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GLOBALMED Report Summary

Project ID: 337372
Funded under: FP7-IDEAS-ERC
Country: France

Mid-Term Report Summary - GLOBALMED (Artemisinin-based combination therapy: an illustration ofthe global pharmaceutical drug market in Asia and Africa)

The GLOBALMED research program concerns the global pharmaceutical market, an ideal window into studying contemporary societies and understanding how and why they change. It proposes to study the realities affecting this market, both in terms of supply (public policies, production, distribution) and demand (uses, consumption) in 3 countries in the South (Benin, Ghana, Cambodia) with very different pharmaceutical systems. Theoretically, this project is aimed at comparing the phenomenon of the global pharmaceutical market with analyses of economic and political (neo)liberalism. In this regard, Artemisinin based Combination Therapies (ACT), recommended first-line treatment for malaria since the 2000’s was chosen as the door of entry. The project is a multidisciplinary one combining Anthropology, Sociology and Epidemiology to provide an integrated view of the “pharmaceutical chain”, from the point of production to consumption. The research team is constituted by PI, Carine Baxerres, and 5 other researchers (1 from Benin, 1 from Ghana, 3 from France) and Beninese, Ghanaian, Cambodian and French students and research assistants (4 PhD, 5 Masters, 7 research assistants).
Since 2014, empirical studies concerning pharmaceutical markets and their effective modes of regulation have been initiated in the 3 countries. Individual and public health impacts of these markets on pharmaceutical consumption are investigated. The project in its mid-term period and with the commencement of data analysis, innovative and in-depth results have emerged in 5 important areas:
1) Pharmaceutical markets, the issue between public health and business: typology of involved actors, hierarchy of markets, cross-border products circulation, modalities of competition, stakes arising from the monopoly of pharmacists;
2) Construction of political apparatuses in the South, between dependence and taking of leadership: interactions between national, regional and transnational actors, mechanisms of ACTs provision, regulation and control of markets’ tools, structuring of national regulation agencies;
3) Stakes and revival of local production in Africa: history of local production, typology of involved firms, debate on local productions viability in terms of production costs and manufacturing and quality standards;
4) Health systems’ Pharmaceuticalization: diversity of the biomedical offer (public, community, private, denominational, informal), modalities of prescriptions, accessibility and availability of pharmaceuticals, impact of health insurance implementation;
5) Pharmaceutical consumption under influences: construction of popular knowledge, perceptions of pharmaceuticals (origin, quality, effects), kinds of developed uses (self-medication), influence of producers and distributors.
The description and analysis of these questions benefit from the comparison of the current situations in the 3 countries in relation to their historical postcolonial situations. GLOBALMED will underline tensions existing between Globalization, through the donors and global market regulators (WHO, Global Fund, USAID, etc.) and Localization of markets and productions, through numerous private and informal wholesalers and retailers, local firms which are renewed and strengthened national and regional regulation apparatuses. Additionally, it will highlight the gaps and adjustments between global health policies promoting subsidized markets through the distribution of volumes of pharmaceuticals whose usage most often than not are not guided by biological tests, and local uses shaped by domestic networks and markets in a context of low biomedical or pharmaceutical prescriptions practices. With regard to malaria, Pharmaceuticalization is produced at the same time by WHO recommendations, Global Fund financing and regulation, strong influence of the local markets entrenched by a low pharmaceutical regulation and subjectivities of consumers and prescribers.

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