AIDS Drugs for All: 2013 Book

Photo: ACT UP protest at 1996 Vancouver International Conference on AIDS

Winner of the 2014 Don K. Price Award
(the APSA award for the best book on science, technology, and environmental politics)

In fall 2013, Ethan Kapstein and I published “AIDS Drugs for All: Social Movements and Market Transformations” for Cambridge University Press. It is based on our previous work for Global Policy and the Center for Global Development. An article length extension was published in International Studies Quarterly in 2016.

Below is an abstract from the opening chapter and two draft chapters as a teaser. The first sample is Chapter 1 which lays lays out our theoretical argument. The second sample Chapter 7 applies our argument to a number of other cases including malaria, non-communicable diseases, diarrheal disease/clean water, education, climate change, the elephant ivory trade, sex trafficking, and the historic slave trade.

Markets provide a mechanism for allocating goods and services, but they don’t always work in the way that political and economic agents deem to be consistent with their interests. Take pharmaceutical products, the main topic of this book.  Should drugs be allocated by free markets and priced accordingly, or should public agencies make drugs available according to some determination of need? Because the answers to such questions are open to debate—indeed, polities around the world approach the issue of access to health care quite differently—markets may become contentious, as governments, firms, and consumers all seek a hand in shaping patterns of supply, demand, and price.

This is a book about market transformations, about how social movements have inserted themselves into market processes with the objective of changing their outcomes or distributive effects. Specifically, we are interested in how the AIDS social movement was able to catalyze a profound transformation in the market for antiretroviral (ARV) medications at the turn of the millennium, from one whose business model was “high-price, low volume” to one that was characterized instead by “universal access to treatment,” meaning that everyone, everywhere should be able to obtain ARVs irrespective of the nationality or their income level. In short, ARVs were transformed from private goods into what we call “merit goods.”

How and why did that dramatic change occur in the marketplace for antiretroviral drugs? And what are the lessons for other issue-areas? These are the central questions we address in these pages, in the hope of shedding light on how and when social movements can alter market structures. Accordingly, in addition to examining the prospects for market transformation in other areas of global health, we also compare the AIDS story against a range of cases where activists have tried to influence economic behavior and outcomes, such as climate change.

Preface and Chapter 1 – Introduction: Global Markets and Transnational Social Movements (PDF)

Chapter 7 – Lessons for Other Campaigns (PDF)

Podcast of my 2014 LSE lecture

Video of Ethan Kapstein’s 2014 lecture at the Center for Global Development

Praise for AIDS Drugs for All

“One of the most profound social movements of our time was the one that pitted people with AIDS against Fortune 500 drug companies, fighting to push treatments through the R&D pipeline, and then bring their prices down to levels affordable for the entire world. Kapstein and Busby tell the saga, and offer powerful insights into why this battle was won for AIDS, but not for other global health issues. Bravo!”
Laurie Garrett, Pulitzer Prize-winning writer and Senior Fellow for Global Health, Council on Foreign Relations

“Kapstein and Busby provide the most complete and rigorous analysis of the untold story of how millions of people in poor countries obtained access to life saving HIV therapy. It will undoubtedly become a classic text.”
Peter Piot, Director, London School of Hygiene and Tropical Medicine, and former Executive Director, UNAIDS

“How can social advocacy alter the fundamental economic laws of supply and demand? The future of social entrepreneurship hangs on the answer. Kapstein and Busby offer us a fascinating study of how the market for AIDS drugs was transformed from scarce and expensive to cheap and universal. The lessons of when the conditions for such transformations are and are not met will be valuable for scholars, activists, and policymakers alike.”
Anne-Marie Slaughter, President, New America Foundation, and Director of Policy Planning, U.S. Department of State, 2009–2011

“As an integrated exegesis of a revolutionary social upheaval the book is an invaluable resource and helps define the necessary and sufficient conditions by which a large scale social transformation has arisen and might arise again in the future.”
Mark Boyd, The Lancet Infectious DiseasesJuly 2014

“In advancing a ‘theory of strategic moral action,’ Kapstein & Busby provide a detailed account of the political economy of AIDS drugs dissemination, but also offer new ways to understand social movement efforts on issues from climate change to energy development to human trafficking. In this sense, AIDS Drugs for All is political science at its best: topically relevant, theoretically broad, empirically rigorous, and morally compelling. It is a fitting homage to Professor Don K. Price.”
Manny Teodoro, Texas A&M University in announcing the 2014 APSA Science, Technology, and Environmental Politics (STEP) section Don K. Price Award

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  1. […] Busby’s blog on “The Duck of Minerva.” I am putting the finishing touches on a new book manuscript on social movements and market transformations with my co-author Ethan Kapstein. In the process […]

  2. […] and the Atlantic slave trade. In that comparative chapter, a draft of which is available here, we code these diverse cases for the likelihood of market transformation. Most of these cases were […]

  3. […] and the Atlantic slave trade. In that comparative chapter, a draft of which is available here, we code these diverse cases for the likelihood of market transformation. Most of these cases were […]