National policies toward intellectual property (IP) were revolutionized in the 1990s, as countries adopted new systems to conform to the World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs). TRIPS-style IP regimes make patents available for more types of knowledge, grant long periods of patent protection, and endow patent owners with strong rights of exclusion. This paper analyzes two contrasting patterns of political mobilization and pressures for change that newly-introduced, TRIPS-style regimes became subject to by the early 21st Century. Most governments faced pressures to address aspects of their IP systems regarding pharmaceutical patents; governments came under pressure to reform their new patent systems, calling into question the appropriateness and utility of broad and strong private rights of exclusion as tools for disseminating knowledge. Most governments also faced pressures to modify aspects of their patent systems more broadly related to science, technology, and indigenous innovation (STI); governments came under pressure to reinforce their new patent systems, buttressing the role of private rights of exclusion as mechanisms to incentivize the creation and distribution of knowledge and technology. I provide a political explanation for the contrasting trajectories of reform and reinforcement by examining how different policy arrangements generate and mobilize interests for continuity and discontinuity. The focus is on asymmetric patterns of interest mobilization: those actors who benefit from policy interventions tend to mobilize more than those who suffer; those actors who suffer retain the capacities for mobilization and resistance more in the area of health-drugs than STI.