Bridging Innovation and Equity: Compulsory and Voluntary Licensing in Global Access to Medicines

Abstract

Access to essential medicines remains a cornerstone of global public health, yet significant disparities persist due to patent protections, high drug prices, and inequitable distribution systems. Licensing mechanisms-particularly compulsory licensing (CL) and voluntary licensing (VL)-have emerged as critical tools to balance intellectual property (IP) rights with public health priorities. This review critically examines the legal, economic, and ethical dimensions of CL and VL within the framework of the TRIPS Agreement and global health governance. Drawing on recent developments, including the COVID-19 pandemic, it evaluates their effectiveness in improving affordability and availability of medicines. While voluntary licensing fosters collaboration and facilitates technology transfer, compulsory licensing remains an indispensable safeguard during public health emergencies. Persistent challenges-including geopolitical pressures, restrictive licensing terms, and limited manufacturing capacity-continue to constrain equitable access. Adopting a human-centred perspective, this review highlights the lived realities of patients in low- and middle-income countries (LMICs) and underscores the urgent need for more inclusive and transparent policy frameworks. The paper concludes with recommendations aimed at strengthening global health equity while preserving incentives for pharmaceutical innovation.