Review of regional and bilateral trade agreements restricting space created by Doha declaration on TRIPS and public health.  Trade agreements, especially with US and EU, set additional TRIPS+ measures placing greater restriction e.g. patent term extensions.  

These agreements are negotiated in secrecy. The measures related to medicines are negotiated as part of greater policy with complicated range of considerations. MOH has to become patent police to stop compulsory licensing.

Competition is the best way to get price reduction. Approaches to find solutions to patent system include UNITAID considering patent pool. Need to stimulate local production of essential medicines.

EU negotiating FTA with most developing countries. EU tries to get countries to harmonise to European law to limit access to generics.  European Parliament has urged EU not to pursue this.

WTO can impose TRIPS + on countries wishing to join. Bilateral investment treaties place infinite data exclusivity which means government can never grant a compulsory license. 

FTA between US and other American countries including NAFTA&CAFTA place significant barriers to access.  In Guatemala data protected drugs cost from 249% to 846% more than non-data protected drugs.

CS has gained expertise in supporting the use of TRIPS flexibilities.  Thai PLHIV brought FTA negotiations with US to a halt.

Activists play a role in pushing US gov and developing country CS have to

There is possibility of using international human rights law. Malaysia was called before the Commission on the Rights of the Child on the basis that the impact of TRIPS+ denying children the right to health.

Argument that IP is necessary for ongoing AIDS research premised on claim that Pharma spend a lot on R&D.  Private industry is only running 15% of clinical trials, US gov 70%.

Always room to negotiate: can take a pro health perspective or a pro IP perspective.