Introduction

With ever greater frequency, non-state and supra-state actors are defining the struggle for claims to health, specifically access to medicines that permit individuals to live longer, higher quality lives. Non-governmental organizations (‘NGOs’), including the Treatment Action Campaign, Knowledge Ecology International, ACT UP and Médecins Sans Frontières (‘MSF’ or ‘Doctors Without Borders’) have revolutionized advocacy on the national and international stage, most dramatically with respect to antiretroviral drugs used to combat HIV/AIDS. Equally important, brand and generic pharmaceutical manufacturers have come to play an increased role in the development of global rules and incentives for production. Large philanthropic foundations, specifically the Bill & Melinda Gates Foundation and the William J. Clinton Foundation, have promoted bulk purchasing, preferential pricing and the rollout of antiretrovirals to developing countries and communities in need. Many large research universities, themselves the recipients of public funding, are engaged in multi-faceted licensing agreements. The Global Fund for AIDS, Malaria and Tuberculosis (‘the Global Fund’), for its part, operates as a public–private partnership. In turn, the Global Fund is championed by Jeffrey Sachs, Bono and other celebrity supporters of the (RED) Campaign, advisers and advocates perhaps, but otherwise quintessentially non-governmental actors.

This chapter examines the role of certain non-state actors in the struggle to increase access to essential medicines. As an illustration of that effort, I rely on the global campaign (usually spearheaded by national or sub-national NGOs) to ensure that people living with HIV/AIDS (‘PLWHA’) obtain antiretrovirals.