign led by like-minded activists, states and corporate actors have slowly begun to accept the right to health as an emerging normative standard and the responsibility for implementing it is increasingly recognized. The second proposition is that opening up institutions of global governance to the input of all those who may be affected by their decisions will enhance the legitimacy of these institutions and the norms that they generate. More to the point, the responsibility of corporations for the human right to health would be greatly enhanced if both human rights groups and corporate actors will be able to partake in the processes through which the right to health is given meaning to, interpreted, elaborated and revised. In section IV I suggest that while this hypothesis may have been confirmed in other issue areas of global governance, it may not apply with equal force to the case under study. When the pre-conditions for discursive engagement are not likely to be met within a lawmaking institution, opening up this institution to civil society input should proceed with caution because it is not likely to produce the desired effect.