Institutional overlap and access to medicines in MERCOSUR and UNASUR (2008–2018). Cooperation before the collapse?

ABSTRACT

The proliferation of international and regional organisations in the last decades led to increasing overlap of memberships and mandates in social policy areas. Whereas the literature has explored the benefits and perils of institutional overlap though neglecting the social policy dimension of such processes, studies on regionalism have focused on single cases of regional organisations. This paper breaks new ground by examining the effects of the overlap in membership, health mandates and institutional mechanisms between the Common Market of the South (MERCOSUR) and the Union of South American Nations (UNASUR) between 2008 and 2018. It focuses on two cases of access to medicines: the creation of the medicine price bank and the price negotiation of high-cost medicines. Our argument is that the overlap was positive, leading to an incipient trend towards cooperation. This was facilitated by the membership structure, the expertise already accumulated in the region and the relations and networks among those involved in health regional cooperation. Overall, the article deepens our understanding of the conditions under which regional organisations, even in the context of institutional overlap, can contribute to adequately respond to transnational challenges, which, as global health, are not only persistent, but also profoundly affect our societies.

KEYWORDS:

• Global health
• Regionalism
• Institutional overlap
• MERCOSUR
• UNASUR

Acknowledgements

We especially thank Anna van der Vleuten for her comments on an earlier version of the paper, as well as the editorial board and two anonymous reviewers of Global Public Health for their excellent suggestions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Regional cooperation in health goes back to the late 19th century. The Pan-American Health Organization (PAHO) is the world’s oldest international public health organisation; it was founded in 1902 and was incorporated into the Inter-American System as a specialised health agency after the creation of the Organization of American States (OAS) in 1948. It also serves as the Regional Office for the Americas of the World Health Organization (WHO). In 1971, the Meeting of Ministers of Health of the Andean Region (REMSAA), under the then Andean Pact, created the Andean Health Organization (Organismo Andino de Salud - Convenio Hipólito Unanue / ORAS CONHU) to promote health through the coordination and support of the actions of member states. ORAS CONHU is set up as an intergovernmental body, bringing together Bolivia, Colombia, Chile, Ecuador, Peru, and Venezuela. It works under the direction of REMSAA, which is also responsible for the election of the Executive Secretary of the ORAS CONHU. These add to other regional organisations that have incorporated a health agenda, and which comprise the Andean Community, the Amazon Cooperation Treaty Organization (ACTO), the Central American Integration System (SICA) and the Caribbean Community (CARICOM).

2 See also Malamud and Gardini (2012).

3 Venezuela was suspended for failure to implement MERCOSUR obligations, including commitments to democracy.

4 There are 11 IC working on tobacco control, blood and blood products, implementation of the International Health Regulations (IHR), food and nutrition security, donation and transplants, price negotiation of high-cost medicines, medicines policy, sexual and reproductive health, no communicable diseases and environmental and worker’s health (MERCOSUR/RMS/AGREEMENT N° 05/18).

5 Personal interview with legal counsel and representative, Argentine Ministry of Health in MERCOSUR and UNASUR, Buenos Aires, 13 August 2018. See also ICSID Award, ‘Philip Morris Brands Sàrl, Philip Morris Products S.A. and Abal Hermanos S.A. v. Oriental Republic of Uruguay, ICSID Case No. ARB/10/7 (formerly FTR Holding SA, Philip Morris Products S.A. and Abal Hermanos S.A. v. Oriental Republic of Uruguay), retrieved July 27, 2020 from https://www.italaw.com/sites/default/files/case-documents/italaw7417.pdf.

6 Coello, C. ‘Crean el banco de precios de medicamentos de Unasur’, edicionmédica, Retrieved July 29, 2020, from https://www.edicionmedica.ec/secciones/gestion/crean-el-banco-de-precios-de-medicamentos-de-unasur-89131.

7 MERCOSUR, ‘Medicamentos más baratos para el MERCOSUR’. Retrieved July 29, 2020, from https://www.mercosur.int/medicamentos-mas-baratos-para-el-mercosur/.

Additional information

Funding

This article is part of the project ‘Regional social regulation in Latin America: A new agenda for development? Prospects and challenges (SociAL-Reg), which is funded by the Ministerio de Economía y Competitividad, Gobierno de España (CSO2015-66411-P, MINECO/FEDER).