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Since the ratification of the Trade-Related aspects of Intellectual Property Rights Agreement in 1994, concerns have continued to be raised about its potential impact in the South. Faced with the risks and promises made in terms of industrial and health development, this paper sets out to clarify the political economy of the patent in the South through a comparative analysis of Brazilian, Indian, and Thai trajectories. This analysis indicates that the strengthening of patent rights may inhibit the development of industrial capabilities in pharmaceuticals and may undermine the accessibility of drugs in developing countries.