'Countermovements from the core: the assetization of pharmaceuticals, transparency activism and the access to medicines movement' by Théo Bourgeron and Susi Geiger in (2024) Socio-Economic Review comments
The assetization of essential goods brings to high-income countries the logics of scarcity that have been dominant for long in low-to-middle income countries—fostering the rise of new forms of activism. Will this new activism strengthen already existing social movements or weaken them through more moderate politics? Building on interviews and the observation and mapping of activist events, we investigate this question through the case of pharmaceuticals. We detail how the assetization of pharmaceutical drugs has triggered the constitution of a new ‘flank’ in the access to medicines (A2M) movement—pharmaceutical transparency activism. We argue that transparency activism has expanded the contestation of the pharmaceutical state of affairs, by bringing into the broader A2M movement countries that were previously at the core of global pharmaceutical chains. Our article illuminates how the assetization of essential goods creates forms of activism that have significant impact on existing social movements.
In May 2019, the World Health Assembly (WHA; the decision-making body of the World Health Organization) voted for an important resolution requesting all countries to increase transparency over the prices of medicines and the public funding that pharmaceutical companies receive to develop them (World Health Assembly, 2019). Although this resolution was not binding for its 194 member countries, it was claimed as a victory for an activist movement that had been campaigning since the mid-2010s for what they called ‘pharmaceutical transparency’, a struggle they found crucial to curb the increasingly high prices of new medicines (Health Policy Watch, 2019). Remarkably, this was the first time that a WHA united under the same resolution the low- and middle-income countries that had been critical of the global pharmaceutical market order for decades (e.g. Mexico, Brazil and Thailand), but also countries at the core of global pharmaceutical markets (e.g. Italy, the Netherlands and Norway), which were traditionally favourable to the interests of multinational pharmaceutical corporations. As representatives from these countries would confess themselves, this shift had resulted from their dissatisfaction of ever-rising prices for new medicines marketed by large pharmaceutical companies, itself the result of the increasingly financialized nature of these companies (Health Policy Watch, 2019). This WHA resolution therefore revealed how recent changes in the pharmaceutical sector had actually expanded the coalition of countries contesting the global pharmaceutical order.
Through the example of the assetization of pharmaceuticals and the access to medicines (A2M) movement, this article investigates the nature and dynamics of countermovements that emerge to contest the assetization of essential goods. Since the 1980s, the ownership and production of pharmaceuticals have been increasingly embedded into financial markets, resulting in rapidly rising pharmaceutical prices and detrimental effects on access to medicines (Gaudilliere and Sundar Rajan, 2021). This has led to the rise of the A2M movement, with activism developing throughout the world to achieve better access to innovative medicines for patients (Baker, 2020). Recently, the vertiginous rise in prices particularly for highly innovative medicines has come to threaten access to medicines in countries that were previously spared by such issues, including in Europe (Krikorian and Torreele, 2021). Focusing on the case of the movement for pharmaceutical price transparency, we trace the rise of A2M movements in countries where such contestation was previously residual. We contend that the recent period has led to a ‘flank movement’ in access to medicines activism, with a triple shift in its orientation compared to previous forms of activism: (a) a shift from the contestation of the root causes of high drug prices to their institutional implementation; (b) from patient-led activism to state-led activism; and (c) from marginal to peripheral and even some core countries in global pharmaceutical markets (see Table 1 for a definition of these terms). We investigate the role that the assetization of pharmaceutical drugs has played in the rise of this movement and the ultimately positive impact that this movement had on the broader A2M one. ...
Our project addresses the important political issue of how assetization changes the social movement landscape. To do so, our analysis bridges two streams of literature: scholarship on assetization countermovements, which has explored how the transformation of goods into financial assets provokes the rise of new social movements that contest such processes; and radical flank theory, which explores how different forms of activism shape social movement dynamics, their objectives and their chances of success. The case of pharmaceutical price transparency activism in the broader context of the A2M movement allows us to investigate a situation where an emerging form of activism arising from the consequences of assetization affects an already-existing social movement. The conditions for the emergence and success of these movements often remain unclear, along with their ultimate political consequences.
We shed light on the ambivalent nature of such counter-‘flanks’ arising from the core of global markets, asking whether they may be more or less effective at achieving institutional or societal change than more radical countermovements that have remained at the margins. Our investigation therefore contributes to understanding how the assetization of essential goods reconfigures social movement dynamics. Beyond this theoretical argument, the ‘flank movement’ that we investigate could have considerable consequences on the space for manoeuvring of the pharmaceutical sector. It brings new groups to the A2M movement, in particular actors that are more moderate than the traditional A2M activists focused on abolishing pharmaceutical patents. It also threatens the coalition between core countries’ governments, pharmaceutical corporations and industry-friendly groups of activists and thus disturbs the ‘quiet politics’ (Culpepper, 2012) that had heretofore prevailed in this sector. In the final count, it thus fundamentally alters the ‘system of alignment’ in the pharmaceutical sector (Hartley, 2002).
In the following sections, we detail the literature on assetization countermovements and radical flank theory before introducing our case context—the transformation of pharmaceuticals into financial assets and its impact on access to medicines. After a brief description of our methods, we develop three empirical sections, which investigate (a) how the A2M movement has been traditionally divided between a radical flank in marginal countries (‘patent activism’) and a broadly cooperative one in core countries (‘patient activism’), (b) how the recent period has seen the rise of a third strand of A2M activism (‘pharmaceutical transparency’) with intermediary objectives; and (c) how this new form of activism has had an ultimately positive impact on the A2M movement, gathering NGOs and individuals from the radical flank with state agencies from core and peripheral countries into contentious activism. We close by discussing the significance of this development for the future of the access to medicines movement and its interactions with the pharmaceutical sector, and we signal the conceptual implications of our case for other assetization countermovements.
