Multilevel Governance Problems at the Intersection of Trade, Health and the ‘Global Knowledge Economyin Multilevel Governance of Interdependent Public Goods 95 (E-U Petersmann ed.), EUI Working Papers, RSCAS 2012/23 (2012)Frederick M. AbbottThe Doha Declaration Plus Ten The year 2011 represents the 10th anniversary of the Doha Declaration on the TRIPS Agreement and Public Health. The anniversary is being recognized in a substantial number of forums, including with the joint participation of the Directors-General of the World Health Organization (WHO), World Intellectual Property Organization (WIPO) and World Trade Organization (WTO) (a more detailed account of the state of play with respect to medicines in the decade since the Doha Declaration, and proposals for the future, is in Frederick M. Abbott, 2011). The social forces that gave rise to the Doha Declaration focused attention on public health and access to medicines problems confronting large parts of the world's population. Funding for procurement and distribution of medicines, particularly to treat HIV/AIDS, malaria and tuberculosis has risen. Support has increased for research and development (R&D) on drugs and vaccines for diseases predominantly affecting individuals in developing countries. Nonetheless, major problems involving innovation and access to health care and medicines remain to be addressed, including in the more advanced economies. The economic difficulties facing the advanced industrial economies in 2008-2011 have exacerbated, and will continue to exacerbate, problems in providing essential health services as countries at all levels of development are restricting payments for government services. It is an opportune occasion to reflect on multilateral institutional mechanisms for improving global public health.