Access to Medicines Activism: Collaboration, Conflicts, and Complementarities

This chapter address three phases of access to medicines [A2M] advocacy. The first phase started in the late 1990s and continuing into at least the mid 2000s when global cooperation and collaboration between A2M advocates grew as they confronted the terrible scourge of HIV compounded by the refusal of pharmaceutical companies and rich country governments to take measures to increase affordability of newly effective ART. After some significant victories in securing lower prices and gaining access to off-patent generic ARVs, the second phase, starting in the mid 2000s, focused on using a plethora of access strategies to overcome or bypass patent monopolies on medicines and to resist Big Pharma and rich government pressure to increase IP protections and to cease use of TRIPS flexibilities. Unfortunately, during this phase fractures developed in the A2M movement about the comparative advantages and potential complementarity of voluntary licensing with other access strategies — most especially patent oppositions. In the third phase, as activists turned to new diseases and new issues like delinkage and transparency and to international high-level forums and drug pricing campaign in rich countries, new tensions have arisen about the impact of these activities on the historical global health justice issue of ensuring affordable and equitable access to existing medicines in LMICs. Although truly monumental efforts have resulted in dramatic improvement in access to medicines, the path forward will be complicated and contested.