The Inverse Boomerang Pattern: the Global Kaletra Campaign and Access to Antiretroviral Drugs in Colombia and Ecuador


This paper examines a global campaign in which transnational advocacy networks challenged the monopoly rights of Abbott Laboratories over the antiretroviral drug Kaletra. It focuses on the cases of Colombia and Ecuador and analyzes the different trajectories of the campaign in the two countries and how each trajectory contributed differently to the global outcome. In both of these cases, I show that activism operated in an “inverse boomerang” pattern, by which an international NGO reached out to local allies to expand its global coalition, prioritizing its agenda over other domestic considerations. I argue that in cases where transnational campaigns are initiated globally, there is a potential mismatch between global and domestic goals and that the campaigns’ contribution to global norm-making depends on the type of relationship established between international advocates and domestic actors. Such relationships are in turn influenced by the political and economic context and the institutional arrangements of each country.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Compulsory licensing is a legal flexibility included in the WTO agreement on intellectual property—Trade-Related Aspects of Intellectual Property Rights (TRIPS)—by which, without the patent holder’s consent, the government allows a third party or a government manufacturer to commercialize a patented invention.

  2. 2.

    The Doha Declaration addresses concerns by developing countries’ governments about the implementation of IP rights and their effect on access to medicines. At Doha, government ministries agreed that the TRIPS Agreement should not prevent member states from using TRIPS flexibilities to protect public health.

  3. 3.

  4. 4.

    Examples of NGOs involved in the GKC are Conectas in Brazil, FTA Watch in Thailand, and Ifarma in Colombia, examples of HIV movements are the Brazilian Interdisciplinary AIDS Association, the Thai Network of People Living with HIV/AIDS, the Ecuadorian Coalition of People Living with HIV, and the Colombian Network of People Living with HIV.

  5. 5.

    Yearly health-care coverage data from Así Vamos en Salud, accessed January 20, 2015,

  6. 6.

    Public Citizen, “Public Health Groups Launch Global Campaign Against Abbott Labs’ Monopoly on Critical AIDS Medicine” [Press release], November 9, 2011, accessed February 23, 2014,

  7. 7.

    “Kaletra - Abbott’s Abusive Practices,” Public Citizen, accessed February 28, 2014,

  8. 8.

    Peter Maybarduk from Public Citizen (referring to a 2008 protest against Abbott for its practices in Colombia), during a forum on “pharmaceutical patents and public health,” Universidad de los Andes, December 7, 2012.

  9. 9.


  10. 10.

    “Governo e laboratório fazem acordo para reduzir preço de medicamento,” Folha de São Paulo, January 31, 2002, accessed February 28, 2014,

  11. 11.

    At the time, the working group comprised several Brazilian civil society groups and two international organizations. Some of the domestic groups represented people living with HIV—e.g., the Brazilian Interdisciplinary AIDS Association, the Group for the Incentive to Live, and the Support Group for AIDS Prevention. Other domestic groups—e.g., Conectas, the Brazilian Institute for Consumer Protection, and the National Federation of Pharmacists—were fighting for access to medicines more broadly. The two international organizations taking part in the group were Oxfam and Doctors Without Borders, in addition to a number of activists and researchers. Today, Oxfam is no longer part of the working group. See

  12. 12.

    Henry J. Kaiser Family Foundation, “Abbott Lowers Price of Antiretroviral Kaletra in Brazil; Government Drops Threat to Break Patent,” The Body, July 11, 2005, accessed February 28, 2014,

  13. 13.

    “GTPI questiona extensão de monopólio indevido que dificulta acesso a medicamento essencial para o tratamento da Aids,” CONECTAS Direitos Humanos, accessed February 23, 2014,

  14. 14.

    “No INPI,” De olho nas patentes, accessed February 23, 2014,

  15. 15.

    “Letter from 35 Members of Congress to USTR criticizing the placement of Thailand on the ‘priority watch’ list.” Public Citizen, June 20, 2007, accessed February 28, 2014

  16. 16.

    “Outrage grows at US trade pressure.” The Nation, May 3, 2007, accessed February 28, 2014,

  17. 17.

    The CAN-EU Alliance produced an impact study of the FTA between the Andean Community and the European Union on the medicine markets in Peru and Colombia, based on different possible scenarios of the evolution of negotiations.

  18. 18.

    Ley de Educación Sexual y el Amor of March 27, 1998 and Ley para la Prevención y Asistencia Integral del VIH/SIDA, in 2000 (Pan American Health Organization 2003).

  19. 19.

    In 1992, these tutelas made their way to the recently inaugurated Constitutional Court, which handed down a set of audacious rulings on the justiciability of the right to health (T-484/92 and T-505/92). In these rulings, the court not only protected the plaintiffs’ right to health care but also underscored the overarching discriminatory practices against people living with HIV in Colombia (Lamprea 2013:72).

  20. 20.

    Interview with Luz Marina Umbacía. October 19, 2012.

  21. 21.

    Interview with David Morales Alba. September 20, 2012.

  22. 22.

    Interview with Francisco Rossi. January 25, 2013.

  23. 23.

    File 2009-00269-01 of the Administrative Tribunal of Cundinamarca. Case filed by the Asociacion Red Colombiana de Personas Viviendo con VIH y el Sida, Recolvih y otros.

  24. 24.

    The Mesa de Organizaciones que Trabajan en VIH/SIDA and the Red Colombiana de Personas Viviendo con el VIH (Colombian Network of People Living with HIV).

  25. 25.

    Resolución 01444 de 2009.

  26. 26.

    Circular 002 de 2009.

  27. 27.

    The recently enacted National Pharmaceutical Policy provides a diagnostic of the access-to-medicines situation in Colombia and associates the deregulation of pharmaceutical prices beginning in 2006 (Uribe’s administration) with the health-care system’s financial crisis and the dramatic increase in drug prices. Conpes 155 of 2012 (DNP and MSPS 2012).

  28. 28.

    He also accused José Miguel Vivanco, director of Human Rights Watch’s Americas division, of defending and being an accomplice of the Revolutionary Armed Forces of Colombia. Amnesty International news report “False accusations of the Colombian president against human rights groups”, November 20, 2008 (in Spanish): In June 2009, Human Rights Watch sent a letter to the US government exposing Uribe’s human rights record and asking the Obama administration to take action. Human Rights Watch, “Colombia: Obama Should Press Uribe on Rights,” June 26, 2009,

  29. 29.

    Interview with Luz Marina Umbacía. October 19, 2012.

  30. 30.

    The relationship between Public Citizen and Colombian activists was so strong that in 2012, after having realized that Ecuadorian HIV groups were not as active or effective as their Colombian counterparts, Public Citizen flew the Colombian Kaletra campaign leader to Quito so that she could share her experiences.

  31. 31.

    See a Mexican report on the simultaneous protests held in Mexico City, Chicago, and Bogota.

  32. 32.

    The radio programs were produced by Comunicación Positiva and are currently hosted at

  33. 33.

    Interview with Ministry of Health’s IP lawyer. August 29, 2013.

  34. 34.

    Carolina Gomez, forum “pharmaceutical patents and public health,” Universidad de los Andes, December 7, 2012.

  35. 35.

    Technical note delivered at the public administrative court hearing by Ifarma (on file with author)

  36. 36.

    Circular 06 de 2013.

  37. 37.

    Interview with Alejandro Giraldo, April 18, 2014.

  38. 38.

    News about this event was published by Tiempo Argentino, El Comercio, and the government newspaper El Ciudadano on August 28, 2012.

  39. 39.

    The decree cites constitutional principles as well as provisions of the National Development Plan and international agreements, including the TRIPS Agreement and the World Health Assembly’s Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property.

  40. 40.

    Interview with Peter Maybarduk, July 1, 2011.

  41. 41.

    Partial translation of the clip made by Peter Maybarduk. The complete video is available at

  42. 42.

    It is worth mentioning that the then-director of IEPI, Andrés Ycaza, had been director of the Ecuadorian Association of Pharmaceutical Laboratories.

  43. 43.

    The letter was signed by the Eurasian Harm Reduction Network; Gestos Brasil; Lawyers Collective HIV/AIDS Unit; Health Global Access Project; Mesa de Organizaciones con Trabajo en VIH/SIDA; International Treatment Preparedness Coalition–Russia; Asia Pacific Network of People Living with HIV/AIDS; Third World Network; Health Action International Africa; Health Action International Europe; Health Action International Global; Positive Malaysian Treatment Access and Advocacy Group; BUKO Pharma-Kampagne; Foundation for Consumers Thailand; Canadian HIV/AIDS Legal Network; Treatment Action Group–USA; Health Care Is Not for Commerce–LAC; Center for Policy Analysis on Trade and Health; and American Medical Student Association.

  44. 44.

    Quito, April 21, 2010,

  45. 45.

    In this respect, the ministry argues that the regulation concerning the granting of compulsory licenses requires the ministry to declare a medical emergency prior to the granting of a compulsory license. Interview with Deyenira Camacho, Martha Cava, and José Manuel Martinez, IEPI, April 20, 2010.

  46. 46.

    Interview with IFI/Promesa members, April 20, 2010.

  47. 47.

    The cables are dated October 13 and 21, 2009, and February 10, 2010. and

  48. 48.

    Interview with Carlos Durán, April 4, 2014.

  49. 49.

    Peter Maybarduk during the forum “pharmaceutical patents and public health,” Universidad de los Andes, December 7, 2012.

  50. 50.

  51. 51.

    Interview with Santiago Jaramillo, October 16, 2012.

  52. 52.

    Confidential Ministry of Public Health document (on file with author).

  53. 53.

    Interview with Carlos Durán, April 4, 2014.

  54. 54.

    Catherine Saez, “Global Fund And Tiered Medicines Pricing Under Debate,” Intellectual Property Watch, April 7, 2014, accessed May 13, 2014,

  55. 55.

    Peter Maybarduk during the forum “pharmaceutical patents and public health,” Universidad de los Andes, December 7, 2012.


  1. Andia T. Pharmaceutical intellectual property rights protection and access to medicines in Ecuador: state sovereignty and transnational advocacy networks. In: Dreyfuss R, Rodriguez Garavito C, editors. Balancing wealth and health: global administrative law and the battle over intellectual property and access to medicines in Latin America. New York: Oxford University Press; 2014. p. 195–224.

    Google Scholar 

  2. Andia T. The invisible threat: trade, intellectual property, and pharmaceutical regulations in Colombia. In Intellectual property, pharmaceuticals, and public health: access to drugs in developing countries. 2011; 77–109.

  3. Bob C. The marketing of rebellion: insurgents, media, and international activism. Cambridge University Press. 2005.

  4. Carpenter RC. Setting the advocacy agenda: theorizing issue emergence and nonemergence in transnational advocacy networks. Int Stud Q. 2007;51(1):99–120.

    Article  Google Scholar 

  5. Cawthorne P et al. Access to drugs: the case of Abbott in Thailand. Lancet Infect Dis. 2007;7(6):373–74.

    Article  Google Scholar 

  6. Chaves GC, Vieira MF, Reis R. Access to medicines and intellectual property in Brazil: reflections and strategies of civil society. Sur Rev Int Dir Hum. 2008;5(8):170–98.

    Google Scholar 

  7. Chorev N. Changing global norms through reactive diffusion: the case of intellectual property protection of AIDS drugs. Am Sociol Rev. 2012;77(5):1–23.

    Google Scholar 

  8. DNP and MSPS. Política Farmacéutica Nacional. 2012.

  9. Flynn M. Corporate power and state resistance: Brazil’s use of TRIPS flexibilities for its national AIDS Program1. In Intellectual property, pharmaceuticals and public health: access to drugs in developing countries, Shadlen KC, Guennif S, Guzman A, Lalitha N, editors. Edward Elgar Publishing. 2012; 149.

  10. Ford N, Wilson D, Chaves GC, Lotrowska M, Kijtiwatchakul K. Sustaining access to antiretroviral therapy in the less-developed world: lessons from Brazil and Thailand. AIDS. 2007;21:S21–29.

    Article  Google Scholar 

  11. Fortunak MJ, Antunes OAC. A Produção de ARV No Brasil–uma Avaliação. Rio de Janeiro: ABIA/MSF, 2006. ABIA; 2008.

    Google Scholar 

  12. Kaldor M. The idea of global civil society. Int Aff. 2003;79(3):583–93.

    Article  Google Scholar 

  13. Keck ME, Sikkink K. Transnational advocacy networks in international and regional politics. Int Soc Sci J. 1999;51(159):89–101.

    Article  Google Scholar 

  14. Keck ME, Sikkink K. Activists beyond borders: advocacy networks in international politics. Cornell Univ Pr. 1998.

  15. Klug H. Campaigning for life: building a new transnational solidarity in the face of HIV/AIDS and TRIPS. Law and Globalization from Below 118. 2005.

  16. Krikorian G. The politics of patents: conditions of implementation of public health policy in Thailand. In: Shadlen KC, Sebastian H, editors. Politics of intellectual property: contestation over the ownership, use, and control of knowledge and information. Cheltenham: Edward Elgar Publishing; 2009. p. 29–56.

    Google Scholar 

  17. Lamprea E. Colombia’s right-to-health litigation in a context of health care reform. In: Gross A, Flood C, editors. The right to health at the public/private divide: a global comparative study. Cambridge: Cambridge University Press; 2013.

    Google Scholar 

  18. Levi M, Murphy GH. Coalitions of contention: the case of the WTO protests in Seattle. Political Stud. 2006;54(4):651–70.

    Article  Google Scholar 

  19. Moon S, Elodie J, Childs M, von Schoen-Angerer T. A ‘win-Win Solution?’: a critical analysis of tiered pricing to improve access to medicines in developing countries. Online Glob Health. 2011;7:39.

    Article  Google Scholar 

  20. MSF. Untangling the web of antiretroviral price reductions. Medicines San Frontiers. 2013.

  21. Nauta W. Mobilising Brazil as significant other in the fight for HIV/AIDS treatment in South Africa: the Treatment Action Campaign (TAC) and its global allies. In African engagements: Africa negotiating an emerging multipolar world. Dietz T, Havnevik K, Kaag M, editors. Brill. 2011; 133–60.

  22. PAHO. Perfil Del Sistema de Salud de Ecuador. Organización Panamericana de la Salud. 2008.

  23. Passarelli CA, Terto Jr V. Non-governmental organizations and access to anti-retroviral treatments in Brazil. Divulg SaúdeDebate. 2003;27:252–64.

    Google Scholar 

  24. Price RM. Transnational civil society and advocacy in world politics. World Polit. 2003;55(4):579–606.

    Article  Google Scholar 

  25. Rodrigues MGM. Global environmentalism and local politics. State University of New York Press. 2004.

  26. Rodriguez Garavito C. A golden straitjacket? The struggle over patents and access to medicines in Colombia. In: Dreyfuss R, Rodriguez Garavito C, editors. Balancing wealth and health: global administrative law and the battle over intellectual property and access to medicines in Latin America. New York: Oxford University Press; 2014. p. 169–94.

    Google Scholar 

  27. Shadlen KC, Massard da Fonseca E. Health policy as industrial policy Brazil in comparative perspective. Polit Soc. 2013;41(4):561–87.

    Article  Google Scholar 

  28. Tarrow SG. The new transnational activism. Cambridge Univ Pr. 2005.

Download references

Author information



Corresponding author

Correspondence to Tatiana Andia.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Andia, T. The Inverse Boomerang Pattern: the Global Kaletra Campaign and Access to Antiretroviral Drugs in Colombia and Ecuador. St Comp Int Dev 50, 203–227 (2015).

Download citation


  • Transnational advocacy networks
  • Access to medicines
  • Compulsory licensing
  • Boomerang pattern