<p>Restrictive provisions in international trade agreements, particularly trade related intellectual property rights (TRIPS), are impeding access to essential medicines in developing countries, making medicines unaffordable to poor people. The extent to which trade restrictions have adverse effects on health and economic development in Fiji and the Pacific region may depend critically on how Pacific Island Countries cope with the forces of regionalism and the realities of joining the global trading system, where there are pressures to make concessions in TRIPS. Yet awareness is relatively low. A central question to be asked here is what underlying factors shape how Pacific islanders view trade and access to medicines, notably in the area of trade, health, local culture, and human rights and what are the regional and national responses to mitigate potential trade impediments. By combining a public health lens with a multi-sector review of population health trends, intellectual property rights law, trade policymaking, and human rights, this research elaborates multidisciplinary findings that are usually less evident because they are conventionally researched and managed on a sector-by-sector basis. The findings suggest human rights are less significant in this debate, with challenges associated with small island developing states, local cultural preferences and pressures from regionalism, having more of a direct influence. The combined effect of these factors may be creating a unique context that is leading the Pacific region not to deal with these issues as well as some other developing countries might. This paper also discusses the emergence of two new challenges for human rights theory; to promote the collective rights of individual countries in the 'new regionalism', and the relationship with traditional knowledge.</p>