Uganda’s ambition to attain middle-income status has raised fresh questions about whether the country is building enough economic and institutional capacity to sustain the gains once it begins losing some of the international support available to least-developed countries (LDCs).
A new report on Uganda’s intellectual property and access to essential medicines warns that the transition could expose critical sectors, particularly healthcare, to higher costs if the country graduates to a middle-income status when not prepared to be self-sustaining by remaining heavily dependent on imported medicines and other external support.
The report, titled ‘Strengthening Intellectual Property Legal and Policy Framework for Access to Essential Medical Products in Uganda’, was being reviewed in Kampala on Friday.
It warns that Uganda’s graduation from the LDC category will have significant implications for access to medicines because the country will progressively lose some of the special flexibilities and support measures available to LDCs.
‘Uganda will no longer be able to rely on the blanket LDC waiver to import or produce generic versions of patented medicines but instead, utilize standard TRIPS flexibilities, which are more complex procedurally, require higher administrative capacity, and have potential for political pressure from originator countries,’ the report warned.
Adding, ‘The loss of this waiver will fundamentally alter public procurement, domestic generic manufacturing, and national IP enforcement…’
Uganda first met two of the three United Nations criteria for LDC graduation in 2024-the Human Assets Index and Economic and Environmental Vulnerability Index-but remained below the income threshold.
The country is due for another assessment in 2027. If it meets the criteria again, it could be recommended for graduation, followed by a preparatory period before formal graduation.
The UN says Uganda’s 2024 gross national income per capita was $909, below the graduation threshold of $1,306, while its Human Assets Index stood at 66.3 against a required 66, and its Economic and Environmental Vulnerability Index was 28.2 against a maximum threshold of 32.
The UN process currently indicates Uganda’s LDC graduation could occur in 2030 at the earliest, while a recent UN Uganda briefing says 2032 is anticipated under a five-year preparatory period.
Further, the report warns that graduation would also change the intellectual property environment under which Uganda accesses and produces generic medicines.
‘Uganda will no longer be able to rely on the blanket LDC waiver to import or produce generic versions of patented medicines but instead utilise standard TRIPS flexibilities, which are more complex procedurally, require higher administrative capacity, and have potential for political pressure from originator countries,’ the report says.
It adds that losing the waiver could affect public procurement, domestic generic manufacturing, and national intellectual property enforcement.
The researchers warn that patients and the government could face higher prices for newer medicines after the country loses LDC-specific intellectual property flexibilities.
They cite second- and third-line antiretroviral medicines, advanced tuberculosis treatments and medicines for non-communicable diseases-including cancer drugs, insulin analogues and cardiovascular medicines-as areas that could be affected if Uganda graduates without being prepared to fly alone.
Dr Denis Kibira and Ms Gloria Imodia, consultants from Dumaic Global Health, who researched on behalf of the Center for Health, Human Rights and Development, KELIN, and ITPC Global, said Uganda’s transition should not be measured only by the prestige associated with changing its economic classification.
‘The biggest benefit we get from being a middle-income country is prestige,’ Dr Kibira said, while questioning whether the country would have sufficient domestic capacity to sustain itself after external support declines.
‘Most of the medicines that we are getting, like for TB and HIV, are patented, and we are getting them through access programmes which are subsidised. So once we declare that we have gone into middle-income, then we shall no longer be eligible for those access programmes,’ the consultants said.
They warned that Uganda could consequently be required to procure some medicines at commercial prices.
The consultants cited lenacapavir as an example, saying a dose currently accessed through subsidised programmes at between $20 and $40 could cost substantially more under commercial arrangements.
Dr Kibira said Uganda should use the transition period to strengthen local pharmaceutical manufacturing and develop the capacity to produce medicines domestically.
Mr James Tonny Lubwama, the Assistant Commissioner for Patents and Industrial Design at the Uganda Registration Services Bureau (URSB), said the country risked losing some of the benefits it currently enjoys because of its LDC status.
‘We are implementing the flexibilities given the fact that we are an LDC under the different patent laws, but those benefits, you get them as long as you are an LDC,’ he said.
He said the government’s push to attain middle-income status should therefore be accompanied by measures to preserve the gains already made in access to medicines and intellectual property protection.
‘There is concern that when we graduate to middle-income, which the government is very intentional about, some of these we shall stop benefiting from. We have made some progress, so we don’t want to lose that progress at the moment when we eventually graduate from LDC,’ Mr Lubwama said.
The report recommends that Uganda introduce transitional legislative safeguards and policy measures before losing LDC-specific intellectual property exemptions.
It also calls for stronger domestic pharmaceutical manufacturing, improved use of intellectual property flexibilities and greater investment in local capacity to reduce dependence on imported medicines.
The concerns come as Uganda prepares for possible LDC graduation. The UN says graduation is not simply a change in classification but requires countries to prepare for the withdrawal or alteration of LDC-specific international support measures.
Uganda remains classified as a low-income country by the World Bank, disagreeing with the Ugandan government’s ongoing declarations of reaching lower-middle-income status.