PROVIDENCE, R.I. [Brown University] — Nitsan Chorev, the Harmon Family Professor of Sociology and International Studies, has spent much of her academic career writing on the politics of globalization and global institutions. Most recently, she’s focused on global health issues, and in her current project she analyzes the emergence and recent trajectory of the pharmaceutical industry in East Africa. The spring 2015 recipient of the Presidential Faculty Award, Chorev will present a lecture titled “Making Medicine in the Global Periphery: Pharmaceutical Production in Kenya, Tanzania, and Uganda” on Thursday, April 2, 2015. The lecture takes place in the John Hay Library Reading Room at 4:30 p.m. It is free and open to the public.
Chorev spoke recently with Courtney Coelho about her current work.
What got you interested in the East African pharmaceutical industry?
My most recent book [The World Health Organization between North and South (Cornell University Press, 2012)] is about the World Health Organization. It analyzes various moments in the history of global health politics. One debate that attracted my attention was access to medicine in poor countries. The spread of AIDS, in particular, brought tense debates over how to allow better access to affordable medicines given patent protection of pharmaceutical products.
Even after finishing the book, I kept thinking about the issue but wanted to take a different angle. In particular, I wanted to see how this issue is experienced not at the policy level but on the ground. I began the project by looking at drugs made in India and imported to African markets, but I soon realized that there were local manufacturers in Africa as well. And this turned into my main question: How to explain the emergence of drug manufacturers in East Africa and their trajectory over time.
How did you research these questions?
I first went to India and looked for those pharmaceutical companies that export their drugs to East Africa. I found many such companies, but I also immediately realized that if I wanted to study Indian drugs in Africa, I should go to where the drugs are. So I went to Kenya, Tanzania, and Uganda and talked with more than 200 people involved in the pharmaceutical industry there. I interviewed local manufacturers of drugs, importers and distributors of drugs, and government officials who are responsible for registering the drugs or for procuring them. I also talked with NGOs and representatives of international organizations. This is how my interest expanded from imported drugs to also locally manufactured ones. I also conducted archival research at the World Health Organization.
What contributed to the emergence of the industry in East Africa?
One of the things that caught me by surprise is the role of foreign aid. Paradoxically, I started this project because I wanted to get away from studying international policies, but eventually I could not avoid it. I found in my research that foreign aid contributed to the emergence of a pharmaceutical industry in East Africa, not so much by directly promoting local manufacturing but indirectly — by creating markets for drugs that local manufacturers could take advantage of. The same thing happened in the 2000s, when foreign donors indirectly provided incentives to companies to invest in more expensive and sophisticated drugs. Another issue I’m analyzing is the contribution of Africans of Asian descent to the emergence of a pharmaceutical industry in East Africa.
Did the emergence of the market improve access to medicine in the area?
Access is not only about the availability of cheap drugs, but also of drugs that are of good quality. Sometimes there is tension between the two goals because the better the quality, the more expensive the drugs are going to be. Local drug manufacturers in East Africa do improve access to medicine not necessarily because they provide affordable drugs — which, after all, could be imported — but because they are more likely than imported manufacturers to bring their drugs to the more remote areas in the country. But this leaves aside the question of quality. One could conclude that if the quality of local drugs is not sufficiently high the companies should be closed down. But this will have a negative impact on access to drugs. Alternatively, one should look for ways to increase the quality of local drugs — and my work contributes to that debate exactly by identifying the conditions that have recently led to greater investment in quality standards across the region.