Essential and Inessential Medicines: Markets, States, and the Globalization of Pharmaceuticals, 1948–2008

This paper puts the commodification of health in global perspective by analyzing the late-20th century production, distribution, and consumption of a set of drugs deemed to be "essential medicines." These compounds by virtue of their powerful ability to transform mortality and morbidity into functions of access rather than nature, became essential to humanitarian efforts to the extent that interfering with their distribution became the equivalent of a crime against humanity. The idea of essential medicines was novel to the postwar era; its vast economic, epidemiological, political, and cultural ramifications extend seamlessly from Harry Lime's film noir penicillin ring in the 1949 classic The Third Man to the contemporary struggle to provide antiretroviral medications to confront the growing HIV/AIDS epidemic in Sub-Saharan Africa. What made a medicine essential? Initially, the World Health Organization's list favored overtly life-saving drugs addressing acute illnesses, such as antibiotics, antiseptics and anesthetics necessary for safe and successful surgeries, pain medications such as morphine, and critical care medications such as epinephrine and atropineover the course of the postwar period, the list of essential medicines came to include more drugs for chronic disease, including agents for high blood pressure, diabetes, and for the first time in 2007, a cholesterol-lowering drug was added to the list. The trajectory of essential medicine programs delineates the broad conflation of geography and history that characterizes the architecture of international development in the post-World War II era. This paper contextualizes the rising importance of pharmaceutical agents in public health and humanitarian assistance, and will explore the evidentiary, regulatory, political, and marketing structures that enable their distribution and movement. In particular, it will explore emergent tensions between public and private, global and local in the attempt to create a rational system of pharmaceutical distribution for global health from WWII to the present.