If the Covid-19 pandemic has had a silver lining, it is the urgency it provoked in the East African Community and elsewhere to become self-sufficient after rich western countries initially appropriated the vaccines for themselves. Now we have at least three EAC countries poised to partner with some of the major pharmaceuticals to set up local vaccine production plants. Rwanda was among the first to express interest in Africa and is set to begin construction of a plant this month in partnership with Germany’s BioNTech. Kenya has already entered a deal with US’s Moderna, while Uganda is considering a partnership with China’s Sinovac. Should these plans pan out, it would not only cheaply satisfy the EAC market now reaching a population of 300 million after DR Congo’s entrance, but would likely supplement other African producers to end vaccine dependence in the continent. This however still lies in the future. For now, Pfizer, another major US drugmaker, has committed to supply all its current and future patent-protected medicines and vaccines on a not-for-profit basis to 45 lower-income countries. Making the announcement at the World Economic Forum in Davos, Switzerland, last month, the pharma explained that it was talking to other big drugmakers about a similar arrangement. One might wonder, therefore, with all these measures to set up plants and provide cheap medicines, what is the ongoing fuss for further concessions? The simple answer is that the big pharma will still hold the monopoly. And, as experience has shown including with examples such as HIV and Aids, there is no guarantee the drugmakers will easily cooperate when the next pandemic, almost certain to occur, hits. Regarding necessity for such a guarantee, access advocates put it bluntly: “We have witnessed over and over again how delays in access to life-saving medicines because of IP barriers can cost lives.” As you read this, the 12th ministerial conference of the World Trade Organisation (WTO) is taking place in Geneva, and among the issues on the agenda is a proposal to remove the intellectual property (IP) barriers. The proposal, first put forward by South Africa and India in October 2020 and supported by over 100 WTO member countries, seeks to waive patent protections that will, in effect, increase people’s access to all COVID medical tools, including for treatment and prevention. But, to protect the big pharma, a small group of wealthy countries including the United Kingdom, the US and the European Union that are home to the drugmakers advance a permutation of concerns against the waiver. The stalemate has led to a new proposal by WTO Director-General Ngozi Okonjo-Iweala that limits the scope of the October 2020 proposal to only waive protections on patents for vaccines. This seems to only have further tangled the issues, which is where we now are with the ongoing negotiations. Organisations such as Médecins Sans Frontières (MSF) point out the problems with the new proposal. First, by insisting on vaccines at the exclusion of treatments, diagnostics and other medical tools, the Okonjo-Iweala proposal sets a negative precedent for future public health emergencies. The proposed set of eligibility criteria could also exclude several low- and middle-income countries with manufacturing capacity, including likely new entrants such as the EAC countries. It also appears to introduce new limitations and introduce even more legal uncertainties into mechanisms already in place under WTO rules. More damning perhaps is that the new proposal only covers patents but fails to consider other forms of IP protections. Other types of IP besides patents, such as trade secrets or clinical trial data, play a major role in blocking or delaying the production and supply of more affordable medical tools. These forms of IP allow the major drugmakers to maintain monopolies and prevent other manufacturers from developing and delivering alternative, affordable health products. It might seem the ministerial meeting will have the final say on the proposals. But should the negotiations not yield a satisfactory outcome by the time it ends on Wednesday, one hopes there could still be another chance at the WTO TRIPS Council meeting next month. In the meantime, state members have been urged to insist that clarifications and interpretations of the relevant WTO provisions are inclusive and applicable for all diseases and technologies without time limits, and for all kinds of the requisite compulsory licenses.