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In November 2001 the World Trade Organization’s ministerial conference in Doha adopted a Declaration on the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and Public Health. The process that led to this declaration is one of the most interesting episodes in recent international economic negotiations. A coalition lacking obvious power achieved significant, unexpected gains despite careful opposition from powerful transnational corporate firms and their home governments. This paper seeks both to explain this puzzling outcome and to consider whether it suggests any generalizations that are likely to be useful in other cases as well.

Like all negotiation outcomes, this one has two dimensions: whether agreement was reached and the agreement’s terms. Given the chasm between the two camps’ perspectives, this agreement itself is surprising. Given the great power disparities, the gains of the weak are also surprising. These gains are defined relative to the status quo prior to the 2001 talks. The 1994 TRIPS agreement established obligations of WTO member states to comply with certain international rules protecting the rights of owners of patents and copyrights. Many national laws allow the government to violate patent rights under some conditions. Thus TRIPS too permitted countries to seize patents and issue compulsory licenses (for example authorizing a domestic firm to produce and sell generic equivalents of a brand name drug without permission from the foreign inventor) under “a national emergency or other circumstances of extreme urgency” and for certain other uses. Patent holders must be …