Access to essential medicines and health technologies is a huge public health challenge, especially in developing countries where the majority of the poor lack any form of social protection and health systems are under-resourced. The long and strong patent regimes introduced by the Agreement on Trade-Related Aspects of Intellectual Property Rights in 1995 and the TRIPS-plus provisions of many bilateral trade agreements are among the challenges to improving this access. Mandated by the World Health Assembly, the independent Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH) recommended that "Bilateral trade agreements should not seek to incorporate TRIPS-plus protection in ways that may reduce access to medicines in developing countries".This publication presents a clear and frank analysis of the subject from a purely public health perspective, and should be of interest to policy-makers in ministries of health as well as ministries of trade, commerce, finance, foreign affairs and all those who take part in trade negotiations on behalf of their citizens. It provides a comprehensive background to the subject, the implications of TRIPS-plus for access to essential medicines and health technologies, and guidance on how to deal with these complex issues.