Beyond HIV in Africa: Solidification and Expansion of the Access Norm
The first decade of the twenty-first century witnessed a dramatic normative shift regarding the very nature of medicines. Medicines had formerly been conceived of as private goods-or at best national public goods-with access only guaranteed for societies wealthy enough to bear the costs of R&D and patent-based monopoly prices. However, by 2010 the idea that certain medicines should be available as global public goods-that is, goods to which all populations should have access-had arguably gained relatively widespread acceptance. The norm of “universal access to essential medicines” had become a key secondary norm for implementing the primary human rights norm of the “right to health.” Much of the debate and political mobilization for improved access centered on the AIDS epidemic and access to ARVs (‘t Hoen et al., 2011). At the same time, many developing countries and CSOs had long insisted that access to medicines was not only about HIV/AIDS or a limited group of diseases (such as infectious or tropical diseases), but rather, about access to all important medicines. However, as of this writing in 2012, the scope and depth of the norm remained highly contested beyond the widely-accepted fields of HIV/AIDS and sub-Saharan Africa. Despite clear successes in practical implementation of the access norm in the field of HIV/ AIDS, two central questions remain: (1) How stable is the norm, given predictable fluctuations in public interest, political mobilization, and the interests of powerful actors? and (2) How inclusive is the norm, in terms of both diseases and countries covered? In other words, would the AIDS crisis in Africa prove to be a beachhead for broader gains in access to medicines, or would it remain a limited exception in a world of ever-expanding intellectual property rights? This chapter examines the evidence regarding the solidification and inclusiveness of the access norm.