Global health. The current scenario and future perspectives

266 principles for a minimum period of 20 years. This not only granted exclusive marketing rights to pharmaceutical companies but, also during that period, obliged countries without price regulation systems to pay the value imposed by the industry until other alternatives could enter the market and generate price reduction through competition. Despite its mainly commercial nature, TRIPS includes certain exceptions or limitations for public health issues regarding patented medicines urgently required in situations of health emergencies. These state that members, when formulating or modifying their laws and regulations, may adopt necessary measures to protect the public health and the nutrition of the population, including use by government or third parties authorized by government (WTO 2017). In an emergency, in order for a patented medicine to be used by the population, a government can make use of compulsory licensing which is the permission granted/issued by said entity to produce a patented product without consent from the patent holder when, after negotiations, no voluntary license is granted (WTO 2017). In 1996, the WHO, based on Iran’s proposals, discussed the consequences of globalization and trade agreements on access to medicines at its World Assembly and adopted the Revised Drug Strategy Resolution (WHO, 1996) which highlighted the need to establish a link and joint work between the WHO and the WTO. While the WHO provides technical support to countries based on recommendations that governments can incorporate into their national regulations, many of the initiatives of the WHO have been driven not by countries but by civil society organizations. For example, the document “Globalization and Access to Medicines: Perspectives on TRIPS/WTO Agreement” (WHO, 1997), published by the WHO’s Essential Drugs Action Program in 1997, identifies from a health perspective all safeguards contained in TRIPS that enable countries to protect health and promote access to medicines (Tobar, 2015). In 1997, South Africa implemented the Medicines Act or Amendment Act on Control of Medicines and Related Substances, which regulated issues such as generic substitution and parallel imports in its National Drug Policy (Republic of South Africa, 1997). The United States strongly opposed this move with both its pharmaceutical industry and the Clinton administration, with Al Gore leading this litigation. Dylan Mohan Gray points out in his documentary “Fire in Blood” (2012) that it took Washington 40 years to threaten South Africa with sanctions over apartheid but less than three months to threaten Mandela’s government over HIV/AIDS drugs after apartheid. Although Mandela was not violating what was established in the TRIPS agreements, the pressure from US on the South African government for trying to provide HIV treatments resulted in an agreement during the