Contemporary Sociology: A Journal of Reviews | 2021
Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa
Abstract
The first two decades of the twenty-first century have seen remarkable shifts in the role of foreign aid for international development. Extraordinarily large new funds for health were created by the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Innovative global metrics for development were implemented through the Millennium Development Goals and later the Sustainable Development Goals. In addition, the West’s near hegemony in foreign aid to poor countries has been significantly challenged by the rise of China as a powerful, proactive new player in development. Yet even with these significant changes in the landscape of development, debates about the value of foreign aid have often remained mired in a polarized, and rather tired, debate. At one pole is economist William Easterly’s position, most clearly articulated in his The White Man’s Burden, that foreign aid is hopelessly flawed by the hubris of western planners who impose their vision with little consultation with poor countries. Economist Jeffrey Sachs in The End of Poverty stakes out the opposite pole with his full-throated call for massive increases in foreign aid to get poor countries out of their poverty traps. Nitsan Chorev, in contrast, provides a much-needed sociological perspective on foreign aid that fundamentally shifts the terms of the debate. At the heart of Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa is the question of how, not if, foreign aid can benefit poor countries. As Chorev deftly reveals, the question of how is not only more sophisticated and interesting but vital for leveraging the true power of foreign aid to improve the lives of billions of supposed beneficiaries. In her compelling book, our attention is effectively reoriented away from how much foreign aid to what conditions make aid an effective catalyst for development— what Chorev terms ‘‘developmental foreign aid.’’ Give and Take examines this central issue through a case that may strike some as niche: pharmaceutical production in East Africa. Yet Chorev makes clear why a focus on drug production is so useful and how a comparative analysis of three East African countries provides much analytical insight into when aid is, and is not, developmental. With regard to the focus on drug production, Chorev notes that economic issues are receiving renewed attention by western policy-makers, spurred in part by East Asian donors’ interest in funding infrastructure and industrialization projects. The pharmaceutical production sector, Chorev argues, is a particularly interesting case of upgrading an industrial sector because it requires significant technological innovation that could help a poor country rise up the global commodity production chain. In addition, and of more significance to sociologists of development, pharmaceutical production is not just about industrial production but about a fundamental social objective of development, namely health. The ability to produce essential medicines is both a reflection of a country’s economic development and a core component of ensuring citizens’ well-being. As Give and Take reveals, a focus on this sector helps us see how foreign aid can produce both synergies and tensions between economic and social development. The comparative analysis of the emergence and upgrading of the pharmaceutical sectors in Kenya, Tanzania, and Uganda is at the center of this book, and it proves exceptionally rich, empirically and analytically. The analysis spans four decades (plus important insights on the colonial and early postcolonial periods) and focuses primarily on the experiences of key companies in the three countries. Through over two hundred interviews with firm founders and managers, government Reviews 221