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The Trade Related Intellectual Property Agreement (TRIPS) has had a profound effect on industrialization and innovation, as well as access to medicines in cases of public health crisis such as HIV/AIDS. However, compliance with TRIPS has varied in developing countries, despite heightened international pressure. For instance, Brazil has pursued a coherent approach to its HIV/AIDS health crisis, while India has failed to take care of its HIV patients despite late compliance with the TRIPS agreement and the presence of business firms that produce the generic medicines for HIV/AIDS. This article suggests that divergence in TRIPS compliance is the result of a linkage politics, in which global variables (global rules, global supply chains and global networks) reach into the domestic political economy to alter the interests and capabilities of domestic actors. Indian pharmaceutical firms have developed external and export interests that lower incentives for the Indian state to design a nationally relevant public health policy, while the Brazilian health movement with its societal and external linkages puts pressure on the Brazilian state to defend the interests of its HIV patients even at the cost of patents. We conclude by suggesting that linkage politics is better at helping us understand compliance with international agreements than existing explanations, with important consequences for the effectiveness of international institutions.

Linkage Politics and the Persistence of National Policy Autonomy in Emerging Powers: Patents, Profits, and Patients in the Context of TRIPS Compliance