Globalization, pharmaceutical pricing, and South African health policy: Managing confrontation with US firms and politicians

Brewing since the advent of South African democracy in 1994 and promises of health sector transformation, an extraordinary drug war between President Nelson Mandela's African National Congress government and U.S. pharmaceutic al manufacturers took on global proportions in 1998-1999. Within months of the passage of South African legislation aimed at lowering drug prices, the U.S. government quickly applied powerful pressure points to repeal a claus e allowing potential importation of generic substitutes and imposition of c ompulsory licensing. At stake were not only local interpretations of patent law and World Trade Organization rules on Trade in Intellectual Property, but international power relations between developing countries and the phar maceutical industry. In reviewing the ongoing debate, this article consider s post-apartheid public health policy, U.S. government pressure to change t he law, and pharmaceutical industry interests and links to the U.S. governm ent, and evaluates various kinds of resistance to U.S. corporate and govern ment behavior. The case thus raises-not for the first time-concerns about c ontemporary imperialism ("globalization"), the role of the profit motive as an incentive in vital pharmaceutical products, and indeed the depth of "de mocracy" in a country where high-bidding international drug firms have suff icient clout to embarrass Vice President Al Gore by pining him against the life-and-death interests of millions of consumers of essential drugs in Sou th Africa and other developing countries.