AbstractA substantial share of the global population continues to face barriers to accessing essential medicines. While the pharmaceutical industry’s business model has successfully facilitated the development of innovative medications, efforts to promote universal access to medicines (UAM) remain ineffective. This paper critically assesses the existing barriers to global access to medicines, including the role of unsuitable governance, the protection of intellectual property rights, and other market barriers such as shortages, quality shortcomings, and high prices. Furthermore, we explore a number of promising potential strategies that can help towards achieving the UAM. Specifically, we evaluate the evidence from various initiatives, including alternative models of innovation, manufacturing, procurement, intellectual property management, and structural/organisational operations. We argue that the effective realisation of UAM requires a robust framework to implement these initiatives. This framework must strike a delicate balance between addressing public health needs, incentivising research and development, and ensuring affordability. Achieving such a balance encompasses a careful oversight and collaboration between national and international regulatory bodies.