However, since its inception, a considerable amount of literature has been published on the effects of the TRIPS ON agreement on public health, but there has been far too little effort to ensure that TRIPS Plus provisions are not affordable for treatments for communicable diseases such as the human immunodeficiency virus (HIV) , affecting the lives of 37.9 million people (, 2019). The IP system, introduced in 1994, has not been sustainable, as it has maximized benefits for some at the expense of development and well-being for many. Yet by 2020, the situation is even worse with intellectual property, which, by limiting the use of TRIPS flexibility or improving the provisions of the original agreement, eliminates the possibilities for affordable and sustainable HIV treatment in order to be within reach in low-income countries. In addition, the signed free trade agreement contains another provision that should be emphasized, as it severely limits the production of generic drugs and, therefore, more affordable drugs. Article 12.40, paragraph 2, states that a 2003 agreement has relaxed the requirement of the internal market and allows developing countries to export to other countries where there is a national health problem as long as exported drugs are not part of a trade or industrial policy. [10] Drugs exported under such regulations may be packaged or coloured differently to prevent them from affecting the markets of industrialized countries. Major developing countries, among others, are currently encouraging this counter-attack and are the first to come forward. India, for example, produces 80% of the generic HIV drugs used by Médecins Sans Frontières (MSF) to treat more than 200,000 people in developing countries. India produced these drugs freely until 2005, when it was forced to begin granting patent protection under the TRIPS agreement (Doctors Without Borders, 2017). However, the country has decided to amend its national patent laws, including guarantees, such as strict standards for what a patent seeks to strike the right balance between recognizing intellectual property protection and protecting the right to affordable medicines. The multinational pharmaceutical industry, which supports the United States, the European Union and other countries, is currently pushing India to strengthen its IP regulations to ensure greater monopoly power for pharmaceutical companies that manufacture brand-name drugs at the expense of public health protection measures.

This poses a potential threat not only to the affordability of drugs in India, but also to the world. If the Indian government decides to abandon this challenge, it could be catastrophic for millions of people in developing countries around the world and for international organizations such as MSF, which depend on Indian generic medicines to ensure sustainable and affordable treatments around the world (Doctors Without Borders, 2017). The main drivers of adoption of these measures PLUS plus are free trade agreements. The agreement between the European Union and India, which has been under negotiation since 2007, is one of the most closely watched agreements, given the large share of generic drugs produced in India. Other countries in Asia and the Pacific are also negotiating with the EU, the European Free Trade Association (EFTA) or the United States of America (as part of the Trans-Pacific Partnership Agreement). In all of these agreements, it is hoped that they include pro-development provisions that would allow access to treatment and would not stand in the way. Otherwise, campaigners warn, drug prices could rise dramatically, preventing low- and middle-income countries from maintaining their treatment reserves. In addition to the basic intellectual property standards set out in the TRIPS agreement, many nations have committed to bilateral agreements to adopt a higher level of protection.