Good Practice Guide: Improving Access to Treatment by Utilizing Public Health Flexibilities in the WTO TRIPS Agreement. UNDP, 2010
(2010; 84 pages)


Over the past ten years, there has been a remarkable and virtually unprecedented global scaleup of a life-saving medical technology: antiretroviral therapy for people with advanced HIV infection. This therapy not only prolongs life for most patients, it keeps people healthy enough to work, to continue their lives in families and as parents, and to contribute to their communities and countries. We now know that antiretroviral therapy also lowers the amount of HIV in the bloodstream, thus making people less infectious and contributing to HIV prevention goals as well.

This achievement is all the more remarkable given that only about 40,000 people in low and middle income countries were benefiting from such treatment in 2000. Now, ten years later, over 5 million people have access.

The successes of the past ten years are directly linked to the drastic fall in the price of these drugs. The cost of first generation antiretrovirals has decreased from over ten thousand US dollars to as low as 67 dollars per person per year. This amazing reduction has been achieved largely thanks to competition from generic manufacturers, which, for millions of people worldwide, has been the difference between life and death. Such competition has in large part been made possible by countries’ utilization of the public health flexibilities in the World Trade Organization’s TRIPS Agreement.

There is still a great deal of work to do. Despite the significant progress in access to HIV treatment worldwide, the global coverage remains low and only about a third of the people who need treatment have access to it. This coverage gap is combined with an increased demand for newer, better antiretroviral medicines, as people on treatment live longer. Resistance to first generation treatment regimens often requires patients to switch to more expensive second line therapy. Furthermore, the recently revised recommendations of the World Health Organization (WHO) will result in patients needing to commence antiretroviral therapy earlier, which will increase the number of people requiring treatment... The Good Practice Guide analyses each of the public health flexibilities in the TRIPS Agreement and provides examples where and how have they been used by national governments. The Guide also provides some examples on the effect of adopting intellectual property protection measures, which exceed the minimum requirements of TRIPS and which are often introduced through bilateral trade instruments. An extensive bibliography allows further research on any of these matters.

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