Even if Indonesia stays out of the Trans-Pacific Partnership (TPP), the US-backed trade pact now under negotiation among 12 countries, the mere existence of the agreement could obstruct access to medicines in the archipelago in a few direct ways.

One of them has to do with economies of scale as Indonesia attempts to build its own generic drugs industry. Generics are based on a volume model, not a price model. Lacking patents, generics makers must compete with one another. This drives prices down, forcing them to sell a lot in order to profit.

If other countries want to buy generics from Indonesia that are still under patent, they will have to issue compulsory licenses. But the TPP would make it harder for them to do that.

"If they agree to the US proposal to make patent monopolies easier to get and longer and to create additional regulatory barriers (e.g. data exclusivity for biologics), it will be more difficult for generics to be produced and imported to these countries (from Indonesia or from other countries), which will reduce/segment the potential for a generics market in the region," Judit Rius, manager of Doctors Without Borders/Médecins Sans Frontières' Access Campaign in the United States, wrote in an email.

For diseases where there is a high prevalence in Indonesia, the local market might be large enough to offset that, said Brook Baker, a law professor at Northeastern University. But for some diseases, even big countries might not have enough patients for domestic manufacturers to profit.

"Broader, stronger, and longer patents in importing countries would block out Indonesian exports," Baker said.

The other way the TPP could affect Indonesia concerns seizures of generic medicines in transit. In 2008 there were at least 17 incidents where legitimate generics on the way from India to a developing country were detained in the Netherlands because Dutch customs officials thought the drugs might be counterfeit, even though they weren't. What has people worried now is that the TPP includes a provision similar to that of the regulation under which the medicines passing through Europe were seized.

Medicines from India to Indonesia could be seized in Malaysia, for example, the latter being part of the TPP. "That is a direct effect as far as I can see," said an IP expert with an international organization who asked not to be named. "A number of people are quite concerned that those provisions are in the TPP."

* This story accompanied "Take it or Leave it", also available in print in this week's edition of Tempo English.

PHILIP JACOBSON