Background: Information regarding the HIV epidemic is in constant flux. New developments in biomedicine, epidemiology, and policy alternatives occur frequently. For national governments structuring responses, decisions about pursuing particular pathway and alternatives can come as the result of several factors, including, e.g., activist pressure or funding streams from IOs and NGOs. This research focuses on how bureaucracies and institutions acquire and manage new information, using it to evaluate and articulate "policy possibilities" — the process of organizational learning.
Method: I describe a theory of organizational learning appropriate to government organizations managing, directing, or contracting disease response; this allows for hypotheses about ideas and behaviors that emerge in learning organizations. I then test the hypotheses on a process-tracing case study of the Mexican government response to the country's epidemic. Drawing from policymaker interviews, scientific articles, government documents, and fieldwork observation, I tell the story of how the quasi-independent response agency CONASIDA addressed the several types of epidemics that Mexico faced.
Results: Organizational learning proves not to be unicausal. When officials intentionally engaged in a process of information prospecting and analysis, they generated more policy possibilities, and the greater number of options provided for more flexible response regimes. For example, Mexico experienced a particularly acute crisis in its blood supply. When research turned up evidence that blood donors were becoming infected, Mexican officials devised two alternative policies for remedying the problem, so that when the first was not effective, they could immediately move to the second. Had they accepted international consensus about the danger being primarily to blood recipients, HIV would have continued to spread via donors.
Conclusions: With much international focus on the implementation and monitoring of "best" practices and policies, organizational learning demonstrates that identifying and designing policy possibilities play an equal or more important role in the success and effectiveness of epidemic responses.