Making Markets for Merit Goods: The Political Economy of Antiretrovirals

Why were AIDS activists successful in putting universal access to treatment on the international agenda when so many other global campaigns have either failed or struggled to have much impact? We focus on: (1) permissive material conditions; (2) convergence on a policy prescription; (3) attributes of the activists; and (4) the broad political support for their cause. In our view, the market for antiretroviral (ARV) drugs was politically constructed; activists had to bring the demand and supply sides of the market together through a variety of tactics and strategies. The idea that motivated the activists was that ARVs should ideally be 'merit goods', goods that are available to everyone regardless of income. But, when ARVs first came on the market, poor people in the developing world lacked the resources to buy them. Activists successfully lobbied donor nations to use foreign aid to buy ARVs, and they pressured pharmaceutical companies to lower their prices, while encouraging generic firms to enter the market. However, even where a policy enjoys favorable material conditions - i.e. low costs, large benefits, demonstrated feasibility - this may not be enough. A clear prescription, credible messengers and resonant arguments may be necessary for an issue to receive adequate political support.