From AIDS to Free Trade Agreements: Knowledge Activism in Thailand’s Movement for Access to Medicines

Abstract

This article examines the movement for access to medicines in Thailand, a country that is a privileged site of observation of the new world order of pharmaceuticals and has been at the forefront in many international negotiations on intellectual property. The movement relies on the appropriation of knowledge and expertise about intellectual property laws, which developed in the context of the fight against HIV/AIDS. Treatment activism in Thailand is particularly vigorous and studying it allows us to grasp both the national and transnational dimension of this type of collective action: a global movement that is structured around the notion of "access to medicines," and is in close but rather orthodox relation to medical knowledge. The relations that one can draw between AIDS activism and the movement for access-to-medicines allows one to trace the origins of the latter and helps us understand key features at the core of this movement. But the analysis also shows that, from the outset, the access to medicines movement in Thailand developed through a new form of activism. The notion of knowledge activism is developed in this paper to seize the particularities of the activism at play in Thailand as compared with other forms of collective action relying on the use of knowledge. Knowledge activism is defined not only by the activists' relation to knowledge--authoritative and institutionalized knowledge, or lay expertise--but also by the inclusion in the movement of "expert activists" such as doctors, lawyers, or academics, together with "grassroots activists." Knowledge activism also implies a permanent circulation of knowledge and information between the various categories of actors involved inside, outside and on the fringes of the movement, and results in a hybrid form of collective action that develops beyond the movement and is constantly reconfigured, according to opportunities or pressures.

Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy

“…Our analysis shows that, since the WTO Doha Declaration on TRIPS and Public Health, access to medicines has become an established frame in many high, low, and middle-income countries and in global debates, which has influenced media reporting and public opinion. Furthermore, economic framing on the costs of medicines has been used in a supportive way in different contexts [ 10 , 23 , 37 , 71 , 80 ], benefiting from the dominant neoliberal paradigm. The studies demonstrate that evidence remains important, but must be translated so it is readily understood by policy actors.…”

“…Seven studies found that economic evidence (i.e. the costs and economic benefits) was used to elevate health goals – particularly in trade disputes regarding tobacco [ 67 , 68 ] and in supporting prioritisation of access to medicines in trade negotiations [ 10 , 23 , 37 , 71 , 80 ]. One study highlighted the generation of public opinion data commissioned by NGOs as influencing EU members of parliament not to support stringent IP measures in the ACTA agreement [ 73 ].…”

“…Finally, the importance of translating evidence for a wider public audience was highlighted explicitly in two studies of trade negotiations where LMICs, such as Thailand and Brazil, successfully defended access to medicines concerns [80][81][82]. Likewise, one study reported that the lack of translation of evidence was a barrier to health goals [56].…”

“…Twenty-one studies identified leveraging exogenous factors outside trade policy processes as a factor that influenced media and public opinion, particularly in trade negotiations [37,39,46,47,49,53,55,58,62,63,65,66,71,80,87,89,92,93,[95][96][97]. Exogenous factors included the rise of HIV as a health and security crisis to draw attention to the issue of access to medicines [87,92,93,95], concerns over product dumping to advance prioritisation of nutrition in domestic trade-related policymaking [39], and concerns over food pricing and global harvest levels to advance food security on the agenda at the WTO [62].…”

On the Multiplicity of Lay Expertise: An Empirical and Analytical Overview of Patient Associations’ Achievements and Challenges

“…The third topic that might be worth exploring is the circulation of certain models of patient activism developed mainly in Western Europe and North America to other regions of the world. Studies on transnational activism show how coalitions of patient associations or activist groups engage in the production and/or discussion of knowledge and expertise in different condition-areas (Krikorian 2017;Rabeharisoa and O'Donovan 2014). It might be interesting to extend studies on how these coalitions situate themselves vis-à-vis large non-governmental and philanthropic organizations which are particularly active in certain regions, and how these coalitions give shape to expertise drawn on concerned people's experiences (if they do).…”