{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:59:44Z","timestamp":1790830784968,"version":"4.1.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pharmaceutical access is essential for medical security systems to convert health protection commitments into actual treatment coverage. TRIPS compulsory licensing gives WTO members legal space to limit patent exclusivity under specific conditions, but legal authorization does not automatically become health policy mobilization. Existing research has not sufficiently tested the public health pressure and governance resource conditions under which compulsory licensing is mobilized in a WTO-corrected country-year risk set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Drawing on the Medicines Law &amp;amp; Policy TRIPS Flexibilities Database, UNAIDS, the Global Fund, the World Bank, and WHO, this study constructs a country-year panel of 103 WTO members from 2001 to 2024, with 2,276 observations. Two-way fixed effects linear probability models are used as the main analysis of the institutional mobilization conditions of compulsory licensing-related events. GEE, first-event, and Poisson models are used as robustness checks, while HIV\/AIDS-related compulsory licensing models and ART coverage outcome models are used as supplementary boundary analyses. ART coverage is treated only as an indicator of HIV\/AIDS treatment access, not as a general measure of access to medicines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Lower ART coverage is relatively consistently and negatively associated with compulsory licensing events, and supplementary analyses of HIV\/AIDS-related compulsory licensing support the same direction. Observed Global Fund HIV assistance is positively associated with compulsory licensing under the all-event measure and in several robustness models, suggesting that governance-resource connections may be associated with the feasibility of converting legal flexibilities into policy action. AIDS deaths, TB incidence, GDP per capita, health expenditure, out-of-pocket expenditure, and manufactured exports do not show stable main effects across models. Supplementary outcome-boundary models do not support the claim that HIV\/AIDS-related compulsory licensing significantly increases ART coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>TRIPS compulsory licensing is better understood as a health policy instrument addressing pharmaceutical access risks within medical security systems. In the current observational panel, its mobilization is associated with HIV\/AIDS treatment access pressure and observed governance-resource connections, rather than operating as a medicine access improvement mechanism that current cross-national data can directly establish.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1944235","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:41:15Z","timestamp":1790829675000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmaceutical access in medical security systems and health policy mobilization: cross-national evidence on TRIPS compulsory licensing from 2001 to 2024"],"prefix":"10.3389","volume":"14","author":[{"given":"Dongmei","family":"Wang","sequence":"first","affiliation":[{"name":"The Institute of Law, Taiwan Research Institute, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/1471-8847.00058","article-title":"The dilemma of intellectual property rights for pharmaceuticals: the tension between ensuring access of the poor to medicines and committing to international agreements","volume":"3","author":"Cohen","year":"2003","journal-title":"Dev World Bioeth"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1093\/jiel\/jgm040","article-title":"The Doha round's public health legacy: strategies for the production and diffusion of patented medicines under the amended TRIPS provisions","volume":"10","author":"Abbott","year":"2007","journal-title":"J Int Econ Law"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"103281","DOI":"10.1016\/j.jinteco.2019.103281","article-title":"Patent protection in developing countries and global welfare: WTO obligations versus flexibilities","volume":"122","author":"Bond","year":"2020","journal-title":"J Int Econ"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"185","DOI":"10.2471\/BLT.17.199364","article-title":"Medicine procurement and the use of flexibilities in the agreement on trade-related aspects of intellectual property rights, 2001-2016","volume":"96","author":"Hoen","year":"2018","journal-title":"Bull World Health Organ"},{"key":"ref5","first-page":"1791","article-title":"Access to medicines and pharmaceutical patents: fulfilling the promise of TRIPS article 31bis","volume":"91","author":"Igbokwe","year":"2023","journal-title":"Fordham Law Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e1001154","DOI":"10.1371\/journal.pmed.1001154","article-title":"Trends in compulsory licensing of pharmaceuticals since the Doha declaration: a database analysis","volume":"9","author":"Beall","year":"2012","journal-title":"PLoS Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1111\/dewb.12124","article-title":"Evaluating the usefulness of compulsory licensing in developing countries: a comparative study of Thai and Brazilian experiences regarding access to AIDS treatments","volume":"17","author":"Guennif","year":"2017","journal-title":"Dev World Bioeth"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s40258-017-0306-1","article-title":"Is compulsory licensing bad for public health? 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