Methods and Findings: We assembled a database of all episodes in which a CL was publically entertained or announced by a WTO member state since Broad searches of CL activity were conducted using media, academic, and legal databases, yielding 34 potential CL episodes in 26 countries.
Country- and product-specific searches were used to verify government participation, resulting in a final database of 24 verified CLs in 17 nations. We coded CL episodes in terms of outcome, national income, and disease group over three distinct periods of CL activity. Conclusions: Given skepticism about the Doha Declaration's likely impact, we note the relatively high occurrence of CLs, yet CL activity has diminished markedly since We conclude that there is a low probability of continued CL activity.
We highlight the need for further systematic evaluation of global health governance actions. Abstract: The innovation impact of intellectual property compulsory licenses - government-imposed access without the authorization of the property owner - has generated great interest in the academic literature. Moreover, recent measures by the governments of Thailand and Brazil have generated increased international awareness of the issue.
Equally significant, but receiving less attention is the impact of compulsory licenses on flows of foreign direct investment FDI to the granting nation. It is quite likely that FDI mechanisms provide an important attenuating factor that influences a country's compulsory license strategy. This paper investigates the compulsory license-FDI relationship, using essential medicines as a context. It explores the potential for collective action and bargaining on the part of licensing nations to minimize FDI losses while preserving access.
Middle-developed countries MDC such as Egypt and Brazil are highlighted to demonstrate the extent to which nations with differing abilities to resist political pressure can influence FDI losses. The paper concludes by demonstrating optimal negotiating strategies using a unique game theory framework that models real-world licensing decisions. Abstract: We analyze how a price control and the threat of compulsory licensing CL affect consumer access in a developing country South to a patented foreign product.
In the model, the Southern government sets the level of the price control on a Northern patent-holder who chooses between entry and voluntary licensing VL. If the patent-holder does not work its patent locally, the South is free to use CL. The threat of CL: ensures that consumers have access to a lower quality version of the patented good when the patent-holder chooses not to work its patent locally; improves the terms at which VL occurs; can cause the patent-holder to switch from VL to entry; and can delay consumer access when CL replaces VL or entry.
We also show that a price control and CL are mutually reinforcing instruments. Abstract: Patents pose a significant barrier to accessing innovative medicines, due to exclusivity granted to inventors by the Trade Related Agreement on Intellectual Property Rights TRIPS , which sets the basis for protection of intellectual property at the international level.
Compulsory licenses are exemptions to patent exclusivity, allowing a government or a third party to use patented subject matter for commercial, public or emergency use provided certain requirements are fulfilled.
Objective: To evaluate outcomes and policy approaches used by different countries for compulsory licenses under the Article 31 framework of TRIPS, and identify shortfalls and best practices in order to inform policy changes on national, and multilateral levels.
Methods: This retrospective study is comprised of a cross-case comparison of compulsory licensing in varying countries, including Low, Middle and High Income Countries to enable access to generic medications.
Each case has been driven by varying contexts and scenarios. After a detailed search for all compulsory licenses threatened and issued after , a database was developed and focus cases selected. Specifics of license and outcomes associated with use were then recorded and compared. Among aspects evaluated were national legislation and delivery instruments for procured generics.
Findings: Following the Doha ministerial declaration on Public health in , there has been more frequent use of compulsory licenses CL to procure HIV medications, and increasingly, non-essential medicines such as oncologic agents, anti-inflammatory agents, and prophylactic drugs for heart disease. Approaches taken by countries include an official Government-use policy to compulsory license drugs, use of CLs as a threat, an emergency use for pandemic preparedness, and anti-competitive tool to promote parallel trade.
Each case has unique motivators and reveals context specific outcomes. Conclusions: While use of compulsory licenses is controversial, countries have traditionally used them in case of exceptionally expensive medicines Cancer drugs, and 2nd line ARV medication , often after failed negotiations Brazil, Thailand, and Taiwan.
The TRIPS Article 31 framework allows significant liberty in issue and use of compulsory licenses, but requires further clarifications of certain provisions to clarify ambiguities passed down from the Paris convention of Some further policy clarifications are also prudent given the evolving nature of the patent landscape, and current global discussion on impending need for change to the innovation framework has been motivated by conflicting goals between Human rights and Inventors rights.
Abstract: The patent system is built on the premise that patents provide an incentive for innovation by offering a limited monopoly to patentees. The inverse assumption that removing patent protection will hurt innovation has largely prevented the widespread use of compulsory licensing—the practice of allowing third parties to use patented inventions without patentee permission.
In this Article, I empirically test this assumption. I compare rates of patenting and other measures of inventive activity before and after six compulsory licenses over drug patents issued in the s and s. As reported below, I observe no uniform decline in innovation by companies affected by compulsory licenses and find very little evidence of a negative impact, which is consistent with earlier empirical work.
While anecdotal, these findings suggest that the assertion that licensing categorically harms innovation is probably wrong. Based on the data, I comment on the use of compulsory licensing to reduce the price of AIDS and other drugs for developing countries.
I suggest that, based on past experience, compulsory licenses need not result in a decline in innovation and that this policy option for increasing access to medicines deserves greater exploration. This paragraph sought a solution to situations where patented pharmaceuticals which are not available in a country with no or insufficient manufacturing capacity can be supplied by a foreign provider. As originally adopted, the TRIPS Agreement did not allow the grant of compulsory licenses for exports only, thereby preventing generic manufacturers from exporting the required products to countries unable to produce them.
While the new article 31bis is a step forward as it reflects public health concerns, it would be necessary to streamline the procedures to effectively ensure broader access to pharmaceutical products at low cost and in a timely manner. Abstract: Like other rights, patent rights are not absolute. There are situations in which their exercise can be limited to protect public interests. Such situations may arise, for instance, when access to needed pharmaceutical products must be ensured.
Compulsory licenses and government use for non-commercial purposes are tools, provided for under most laws worldwide, that can specifically be used to address public health needs. This document is intended to provide legal guidance for the effective use of such tools, consistently with the international law.
Abstract: The continuous application of Special Section by the Office of the United States Trade Representative USTR undermines the rule of law as a fundamental principle of a multilateral system based on the sovereign equality of states and the respect for international law. It argues that the regulations and practices identified by the USTR show a legitimate use of the flexibilities provided for by the Agreement on Trade-Related Aspects of Intellectual Property Rights TRIPS , and that the ignorance of the public interests of the countries concerned for instance, with regard to access to affordable medicines has contributed to the discredit and ineffectiveness of the Special Section Third, it examines the case of access to medicines for the treatment of Hepatitis C, illustrating the barriers to access created by intellectual property and the high prices normally associated with its exercise.
To conclude, this paper examines the experiences of compulsory licensing and government use of patents in Latin America particularly in Ecuador, Peru and Colombia. Through an innovative and multifaceted campaign, and despite initial resistance from multinational pharmaceu- tical companies, the government of Brazil was able to negotiate price reductions for HIV medications and de- velop local production capacity, thereby averting a public health disaster.
Using interview data and document analysis, the authors show that the exercise of corporate social responsibility can be viewed in practice as a dy- namic negotiation and an interaction between multiple actors. Action undertaken in terms of voluntary CSR alone may be insufficient. This finding highlights the importance of a strong role for national governments and international organizations to pressure companies to perform better.
Abstract: The chapter argues that since there is no conclusive evidence for a causal relationship between the issuance of compulsory licences CL for medicines and any fall in innovation or foreign direct investment FDI inflow, various other factors like predictability and market potential need to be taken into account for understanding the after-effects of a grant of CL.
The chapter examines the trends in CLs after the Doha Declaration and carves out a case for adhering to transparent procedures for imparting some predictability to the process in order to mitigate losses from possible repercussions.
One important feature of Bayh-Dole, however, has been overlooked in this debate-a feature that arises from the global-public-good nature of knowledge. Without patents on US taxpayer-funded inventions, the United States would have no practical way of internalizing the positive externalities these inventions confer on consumers in other countries. Rather than relying on internalization theory to defend Bayh-Dole, we highlight ways in which this novel theory can inform Bayh-Dole debates.
Abstract: The challenge of providing access to high-priced patented medicines is a global problem affecting all countries. Today a number of upper-income European Union EU Member States are contemplating the use of compulsory licensing in their efforts to reduce expenditure on pharmaceutical products.
EU regulation of clinical test data protection and the granting of market exclusivity interfere with the effective use of compulsory licensing by EU Member States and can even prevent access to off-patent medicines because they prohibit registration of generic equivalents. EU pharmaceutical legislation should be amended to allow waivers to data and market exclusivity in cases of public health need and when a compulsory or government use license has been issued.
Such an amendment can be modelled after existing waivers in the EU Regulation on compulsory licensing of patents for the manufacture of pharmaceutical products for export to countries with public health problems outside the EU. In addition, some recent cases from the United States and Italy on compulsory licenses for non-ARVs show that this important tool for public health is also used in developed countries.
Copies of the actual compulsory licenses of developing countries are also included for reference. Methods: By using government's perspective, budget impact was estimated within a 5-year period after the introduction of the policy. The number of patients who need treatment with each drug and the costs of treatments by both original and generic versions were obtained from Thai government agencies. Probabilistic sensitivity analysis was used to determine the impact of uncertainty surrounding parameters such as the numbers of patients and the health-care costs.
It was also found that each drug had a different effect on budget saving depending on the number of patients treated, the difference in drug costs between original and generic drugs, and the lag time from the introduction of the policy to the availability of the generic drugs on the market.
Conclusion: The study showed that the introduction of the government use licenses policy in Thailand would provide significant benefits for the study timeframe; however, there are several issues that should be taken into account when the government use licenses policy is adopted.
Abstract: Since , when antiretroviral ARV treatments started being guaranteed to people living with HIV in Brazil, the government has faced the challenge of ensuring sustainability of this policy within a context of incorporating patented medicines. Results show that, between and , there were efforts to use compulsory licensing as a threat. From to , initiatives by different stakeholders were identified: declaration of public interest, pre-grant opposition "support to examination" and civil action.
From to , compulsory licensing initiatives in other countries resulted in a price reduction in Brazil. Abstract: Compulsory licensing CL of medicines by a developing South unambiguously improves access to treatments by its population. Its impact on profits and thus innovation rates and welfare is a more controversial issue in the literature. This paper proposes a North—South model dealing with parallel trade, price controls and compulsory license if the South is not served.
Our results challenge the literature claiming that parallel trade leads to higher innovation and welfare. Moreover, conditions apply for CL to be used; in particular, it should never be used for neglected diseases, as malaria and tuberculosis. When the South issues CLs, it is compensated for the welfare losses caused by the North allowing parallel trade, and innovation and northern welfare do not decrease. The best outcome, however, is market segmentation, i.
Abstract: To examine patterns and trends in attempts, distinguished from issuance, to issue compulsory licensing of pharmaceuticals and to assess related implications in the era of high-cost medicines. Documents from various civil society organisations were primarily used to search attempts, as well as published literature. The identified attempts were analysed by pharmaceutical level, national level, claimers, and the outcomes of the attempts.
There have been attempts to issue compulsory licensing for 40 pharmaceuticals in 27 countries since Moreover, when the claimer was the government, the likelihood of approval and positive outcomes increased. Resurgent compulsory licensing in and , influenced by the global justice movement, might represent a policy window in the near future as the Doha Declaration did in the s. In this context, various experiences should be circulated and analysed at the global level to better understand the circumstances under which successful issuance has been achieved at the country level.
Abstract: Millions of people, particularly in low- and middle-income countries, lack access to effective pharmaceuticals, often because they are unaffordable. The declaration recognized the implications of intellectual property rights for both new medicine development and the price of medicines. These measures include compulsory licensing of medicines patents and the least-developed countries pharmaceutical transition measure.
The aim of this study was to document the use of TRIPS flexibilities to access lower-priced generic medicines between and Overall, instances of the possible use of TRIPS flexibilities by 89 countries were identified: The remainder were: 1 case of parallel importation; 3 research exceptions; and 32 non-patent-related measures.
Of the instances, They covered products for treating 14 different diseases. However, Given the problems faced by countries today in procuring high-priced, patented medicines, the practical, legal pathway provided by TRIPS flexibilities for accessing lower-cost generic equivalents is increasingly important. The Thai move prompted rigorous protests and pressure from multinational drug companies and their national governments.
At the same time, the use of public health safeguards was praised by international agencies and non-governmental organisations NGOs. This study assesses the roles of key actors and contextual elements that shaped the processes of policy making and implementation. This analysis suggests that despite continual advocacy by civil society organizations, the idea of enforcing TRIPS flexibilities for essential medicines in Thailand was heightened on the governmental agenda and adopted as a public policy when the new administration took office after a military coup in September Diverse strategies were employed by responsible government agencies and civic networks in order to alleviate political pressures and avoid trade retaliations.
It could be observed that the government use policy often moved back and forth between the formulation and implementation stage, while limited groups of key stakeholders were involved. While international authorities, such as the World Health Organization WHO , seemed to be reluctant to participate in the disputes between Thailand and the opponents to the government use policy, global concerns about the unaffordable costs of patented drugs that hampered access to essential health care in the South was beneficial to the Thai action.
The potential diffusion of this policy from Thailand to other developing countries triggered substantial tensions between the supporters and opponents of the government use enforcement. The introduction of TRIPS flexibility for medicines in Thailand offers several lessons which may be helpful for resource-poor settings and health advocates coalitions, for example, the roles of public civic networks, relentless advocacy and collective learning among partners, as key factors of success.
Policy recommendations derived from this study emphasize the needs for the commitment and leadership of the WHO, in collaboration with other parties, to bridge. Abstract: While Trade-Related Aspects of Intellectual Property Rights TRIPS was expected to hike up prices of patented medicines, there was no consensus on its likely final impact on access, because the agreement housed instruments to address this challenge.
For instance, compulsory licensing, through the facilitation of price reductions, was considered to be an important countermeasure. However, little is known about the extent to which compulsory licensing has actually been effective in reducing prices of much- needed patented drugs.
To fill this gap, this paper undertakes a systematic- review of the existing evidence on the impact of compulsory licensing on drug prices. Retrieval and analysis of 51 observations of pre- and post-compulsory licensing prices indicate that a compulsory licensing event is likely to reduce the price of a patented drug, albeit with some caveats.
Moreover, compulsory licensing procurement from the international market is likely to be more effective in reducing drug prices than contracts to local companies. Clearly, the future incidence and impact of compulsory licensing will depend on further possible procedural refinements to ease its implementation, the development of technological and manufacturing capabilities in developing countries, and the importance of biologics among life-saving drugs.
Abstract: Compulsory licences are generally available on a variety of grounds, most notably on patents where the patentee is found to have abused its rights in one manner or another. Abstract: As we observe the 18th anniversary of the Doha Declaration on the TRIPS Agreement Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health, it is appropriate to take stock of intellectual property developments and endeavour to present a comprehensive account of the situation in the African continent in respect of the implementation of TRIPS flexibilities, specifically those regarding access to medicines.
This research paper provides an overview of the extent to which selected African countries have adopted legal and policy frameworks with regard to TRIPS flexibilities, examines the actual use of these flexibilities in enabling access to medicines in those countries, and suggests some recommendations for optimising the use of the flexibilities in pursuing public health imperatives.
The decision to grant the government use licenses was contentious both within and beyond the country. In particular, concerns were highlighted that the negative consequences might outweigh the expected benefits of the policy. Developing countries that have not previously used compulsory licensing should leverage the experiences of countries that have. Whether it is through virtual workshops or other collaborative online forums, now is an important time to help developing countries build the legal and logistical capacity to use compulsory licensing in the face of COVID Several countries have already publically considered compulsory licensing as part of their COVID response.
AbbVie has announced that it will not enforce its patent in light of the current pandemic [ 11 ]. In order for a government to use compulsory licensing for COVID related purposes, its domestic laws must have procedures in place to authorize such government action.
Several countries have already taken legislative steps to ensure their governments can swiftly issue compulsory licenses as part of their COVID response. The amendment allows the government to issue a license for necessary innovations and to negotiate remuneration later [ 12 ].
Specifically, the resolution declares that the coronavirus pandemic constitutes sufficient justification to grant compulsory licenses for COVIDrelated technologies [ 13 ].
Similarly, a Committee of the National Assembly in Ecuador has passed a resolution requiring the Ecuadorian President and Minister of Health to provide free or affordable access to COVIDrelated preventative, diagnostic, and treatment technologies through the use of compulsory licenses [ 14 ]. Other developing countries should take similar legal and legislative steps to establish a framework for using compulsory licenses in case it is necessary.
Ultimately, compulsory licensing may not be necessary. Even if the discovered cure is patent-protected, there may be drug donations, discounts, or the patent holder may offer voluntary licenses at affordable rates.
However, in case compulsory licenses do become necessary when a cure is available, countries should take the appropriate legislative steps to prepare as soon as possible. Compulsory licensing is a powerful public health tool — it can be instrumental for alleviating insufficient supplies of necessary pharmaceuticals as well as mitigating prohibitively expensive drug prices.
While the rewards of patent protection are necessary to support continual innovation, the compulsory licensing exception exists for public health emergencies such as the current COVID crisis. Governments must do what is necessary to fight the present pandemic. International organizations can play a key role by providing the legal know-how as well as setting a supportive tone for using compulsory licensing. In the process, pharmaceutical companies and G20 countries should not deter or retaliate against developing countries pursuing such public health measures in the time of a pandemic.
Authorship contributions: HW is the sole author. Competing interests: The author has completed the ICMJE uniform disclosure form available upon request and declares no conflicts of interest. National Center for Biotechnology Information , U.
Journal List J Glob Health v. J Glob Health. Published online May Hilary Wong. Author information Copyright and License information Disclaimer. All rights reserved. This work is licensed under a Creative Commons Attribution 4. Third, it is difficult to identify and unravel the impact pathways of compulsory licenses, as information is simply not available. Analysis of 11 out of the 24 compulsory licensing events is not based on official sources at all.
Also, as discussed in the limitations, there are at least other 50 compulsory licensing events for which no price data could be retrieved. If no price data are ever published, it is simply not possible to assess the effectiveness of this policy tool.
Therefore, official information on prices pre- and post-compulsory licensing should be disclosed to prevent misuse and to ensure that private interests are not put before public interests. Fourth, industrial polices for creation and accumulation of technological capabilities in development and production of pharmaceutical products in developing countries are needed.
Compulsory licensing is often invoked as a panacea for the constraints imposed by TRIPS to ensure access to needed patented medicines during times of health crises. In this regard, the objective of the present paper was to review the existing evidence on the impact of compulsory licensing events in order to assess its utility as an instrument to improve access.
In our systematic review, we verified a mean price reduction between Therefore, it would seem that compulsory licensing is indeed an effective mechanism for price reduction with increased availability. However, this result is modulated by the evaluation that it is not clear if compulsory licensing is the most effective alternative to make patented medicines more affordable. Nevertheless, it is still the only mechanism available to many developing countries without manufacturing capabilities in pharmaceuticals.
What about the effectiveness of compulsory licenses as an instrument to improve access to medicines in the future? This is a moot question. It makes sense for a government to issue a compulsory license to procure a branded drug for a health crisis only if there are alternative existing generic producers or potential generic producers of the same.
The latter could be national companies or a set of actors e. Thus, the future of compulsory licensing as an instrument of increasing access to medicines will be shaped by the evolution of two factors. First, under crisis situations, TRIPS has made the window of opportunity for generic producers to supply the rest of the world with drugs under patent, not only much smaller, but much more difficult to even open, given the cumbersomeness of the Paragraph 6 system.
In the future, if there are other health crises, and activists force further refinements, this may change. Second, new drugs may be biologics in which emerging countries have an enormous technological and often regulatory retard. In such cases, if no alternative sources to a patent drug are available, a compulsory license will serve no purpose.
Thus, in the long run, the best option for developing countries seems to be to build bargaining strength through investment in improving scientific, technological, and innovation capabilities in pharmaceuticals. The ability of governments to negotiate prices or even issue compulsory licenses is likely to be very limited if the technological capabilities of their country are underdeveloped. This is even more extreme in the case of biologicals, for which the technological competence is concentrated in developed countries, mostly in companies that also manufacture innovative products.
This calls for entrepreneurial state interventions towards technological capacity and promotion of innovative models for drug development, production, and distribution. The use of compulsory licensing as an industrial policy instrument can be an important trigger of such a process of technological capacity building. For this, nevertheless, it is important to have other instruments and mechanisms to ensure competitiveness and compliance with safety and quality standards.
It is worth mentioning that compulsory licenses can also be used to improve access to drugs due to reasons other than solely affordability. A similar move was observed in , when the United States was concerned about the availability of Tamiflu from the patent owners if confronted with an avian flu pandemic Love, The Medicines Patent Pool was established in to improve access to low-cost generic versions of patented medicines in low- and middle-income countries through the negotiation of voluntary licences with pharmaceutical companies and other patent holders.
His research interests include the impact of intellectual property rights on access to medicines, technological catch-up in biopharmaceuticals, circular economy, integration between science and society and public engagement through science shops and community service-learning, and inter- and transdisciplinary knowledge integration. Her research focuses on the relationships between technology, innovation and their governance for inclusive development.
Her work examines the role of technology and innovation in conjunction with actor government, firms, citizens, public laboratories, NGOs, etc. Publisher's Note. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article has been with the authors for three revisions. National Center for Biotechnology Information , U. J Int Bus Policy. Eduardo Urias 1, 2, 3 and Shyama V. Ramani 1. Shyama V.
Author information Article notes Copyright and License information Disclaimer. Eduardo Urias, Email: ude. Corresponding author. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. Abstract While Trade-Related Aspects of Intellectual Property Rights TRIPS was expected to hike up prices of patented medicines, there was no consensus on its likely final impact on access, because the agreement housed instruments to address this challenge.
Keywords: compulsory licensing, access to medicines, intellectual property protection, systematic review, pharmaceutical industry. Introduction Patent protection gives market exclusivity to inventors. Open in a separate window. Figure 1. Compulsory licensing flow chart for countries. Methodology Systematic Reviews of Literature A literature review can be a research method in its own right and its format varies depending on its purpose Jesson et al.
Inclusion Criteria In order to delimit the final set of studies to be included in this systematic review, four main eligibility criteria were applied. Figure 2. Table 1 Compulsory licensing events per study retrieved.
Study no. Authors no. Characteristics of the Compulsory Licensing Events In our review, we found 24 compulsory licensing events in eight countries Brazil, Ecuador, India, Indonesia, Thailand, Malaysia, Rwanda, Zimbabwe for which prices before and after the compulsory licensing were available see Table 2.
Table 2 Compulsory licensing events. Country no. Table 3 Number of observations on prices per compulsory licensing events by the type of source.
Impact on Prices The impact on prices is summarized in Table 4 , and its examination leads to the following inferences. Table 4 Impact on prices. Result 2: However, the Existing Public Knowledge on the Degree of Price Drop is Imperfect Indeed, in the articles that specify the prices before and after, there are contradictions regarding the degree of price drop following an event.
Result 3: Moreover, After the Compulsory Licensing, Procurement from the International Market is More Effective in Achieving Price Reductions than Contracts to Local Companies Recalling the second section, after issuing a compulsory license, the public agency can either procure the concerned branded drug from the international market or from local firms with the requisite technological and manufacturing capabilities. On the Impact of TRIPS on the Incidence of Compulsory Licensing The caveats with respect to the impact of compulsory licensing along evoked in the previous section, in conjunction with the three central global trends detailed below, raise doubts on the possible use of compulsory licensing by developing countries not developed ones to improve access to medicines in the future.
The Race to Improve Remdesivir to Address the Covid Challenge The main findings of this paper have been illustrated almost presciently under the corona virus siege.
Compulsory licensing is also considered an important tool by developed countries when crisis hits them Although compulsory licensing is a TRIPS flexibility that is often perceived as the main mechanism to facilitate increased access to patented pharmaceutical products in developing countries under the coronavirus siege, only developed countries moved fast towards facilitating compulsory licensing.
Compulsory licensing can be averted through voluntary licensing Following Figure 1 , the important patent holders concerned have initiated voluntary licenses. Addressing COVID and future pandemics via compulsory licensing will depend upon bargaining versus collaboration Currently, there is no vaccine to protect against the virus, and nor are there effective pharmaceutical treatments approved for this specific condition. Limitations of Study In our study, we could identify only 24 compulsory licensing events for which data were available on prices before and after the event.
Policy Implications Our review highlights the following policy challenges for developing countries which need to be addressed with respect to compulsory licenses to improve their effectiveness with respect to access to medicines for improved health status. Conclusion Compulsory licensing is often invoked as a panacea for the constraints imposed by TRIPS to ensure access to needed patented medicines during times of health crises.
Notes It is worth mentioning that compulsory licenses can also be used to improve access to drugs due to reasons other than solely affordability. Footnotes Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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