Coping with Counter-Mobilisation Against the Regulatory State: Insights from Pharmaceutical Regulation

How do regulatory policymakers tackle counter-mobilisation against them? The question has become even more important in recent years, as the effectiveness and legitimacy of the regulatory state have increasingly been criticised and openly contested. Drawing on the diverse literatures on bureaucratic politics and public policy, this paper examines different strategies that policymakers use to cope with political contestation against their policy production. It explores how mobilisation of the existing organisational resources shapes policymakers’ strategies for circumventing criticisms and justifying their course of actions. It also highlights the limitations of the different strategies and how they are related to regulatory change. The paper uses case studies from pharmaceutical reimbursement policies in England and France in the recent decades to illustrate how different strategies affect the trajectories of regulatory development. Characterised by a powerful industry, on the one hand, and popular criticisms on “rationing” and high-cost medicines, on the other, the sector offers an excellent opportunity to develop a theory of the regulatory state-building under pressure. The paper seeks to contribute to the literature on changes in the regulatory state and has broader implications for the theories of institutional development.