However, in general, in the poorest of the poor countries, diffusion is not happening. In these places, economic institutions experience problems and IPR is not properly defended. When entrepreneurs in developing countries do bring their products to market, they sell to OECD countries, not their own. Sachs believes technological innovations favor rich markets and poor countries cannot sustain innovation because of the incentive structure. He also believes diffusion will not solve the problems of the poor.
Access is also an important issue.
He uses the example of Hepatitis A drugs, which are available but not reaching the millions in China who die as a result. Sachs realizes a balance must be made between protecting the IPR of richer countries while still accessing segmented markets. He believes these drugs should be provided at cost to the poor, but that even to do this will be difficult because the poor cannot afford these drugs, even at cost. Here, Sachs urges greater involvement from the World Bank to provide grants, not loans. He believes the Bank should be creating knowledge in poor countries and working on targeted innovations such as disseminating AIDS medicines in Sub-Saharan Africa, and creating renewable energy sources in developing countries.