Intended for healthcare professionals

CCBYNC Open access
Analysis Trade and Health

Threat of compulsory licences could increase access to essential medicines

BMJ 2019; 365 doi: (Published 28 May 2019) Cite this as: BMJ 2019;365:l2098

Linked analysis

The upside of trade in health services

  1. Gorik Ooms, professor of global health law and governance,
  2. Johanna Hanefeld, associate professor of health policy and systems
  1. Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to: G Ooms gorik.ooms{at}

Gorik Ooms and Johanna Hanefeld argue that low and middle income countries could increase access to medicines by forming an alliance to credibly threaten companies with compulsory licences

Access to affordable medicines and vaccines is essential for both universal health coverage and meeting the sustainable development goals. However, as innovations of medicines are owned by companies, it is important to recognise that improving access to them is intertwined with international trade laws and intellectual property rights.

The sustainable goal development targets explicitly recognise this. They include a target for increasing access to medicines using the flexibilities to protect public health in the major international trade agreement that underpins intellectual property rights—namely, the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS).1 However, many scholars argue that the TRIPS agreement and the subsequent political declaration designed to support countries’ access to medicines—the Doha declaration—does not provide a solution for the poorest countries.2

The main argument for intellectual property rights is the cost of research and development. Some argue that for medicines this should simply be financed differently—for example, through prize funds financed by public resources. We agree, and in September 2016, the United Nations high level panel on access to medicines issued a report on promoting innovation and access to health technologies. It recommended breaking the connection between the cost of research and development and the end product.3

The TRIPS agreement and the Doha declaration “solution” for increasing availability of essential medicines has two distinct advantages over alternative mechanisms: it is already included in international law, and it has the political backing of the sustainable development goal declaration.

In this paper, we discuss the difficulties that low and middle income countries face when they want to use the Doha declaration. However, we also argue that compulsory licences, …

View Full Text