Two proposals to change the current patent system are causing a new diplomatic battle at WHO this week. One concerns the launch of new medicines and the other seeks to make existing drugs available at low prices in developing countries. A coalition of developing countries, amongst them Brazil, and non-governmental organisations are defending a “patent pool” to combine intellectual property rights on existing medicines, and a “prize fund” to reward and stimulate discovery of new medicines for so-called neglected diseases. The two initiatives are receiving strong opposition from some rich countries and the pharmaceutical industry. They have also caused a split between the two major Latin American countries. Mexico is moving away from Brazil’s position and is making alliance with the US, alleging that it has commitments in the trade agreement with Washington. According to the proposals, the pharmaceutical industry would be paid for research and development, at the same time as generic companies would be authorised to produce the medicines at the lowest price and more rapidly, immediately after their launch. The objective is to provide an alternative to the conventional approach in the development of medicines, which currently guarantees exclusive marketing rights for 20 years to the company that developed a medicines, and doesn’t stimulate research to fight diseases that affect poor countries. WHO put on the table an alternative proposal for the distribution of cheaper medicines - through the support of generic companies, through compulsory licenses and the use of the TRIPS flexibilities of WTO, and through lower and more transparent prices. In July this year, Brazil gathered the Latin American countries in Rio, and another text was written, alternative to the one that WHO drafted, and that included the two points specially questioned by industry. But Santiago Alcazar, special envoyee of the Brazilian Health Minister, insisted that Brazil is not requesting a change in the international patent system, and that the flexibilities already foreseen in the international agreement can be really implemented. Washington, on the other hand, favours a text reinforcing intellectual property rights. The American delegation indicated that Brazil and other Latin American countries can turn the process “more difficult and significantly postpone” a plan of action of the WHO if they want to use the “Rio text” as a basis for negotiation. Alcazar answered that he had a conversation with the Americans and see the possibility of a compromise on different points. Meanwhile non-governmental organisations have accused USTR, a representation of US trade, of intimidating Latin American countries so that they withdraw their support to the “Rio text”. The USA and the European Union have questioned an expansion of the role of WHO to cover patents and health. One of the flexibilities in the WTO rules allows poor countries to issue compulsory licenses for medicines that they cannot produce, to fight public health crises. But the problems are huge. Firstly because of pressure not to use this instrument. Secondly, because of countries’own limited technical capacity to use it. “Brazil has a constructive position,” insisted Alcazar. NGOs consider that the negotiations have the potential to change the way medical research is conducted and assure that urgently needed products are developed and accessible. It is worth noting that only 1% of the 1.556 medicines developed in the past 25 years are for neglected diseases and tuberculosis, although these diseases represent 10% of the total burden. For NGOs, the negotiation is a first chance for countries that started to build a medical innovation system and access to medicines that prioritize diseases that are neglected by pharmaceutical industry. The NGO Médecins Sans Frontières estimates at US$ 600 billion the world pharmaceutical market and notes that the lack of resources for research and investment in tuberculosis is estimated at US$ 950 million a year.