Acknowledgments V

Acronyms and Abbreviations VII

Executive Summary IX

Introduction: IP as Infrastructure for Innovation 1

International Rules Governing Access to Pharmaceutical Products 5

Covid-19 as a Test Case: What Determined Access During the Pandemic? 6

Voluntary Licensing as a Mechanism for Scaling Innovation and Access 11

IP: The Enabler for Voluntary Licensing 12

Voluntary Licensing and the Potential Expansion of Local Innovation Ecosystems 14

The Limited Impact of Compulsory Licensing 17

Beyond Intellectual Property: The Real Determinants of Access 21

Export Controls and Trade-Related Impediments 21

Regulatory Delays 23

Significant Local Infrastructure Gaps 23

Counterfeit Drugs 24

Conclusion and Policy Recommendations 27

Appendix A: Compulsory Licensing During the Covid-19 Pandemic 31

Israel 31

Bolivia 32

Hungary

Russia 32

India 33

Appendix B: Voluntary Licensing During the Covid-19 Pandemic 35

Bilateral License Agreements 35

Medicine Patent Pool 36

Gilead and Remdesivir 36

Eli Lilly and Baricitinib 36

Additional Examples 37

Licensing by the Medicines Patent Pool 37

About the Authors 39

About CSIS 41

Endnotes 43