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

Abstract

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.