Canada was the first country to implement the WTO Decision of August 30, 2003, authorizing the export of generic drugs manufactured under a compulsory license to developing countries in response to a proposal brought forward by non-governmental organizations (NGOs) that now claim dissatisfaction with the Canadian legislation. This empirical case study examines what success means for an NGO campaign. It contrasts interviews, documents, media coverage, and public statements of stakeholders, using quantitative and qualitative analyses. It concludes the NGO network experienced a shift from a mobilizer of public sentiment at the international level to a policy adviser at the domestic level. This shift crystallized a change in leadership toward local, rather than transnational NGOs, and a shift in strategy from being radical to more reformist. While this process of institutionalizing the outcomes of international campaigns is necessary for the implementation of international norms into domestic policy, it required NGOs to compromise their ideal positions, producing some objective successes in legislative reform but subjective dissatisfaction of the NGOs in the failure of Canada's domestic regime to enhance access to medicines on the ground in developing countries.