The granting of a compulsory licence involves, by definition, three main actors: nor has it been possible to carry out a statistical meta-analysis of the impact of compulsory licences on prices using the available information. This method requires that the interventions be very similar in order to compare the “outcome measure”. However, there are many contextual factors that influence the final price after a compulsory license, even if the same drug formulations are compared. For example, market structure, pocket payments and technological capacity, among others, are expected to influence price outcomes. In addition, as indicated in the results, the included studies provided price data from a large number of sources of credibility and no information was available on price component levels. Subsequently, several potential exporting countries amended their laws and regulations to implement the exemptions and allow production exclusively for export under compulsory licensing. At the time of the letter (September 2006), Norway, Canada, India and the EU officially informed the TRIPS Council. The 2003 declarations of renunciation are provisional; The final objective is to amend the TRIPS Agreement itself and a decision was taken in December 2005 and was again accompanied by a statement by the President. The modification of a direct translation of the declarations of waiver shall enter into force if two-thirds of the members accept it. It should be noted that compulsory licensing can also be used for reasons other than affordability to improve access to medicines. For example, in 2001, motivated by terrorist attacks involving anthrax, the United States considered using a compulsory license to ensure the availability of ciprofloxacin (Ooms & Hanefeld, 2019).

A similar measure was observed in 2005, when the United States was concerned that Tamiflu might be available to patentees when faced with an avian influenza pandemic (Love, 2007). The TRIPS Agreement and the “solution” of the Doha Declaration on Increasing the Availability of Essential Medicines have two key advantages over other mechanisms: it is already enshrined in international law and enjoys political support for the Declaration on the Sustainable Development Goal. All WTO members have the right to export medicines under this specific compulsory licensing mechanism. With regard to members eligible for import, least developed countries may use them immediately; Others must communicate their intention to do so through a brief communication. For their part, the industrialized countries have decided not to use it for imports.