Background: It is now a decade since the World Trade Organization (WTO) adopted the ââ?¬Ë?ââ?¬Ë?Declaration on the TRIPS\r\nAgreement and Public Healthââ?¬â?¢Ã¢â?¬â?¢ at its 4th Ministerial Conference in Doha. Many anticipated that these actions would lead\r\nnations to claim compulsory licenses (CLs) for pharmaceutical products with greater regularity. A CL is the use of a patented\r\ninnovation that has been licensed by a state without the permission of the patent title holder. Skeptics doubted that many\r\nCLs would occur, given political pressure against CL activity and continued health system weakness in poor countries. The\r\nsubsequent decade has seen little systematic assessment of the Doha Declarationââ?¬â?¢s impact.\r\nMethods and Findings: We assembled a database of all episodes in which a CL was publically entertained or announced by\r\na WTO member state since 1995. Broad searches of CL activity were conducted using media, academic, and legal databases,\r\nyielding 34 potential CL episodes in 26 countries. Country- and product-specific searches were used to verify government\r\nparticipation, resulting in a final database of 24 verified CLs in 17 nations. We coded CL episodes in terms of outcome,\r\nnational income, and disease group over three distinct periods of CL activity. Most CL episodes occurred between 2003 and\r\n2005, involved drugs for HIV/AIDS, and occurred in upper-middle-income countries (UMICs). Aside from HIV/AIDS, few CL\r\nepisodes involved communicable disease, and none occurred in least-developed or low-income countries.\r\nConclusions: Given skepticism about the Doha Declarationââ?¬â?¢s likely impact, we note the relatively high occurrence of CLs, yet\r\nCL activity has diminished markedly since 2006. While UMICs have high CL activity and strong incentives to use CLs\r\ncompared to other countries, we note considerable countervailing pressures against CL use even in UMICs. We conclude\r\nthat there is a low probability of continued CL activity. We highlight the need for further systematic evaluation of global\r\nhealth governance actions.
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