18 J. World Intell. Prop. 1 (2015)

handle is hein.journals/jwip18 and id is 1 raw text is: 



                                       The Journal of World Intellectual Property (2015) Vol. 18, no. 1-2, pp. 1-28
                                                                                doi: 10.1111/Jwip.12032


Improving Access to Medicines in Low-Income

Countries: A Review of Mechanisms

Cindy  Bors
Ki ger Partners, Australia

Andrew Christie
Melbourne Law School, Australia

Daniel  Gervais
Vanderbilt Law School, Tennessee

Ellen Wright   Clayton
Vanderbilt University, Tennessee


Individuals in low-income countries (LICs) often lack access to appropriate medicines. The multi-disciplinary
nature of this problem requires a holistic approach. Whereas, other writings on the topic tend to focus on one or a small
number of issues, often from the perspective of a single discipline, this paper seeks to consider the major issues from a
multi-disciplinary perspective. It first considers mechanisms for improving the availability of medicines in LICs,
through grants, prizes, treaties, advance market commitments, priority review and product development partnerships
to incentivize and fund R&D for neglected diseases. The paper then assesses mechanisms for improving affordability
of medicines in LICs, such as differential pricing mechanisms, monopsonies, patent law flexibilities and human rights
obligations. Next, the paper reviews mechanisms for improving the efficacy of medicines in LICs, including
authentication, criminalization, international and national enforcement and communication and education. Finally, the
paper examines mechanisms for improving the obtainability of medicines in LICs, through low-cost intervention,
task-shifting, efficient regulation, grass-roots service provision and education. The paper concludes by identifying
areas warranting further research.
Keywords  TRIPS; WHO;  Africa; Caribbean




On  the 24th and 25th of July 2013, the University of Melbourne  and  Vanderbilt University held the
Melbourne-Vanderbilt   Roundtable  on Access  to Medicines  (the Roundtable)  at the University of
Hawaii.  In attendance were  ten participantsI with expertize in a variety of  disciplines, including
intellectual property law, health policy, medical ethics, medicine, genetics, public health, economics,
pharmaceutical markets and development. The Roundtable  was moderated by Andrew  Christie and Daniel
Gervais, being representatives of the University of Melbourne and Vanderbilt University, respectively.
The participants were brought together to contribute to a group discussion on one of the most important
global public health issues: improving access to medicine in low-income countries (LICs)2 (Commission
on Intellectual Property Rights 2002; Commission on Intellectual Property Rights, Innovation and Public
Health, 2006; Lanjouw, 2005; Watal, 2000; World Bank, 2013, 2014; World  Health Organization (WHO)
Commission   on Macroeconomics   and Health, 2001).
    The  multi-disciplinary nature of the problem of access to medicines in LICs  requires a holistic
approach, especially one that identifies and examines the areas where cross-disciplinary collaboration is
valuable. The need  for such a discussion was the primary reason for convening  the Roundtable. The
Roundtable  proceedings included presentations on all participants' areas of expertize, reflections across


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