Research is often decisively influenced by unexpected encounters and serendipity, for which we should be thankful. One of those happened in October 2016, as I had just arrived in Mozambique to do my first fieldwork. My PhD research was to analyse the technology transfer from Brazil to Mozambique to install a generic medicine factory to produce antiretrovirals and other essential drugs near the capital Maputo. This cooperation project was officially launched in 2003 but still ongoing when I started my research. I was interested in the present as much as into the recent past to document the steps of the unfolding project.
One night, as I sat for diner with the family of the friend I was staying with, I was surprised with their enthusiasm hearing about my research. They immediately had a recommendation: “You should talk to Helder Martins.” They explained he was Mozambique’s first Health Minister just after independence and he had conducted a successful policy to make drugs and vaccinations accessible during the first socialist government administration (1975–1980).
Although my research focused on a project happening in the 21st century, out of politeness for the friends who were happy to get in me in touch with an important political figure and some curiosity about this history, I contacted Dr Martins. He received me warmly at his home one afternoon and had much to tell me while sipping coffee.
To my astonishment he said he was involved in the Brazilian cooperation project during the technical and economic studies mid-2000s, as an advisor to the then Minister of Health of Mozambique, to assist evaluating the generic drug factory blueprints. Why was he involved? Because during his time as Minister of Health, Dr Martins had drawn up plans to install local pharmaceutical production in Mozambique.
He told me how he and his team at the ministry of health visited several countries and exchanged on the possibility to get technology and training from them. Because of socialist solidarity links, they went to Yugoslavia and Hungary, who were then, as Martins defined, the pharmaceutical hubs for the COMECON (Council for Economic Assistance of the Eastern Bloc, founded in 1949). The Mozambicans also visited Cuba, asked the World Health Organization for technical aid and got support from the Swedish cooperation to try a private investment joint venture, showing a lot of the famous Mozambican pragmatism.
As I listened to Martins, I became aware that to understand the present-day drug factory installed with Brazilian help and funding, I had to turn my gaze into the past. To Mozambique’s rich history of links and experiences with physicians and health experts’ networks from socialist countries and progressive western movements. While researching this history and its continuities to the present-day South-South Cooperation between Brazil and Mozambique, I grew convinced that several historical threads deserved to be unfolded to understand the experiences of African countries’ health policies, caught nowadays with Global Health programmes. One important Mozambican scholarly book on HIV/AIDS policies funded by international donors is called provocatively Tabula Rasa. The author, the anthropologist Cristiano Matsinhe reminds us that nothing takes place in a vacuum: histories, values and culture shape ideas and actions.
Coming from social studies of technologies on pharmaceuticals, the questions driving my research on a recent drug factory were very similar to the questions and drivers of drug factories in the 1970s. Why create local drug production capacities? In what ways does it answer public health needs or developing needs, or both? How to create capacities and capabilities in a country with few or no industries? What kind of knowledge and technology are required? Who can provide this knowledge? How does local production of drugs fit in a health system’s priorities and constrains? What kind of imaginaries on health and technology drive these actions? But looking comparing the specificities of the 1970s context and today’s helped understand trajectories and decision-making.
As Martins told me, not unlike many third-world countries producing drugs locally was strategic for Mozambique then and still are for Global South and North countries alike. Since the 1950s, countries other than the original western European hub of chemical-pharmacy were investing on or inciting projects to install local drug factories. Many had left leaned or socialist orientations that combined access to health and economic development to foster local pharmaceutical production. Today’s “pharmacy of the world”, India, famously started its state-owned company with Soviet pharmaceutical assistance. Others developed outside the socialist networks: Brazil under a right-wing military dictatorship invested in creating a network of state-owned pharmaceutical laboratories in the 1970s, which laid the capacities offered to the Mozambican thirty years later.
Simple life-saving drugs were expensive, mostly produced and patented by Western multinationals (spoiler alert: many still are, for example insulin in the United States). These companies have a monopoly on the knowledge on how to produce and control the quality of drugs, and on how much these actions cost. Multinational’s marketing is driven by the need to make profits, not necessarily to the health needs of a country and its population. Knowledge is also fundamental to the registration and local quality control of drugs.
To be able to produce locally, especially in generic form (i.e. non-patented drugs), aims to reduce costs, have more autonomy over supply and align drug production with health needs (ex: producing for neglected diseases). The learning process also benefits the regulation and the quality control process. Knowing how much it cost to produce drugs contributes to the capacity of Health Authorities to negotiate prices with Drug companies. Beside health access, producing drugs locally was also a matter of economic development. It participates in the improvement of local industries, not only pharmaceutical but auxiliary products and services (packaging, maintenance…). Local production also foster training and improving capacities of high-skilled professionals (pharmacists, chemists, engineers…) but also of all skilled workers (machine operators, electricians, laboratory assistants).
Entering this history through medicines allows casting light on many crucial aspects of health, economic development, and the knowledge and technologies required to successfully incorporate them and how these circulated. Indeed, Martins not only acted to create new pharmaceutical policies inside Mozambique linking with other countries’ experiences, he also participated actively in the debates at the WHO around the Essential medicines list in the late 1970s. Following Martins and the Mozambican and international actors he interacted with allows us to better understand how policies and international programmes were negotiated in a time of intense fights between North and South over the priorities of health and its relation to markets. Shifting my socio-anthropological toolbox to inquire on the history of those entanglements and their legacies in today’s geographies of drug production is the starting point for my research at the ERC Socialist medicine.
This website is part of a project that has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Grant agreement No. 949639)