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In the late 1970s and early 1980s, it was common for both foreign and national observers of Brazil to lament the weak state of the pharmaceutical industry. Despite the extensive period of industrial development that the country had experienced, the production and sales of medicines, as well as the inputs for making medicines, were dominated by foreign firms. Peter Evans pointed to pharmaceuticals as a sector where efforts to create local industrial capabilities were decidedly unsuccessful, a finding that was echoed by Gary Gereffi’s comparative analysis of pharmaceutical industries in the developing world (Evans 1976; Gereffi 1983). Indeed, in the early 1980s, Brazilian firms accounted for less than 20 percent of sales in the domestic retail market, with only one national firm featuring among the top 20 (ALADI 1985). The state of affairs was most aptly captured by a Ministry of Health official who concluded that “there does not exist a Brazilian pharmaceutical industry, rather there simply exists a pharmaceutical industry in Brazil” (Saraiva 1983, 169).

Much has happened in the ensuing decades. The 1980s witnessed greater state efforts to encourage “backwards integration” of the pharmaceutical industry by triggering local production of active pharmaceutical ingredients, i.e. the chemicals that are used by drug producers to manufacture medicines (Rebouças 1997). These efforts are often overlooked, because of what followed in the 1990s: liberalization and economic opening (most notably, lowering of import tariffs and revision of government purchasing practices), and the introduction of pharmaceutical patents. But the 1990s were also a period of massive expansion of health provision. Following the return to democracy and the new constitution, this period witnessed the establishment of the Unified Health System (SUS), the expansion of pharmaceutical assistance (including, notably, a globally-recognized program of universal treatment for HIV/AIDS), the creation of a national health regulatory agency, and an entirely new legal and institutional framework for generic medicines (Fonseca 2014).  

Then, in the 2000s, we have witnessed the resurgence of new industrial and innovation policies for the pharmaceutical sector, including a wide array of instruments from the national development bank and, ultimately, the establishment of the Health Industrial Complex (CIS). These policies are related to what transpired before, in that the motivations driving the establishment and implementation of the CIS were concerns about the viability of the SUS, and the health system more generally, in the absence of a dynamic and productive pharmaceutical industry in Brazil. In sum, a period in which health and industrial policies were fragmented and weak was followed by a period in which health policies advanced without industrial policies, and then, at last, health policies and industrial policies became fused (Shadlen and Fonseca 2013). 

This new book digs deep into the intricacies of the CIS to shed light on what it is, how it functions, what it has achieved, and what the obstacles are for achieving its goals. The key issue guiding all the analyses are how the CIS affects the health sector. How do the industrial, innovation, and technology policies established in the 2000s affect the viability of the SUS and the ability of the Brazilian state to fulfil its constitutionally-derived obligations to deliver healthcare?

SUMÁRIO

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Presentation 5

Introduction 17

Evaluation of technological capability and learning strategies
for biological drug production in the pharmaceutical industry 23

Ricardo Lobato Torres
Lia Hasenclever
Thiago Cavalcante Nascimento

Potentials And Vulnerabilities Of The Interaction Between Companies And Scientific And Technological Institutions
In The Pharmaceutical Sector: The Actors’ View 51

Julia Paranhos
Fernanda Steiner Perin
Bruna Cataldo
Thiago Moreira

The Phytotherapy Industry: Challenges and Opportunities Associated with the Use of Biodiversity 73

Lia Hasenclever
Cíntia Reis Costa
Julia Paranhos
Gabriel Cunha
Diego Vieira

The Medical, Hospital, and Dental Equipment
and Material Industry: Characterization and Development 99

Lia Hasenclever
Rosa Dória
Eduardo Mercadante
Caroline Miranda
Vitor Pimentel

Clusters and Innovation: Case studies of
two pharmaceutical agglomerations 139

Eduardo Braz Pereira Gomes
Lia Hasenclever
Julia Paranhos

Government strategies to reduce the price of drugs
in monopoly markets: local production and
overcoming patent barriers 179

Gabriela Costa Chaves
Maria Auxiliadora Oliveira

Strengths and weaknesses of models for the supply
and financing of drugs 209

Vera Lucia Luiza
Rondineli Mendes da Silva
Leonardo Vidal Mattos
Ligia Bahia

Institutional arrangements in equipment dependent
services for the diagnosis and therapy of cardiovascular
disease: a study of the North and Northwest regions
of the State of Rio de Janeiro 247

Maria de Fátima Siliansky
Lia Hasenclever
André Luís Almeida Peixoto

Main proposals for legislative amendments related
to the Health Industrial Complex 271

Marcela Fogaça Vieira

Authors and Coauthors 305