title: Could international compulsory licensing reconcile tiered pricing of pharmaceuticals with the right to health?
abstract: BACKGROUND
  The heads of the Global Fund and the GAVI Alliance have recently promoted the idea of an international tiered pricing framework for medicines, despite objections from civil society groups who fear that this would reduce the leeway for compulsory licenses and generic competition. This paper explores the extent to which an international tiered pricing framework and the present leeway for compulsory licensing can be reconciled, using the perspective of the right to health as defined in international human rights law.
  
  
  CONCLUSIONS
  We explore the practical feasibility of an international tiered pricing and compulsory licensing framework governed by the World Health Organization. We use two simple benchmarks to compare the relative affordability of medicines for governments - average income and burden of disease - to illustrate how voluntary tiered pricing practice fails to make medicines affordable enough for low and middle income countries (if compared with the financial burden of the same medicines for high income countries), and when and where international compulsory licenses should be issued in order to allow governments to comply with their obligations to realize the right to health. An international tiered pricing and compulsory licensing framework based on average income and burden of disease could ease the tension between governments' human rights obligation to provide medicines and governments' trade obligation to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights.
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium. gooms@itg.be.|Law and Development Research Group, Faculty of Law, University of Antwerp, Antwerp, Belgium. gooms@itg.be.
authors.forename: Gorik
authors.initials: G
authors.lastname: Ooms
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. lisa.forman@utoronto.ca.|Munk School of Global Affairs, University of Toronto, 155 College Street, Toronto, M5T 3M7, Ontario, Canada. lisa.forman@utoronto.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Forman
authors.affiliation: School of Population Health, The University of Queensland, Herston Road, Brisbane, 4006, Australia. o.williams@uq.edu.au.
authors.forename: Owain D
authors.initials: OD
authors.lastname: Williams
authors.affiliation: School of Population Health, The University of Queensland, Herston Road, Brisbane, 4006, Australia. peter.hill@sph.uq.edu.au.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hill
mesh_terms: D003132:Commerce; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003906:Developing Countries; D016527:Drug Costs / Q000331:legislation & jurisprudence*; D004345:Drug Industry / Q000191:economics / Q000331:legislation & jurisprudence; D016568:Drugs, Generic / Q000191:economics; D006262:Health; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D006806:Human Rights; D006801:Humans; D007182:Income; D018973:Intellectual Property; D007391:International Cooperation; D008004:Licensure; D037141:Mandatory Programs; D012941:Social Responsibility; D014944:World Health Organization
chemical_list: D016568:Drugs, Generic