When access to drugs meets catch-up: Insights from the use of CL threats to improve access to ARV drugs in Brazil

Access to affordable lifesaving medicines is considered a human right. This leads to a question largely understudied in the catch-up literature on accumulation of industrial capabilities. Can the need to improve access to an essential commodity impact the sectoral catch-up trajectory of the corresponding industry? In 1996, Brazil initiated a policy of universal and free access to highly-active ARV therapy, which put an enormous pressure on the Brazilian Ministry of Health (MoH). In order to ensure an adequate supply of ARVs in the public healthcare system with a limited budget, MoH started negotiating price reductions for high-cost patented drugs, often deploying the threat of using compulsory licensing. Through a scoping review of the literature and construction of the Brazilian case study, the paper explores how the need to access is impacted by prior catch-up in the pharmaceutical sector and triggers in turn future sectoral catch-up. It shows that price negotiations may or may not impact both catch-up and access positively. Catch-up can provide bargaining strength in price negotiations and have a positive inter-temporal impact on both future catch-up and access. However, results suggest that only successful catch-up can lead to long term access, as the capabilities accumulated in aborted catch-up are not sufficient for large scale production of low cost essential medicines. Thus, industrial policy and health policy can impact one another and twining between catch-up and access can be helpful.