Patents and pills, power and procedure: The North-South politics of public health in the WTO

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Developing countries have limited control over the distributional and substantive dimensions of international institutions, but they retain an important stake in a rule-based international order that can reduce uncertainty and stabilize expectations. Because international institutions can provide small states with a potential mechanism to bind more powerful states to mutually recognized rules, developing countries may seek to strengthen the procedural dimensions of multilateral institutions. Clear and strong multilateral rules cannot substitute for weakness, but they can help ameliorate some of the vulnerability that is a product of developing countries’ position in the international system. This article uses the contemporary international politics of intellectual property rights (IPRs) as a lens to examine North-South conflicts over international economic governance and the possibilities of institutional reform. Lacking the power to revise the substance of the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), developing countries, allied with a network of international public health activists, subsequently designed strategies to operate within the constraining international political reality they faced. They sought to clarify the rules of international patent law, to affirm the rights established during the TRIPS negotiations, and to minimize vulnerability to opportunism by powerful states. In doing so the developing countries reinforced global governance in IPRs.

Ken Shadlen is lecturer in development studies at the London School of Economics. He is the author ofDemocratization without Representation: The Politics of Small Industry in Mexico (Penn State University Press, 2004). His work on the politics of intellectual property has appeared inWorld Economy, and is forthcoming inInternational Studies Quarterly, Journal of International Development, andReview of International Political Economy.
In preparing this paper I have benefited from discussions of the material with a number of people, including Tom Callaghy, Meghnad Desai, Tim Dyson, Christopher Garrison, Marcus Kurtz, Susan Martin, Christopher May, Monique Mrazek, Andrew Schrank, and Robert Wade. I also wish to thank the journal’s reviewers for their helpful and constructive comments. Financial support was provided by STICERD, LSE.