Responding to Global Constraints and Opportunities: Access to Medicines and the Impact of Intellectual Property and Competition Rules in Post-Apartheid South Africa

This article explores how institutional changes within a state are shaped by a mixture of events, opportunities and constraints, from both within and from across the country's geographical boundaries. Focusing on the interaction between different policy demands and imperatives: from demands for medical care to the promotion of economic competition and the need to implement international trade commitments, including specific levels of intellectual property protection. Within the context of South Africa's democratic transition and HIV/AIDS pandemic, I argue that despite a strong commitment to change, to address the legacies of apartheid, and the relative strength and political will of the dominant political party, the African National Congress, the transformation of the state was significantly framed by the global environment in which the state found itself. As the state responded to a range of shifting opportunities and constraints, whether real or perceived, so impetus was given to different policies and competing political and economic factions enabling particular institutions and rules to be embraced, created, reshaped or simply foregone.