Global or international health was in the post-colonial decades by large understood as health related activities in developing countries founded by donors in the developed world. We are currently witnessing a seminal shift in power between the world´s countries. Middle-income countries (MICs) like China, India and Brazil have in the past decades become increasingly wealthy, and concomitantly raised their political importance globally. There has been a substantial academic interest to explore and reflect upon how changes in global powers are affecting global population health. “Access to medicines” is highlighted as one area where the BRICS (Brazil, Russia, India, China and South-Africa), including other MICs in the South like Thailand and Indonesia, have played a progressive role. Today, about 80% of donor-funded HIV/AIDS medications are produced in India.
Currently many MICs face a complex situation when it comes to access to medicines, public health and increased wealth. First, high income countries pressure them to implement gradually stronger intellectual property protection, mostly through bilateral free trade agreements. Second, the majority of the world's poor live in MICs, and MICs have vast unmet needs for healthcare including better access to patented medicines. Some MICs like the BRICS have presented a strong rhetoric when it comes to South-South solidarity addressing medical needs also in low-income countries (LICs). Third, pharmaceutical innovation leads to new drugs that can save lives, but that are too expensive for most patients in LICs, even in emerging MICs. Currently prices and patents on drugs for treating non-communicable diseases (NCDs) , as well as other infectious diseases like hepatitis, are attracting political controversies, and it is uncertain whether access to these drugs will follow the HIV/AIDS trajectory.
We believe that there is a need for empirical research on domestic and global health policies of powerful states in the global South to understand the future of global health. We set out to study three MICs; China, India and Brazil, to explore how these countries shape access to medicines in LMICs, specially patented drugs.