South Asia stands at a turning point where a technical rule in global trade law may decide who in the region gets medicine and who goes without. The World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) was sold as a neutral floor for patents, but for least developed countries (LDCs) it has been more like a breathing tube: a temporary waiver that keeps affordable drugs flowing until they “graduate” from the LDC category.
Bangladesh shows both the power and the fragility of this breathing space. As an LDC, it can legally ignore pharmaceutical product patents under the TRIPS pharmaceutical transition period, extended to 1 January 2033. Thanks to this, Bangladeshi firms now supply about 97% of the country’s medicine needs and export generics to more than a hundred markets, including many wealthier Asian economies that still import a large share of their drugs. In other words, the country has used TRIPS flexibility exactly as intended: To build a domestic industry while keeping prices within reach for patients at home and abroad.
However, Bangladesh is not alone. Nepal is following a similar path, relying on the same LDC waiver to produce low-cost generics for chronic diseases. Yet Nepal is scheduled to graduate from LDC status in 2026, and studies already warn that, after graduation, its pharmaceutical sector will have to fully comply with TRIPS patent rules, pushing up costs and threatening access to generics. Thus, where Bangladesh today stands as a success story, Nepal is a preview of the cliff edge facing South Asian LDCs once the waiver no longer applies.
Moreover, Bhutan’s recent experience shows that graduation itself is not the problem; the problem is graduating without a serious plan for life after the waiver. Bhutan left the LDC category on 13 December 2023 after deliberately synchronizing its graduation date with the end of its Twelfth Five-Year Plan and designing a “smooth transition strategy” anchored in its Thirteenth Plan. It does not have a large pharmaceutical sector, but it does offer a political lesson for Bangladesh and Nepal: graduation must be treated as a long, managed process, not a one-day celebration.
If we look across the border to India, the region already has a blueprint for a tougher TRIPS world. When India had to introduce pharmaceutical product patents in 2005, it amended its Patents Act to include Section 3(d), which restricts patents on minor modifications and helps prevent “evergreening” of old drugs. This allowed India to comply with TRIPS while remaining a major supplier of generic medicines to developing countries.
The real question, then, is whether South Asia will be allowed to repeat that success. United Nations analyses have argued that ending the pharmaceutical transition period too harshly for graduating LDCs would undermine access to medicines and contradict the public-health spirit of TRIPS. South Asian LDCs should embed every available TRIPS flexibility into their domestic law now—stringent patentability standards, robust opposition procedures, and clear compulsory-licensing rules—while pushing collectively for an extended, staged transition. Otherwise, “graduation” from LDC status risks becoming a paradox: a reward that makes medicines more expensive and development less fair.
