Access to essential medicines and health technologies is a huge public health challenge, especially in developing countries where the majority of the poor lack any form of social protection and health systems are under-resourced. The long and strong patent regimes introduced by the Agreement on Trade-Related Aspects of Intellectual Property Rights in 1995 and the TRIPS-plus provisions of many bilateral trade agreements are among the challenges to improving this access. Mandated by the World Health Assembly, the Commission on Intellectual Property Rights, Innovation and Public Health recommended that “Bilateral trade agreements should not seek to incorporate TRIPS-plus protection in ways that may reduce access to medicines in developing countries”. In the Eastern Mediterranean Region ministries of health have been little involved in bilateral trade negotiations, yet they are having to deal with the implications of the TRIPS-plus provisions. This publication presents a clear and frank analysis of the subject from a purely public health perspective. It should be of interest to policy-makers in ministries of health as well as other ministries and all those who take part in trade negotiations on behalf of citizens.