Access to medicines

An overarching goal of the WTO is to make the management and application of intellectual property rights an integral part of broader public policy objectives in the area of public health.

The WTO works actively with other international organizations, representatives from civil society, the academic community and the private sector. Its activities are regularly carried out in close cooperation with the World Health Organization (WHO) and the World Intellectual Property Organization (WIPO).

The WTO is actively promoting the attainment of Target E of MDG 8, which aims to provide access to affordable medicines on a sustainable basis in developing countries. The past decade has seen a strong policy emphasis on public health and access to medicines in the WTO, with a particular focus on clarifying the way in which flexibilities under the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) should be interpreted and implemented regarding public health. This has included creating an additional pathway for access to medicines.


The WTO is actively promoting the attainment of Target E of MDG 8, which aims to provide access to affordable medicines in developing countries

The Doha Declaration on the TRIPS Agreement and Public Health continues to serve as a landmark in recognizing the linkage between the WTO system and the broader public policy issue of health. It also serves as a benchmark for international cooperation on intellectual property and public health (see Box 4). By bringing together different policies and distinct areas of expertise, it has helped build a stronger framework for multilateral cooperation on intellectual property and public health, and supports governments in making use of TRIPS flexibilities.

For example, countries without sufficient manufacturing capacities can make effective use of compulsory licensing through the so-called “Paragraph 6 System”. This gives poor countries additional flexibility under the TRIPS Agreement to gain access to affordable medicines. Agreed in August 2003, the “Paragraph 6” system allows generic versions of patented medicines to be made under compulsory licence (that is, without the consent of the patent holder) for export to countries that cannot manufacture the medicines themselves.

Paragraph 6 is the first amendment agreed to in the entire package of WTO rules concluded in the Uruguay Round, a measure of the significance that WTO members have given to the question of access to medicines. The understanding that TRIPS supports a balanced and flexible framework for intellectual property protection and enforcement responsive to countries’ broader policy agendas has thus been reinforced, as well as the notion that TRIPS and its flexibilities are part of a wider national and international action to address public health problems.

Since the Doha Declaration was adopted, important developments in the WTO and elsewhere have already had a positive impact on access to medicines in developing countries. This includes making needed medicines available − especially anti-retroviral drugs to combat HIV/AIDS − at lower prices, enhancing international funding and using TRIPS flexibilities to leverage access to medicines. These developments have important repercussions for the achievement of Target E of MDG 8 and, more broadly, they also support Target B of MDG 6, which aims to achieve universal access to treatment of HIV/AIDS.

Box 4: Access to medicines and the Doha Declaration on TRIPS and Public Health

Measuring access to medicines is a complex task, but price is one key factor among others. The Doha Declaration on TRIPS and Public Health recognized concerns about effects on prices while noting the need for innovation. Since the Declaration was adopted in 2001, prices for many treatments have fallen significantly, in part due to generic competition and tiered pricing schemes (see graph below). Surveys also show a marked increase in the use of TRIPS flexibilities to promote access to medicines.

Falling prices of first-line combinations of some first-line anti-retroviral therapies for HIV-AIDS since 2000

Source: Extract from MSF, Untangling the Web of Price Reductions, January 2010