Access to medicines, market failure and market intervention: a tale of two regimes

To date, much of the academic and policy literature has focused on the impact of intellectual property rights (IPRs) on the governance of access to medicine, and in relation to various property rights associated with the regime governing international trade, and other associated bilateral and regional agreements. The paper rehearses how IPR/trade regime has generated particular sets of problems for access to medicines. At the same time, the growth of new actors in global health, and their specific roles in the global governance of access to medicines, has in contrast received limited attention with respect to their role in access. These new actors include Global Health Partnerships (such as GAVI and the Global Fund), major philanthropic foundations (such as the Gates and Clinton Foundations) and new access initiatives (such as UNITAID). The paper problematises these actors’ governance roles with respect to the overarching authority of the IPR/trade regime. It argues that new actors and initiatives can be described as a ‘pro-access regime,’ concerned with widening access to medicines, and that, contrary to popular and political understanding of these agencies wider role in global health, their baseline functions are to intervene in a dysfunctional global drug market.