Despite major medical breakthroughs there are still significant inequalities in the health status of people between developed and developing countries as well as within developing countries. The case of HIV/AIDS in Sub-Saharan Africa is particularly striking. Though life-prolonging treatments for HIV/AIDS have been available for many years only in the last few years did it become a realistic option for most in Sub-Saharan Africa. Even then, of the over 4.6 million people needing antiretroviral therapy (ART) only 1.04 so far had access to these treatments by the end of 2006.

One major reason for this dismal rate of access to ART in Sub-Saharan Africa relates to the costs of providing the medicines. The cost remained very high for quite a long time and though the cost of first-line treatments has dropped significantly in the last five years the cost of second-line treatments remains prohibitive. To a large measure the high prices are because of the monopoly privileges granted under patent protection. Mandatory patent protection for pharmaceutical products became the global norm based as a result of the rules under the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). This is the reason why a major part of the efforts to lower the prices of ART and hence improve the level of availability and accessibility has focused on removing the barriers related to patent protection to pharmaceutical products and processes under TRIPS by using the in-built flexibility in the Agreement. These flexibilities permit governments and other stakeholders to deal with the negative consequences of patent protection.

However, a combination of technical and political factors has made it difficult for developing countries including Sub-Saharan African countries to utilise the TRIPS flexibilities to improve access. The Doha Declaration on the TRIPS Agreement and Public Health adopted by the Fourth WTO Ministerial Conference in 2001 was meant to address some of these challenges. The Declaration clarified that all WTO Members had the right to use these flexibilities to the full to promote access. However, obstacles still remain. Looking at the prevalence and treatment figures above, it is clear that nowhere is it more important than Sub-Saharan Africa to utilise the TRIPS flexibilities to improve access to ARVs and other essential medicines. Consequently, there is an important need examine more closely how Sub-Saharan African countries have dealt with these flexibilities in their legislations. This was the objective of this report. Based on a review of the national legislations of 39 out of the 47 Sub-Saharan African countries, this report finds that though most of the countries, including least-developed countries (LDCs), provide patents for pharmaceutical products, the level of incorporation of the flexibilities in these legislations is very low. In general, a significantly low number of countries have taken advantage of the flexibilities under the TRIPS Agreement to: exclude new use pharmaceutical patents; to implement an international exhaustion regime on patent rights to permit parallel imports from anywhere in the world; to exempt research activities from patent infringement actions; permit the early working (bolar) exception; and to limit the level and type of test data protection. While all the 39 countries provide for compulsory licenses on various grounds and most have government use provisions in their legislations, the actual use of even these two flexibilities remains limited. It notable, however, that full information is not available on the legislative status of the flexibilities in most of the Sub-Saharan African countries. In this regard, though this report makes an important contribution in improving the level of knowledge and has laid a good baseline, significant work remains to be done understand and improve the legislative uptake of most of the flexibilities as well as their actual use to improve access to ART and other essential medicines.