Making Markets for Merit Goods: The Political Economy of Antiretrovirals

Abstract

AbstractWhy were AIDS activists successful in putting universal access to treatment on the international agenda when so many other global campaigns have either failed or struggled to have much impact? We focus on: (1) permissive material conditions; (2) convergence on a policy prescription; (3) attributes of the activists; and (4) the broad political support for their cause. In our view, the market for antiretroviral (ARV) drugs was politically constructed; activists had to bring the demand and supply sides of the market together through a variety of tactics and strategies. The idea that motivated the activists was that ARVs should ideally be ‘merit goods’, goods that are available to everyone regardless of income. But, when ARVs first came on the market, poor people in the developing world lacked the resources to buy them. Activists successfully lobbied donor nations to use foreign aid to buy ARVs, and they pressured pharmaceutical companies to lower their prices, while encouraging generic firms to enter the market. However, even where a policy enjoys favorable material conditions – i.e. low costs, large benefits, demonstrated feasibility – this may not be enough. A clear prescription, credible messengers and resonant arguments may be necessary for an issue to receive adequate political support.Policy Implications Global activists are playing an increasingly important role in world politics, but global activism influences policy outcomes only under certain conditions. Global activists can only succeed when they couple compelling moral arguments with permissive material conditions. Global activists need to build broad coalitions in order to be politically successful. Despite the success of the access to treatment regime, questions remain about its sustainability in light of the great recession that began in 2008, donor fatigue regarding AIDS and the emergence of other policy priorities in the foreign aid community.