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Several leading advocacy groups are asking the U.S. Trade Representative not to sanction or pressure four countries — Brazil, Ukraine, South Africa, and India — if the governments grant requests from cystic fibrosis patients to sidestep or revoke patents on a pricey medicine.

The move comes after the patients and their families last month took the unusual step of petitioning their governments due to ongoing frustration that they are unable to access a Vertex Pharmaceutical treatment. They cited both the high price of the medicine, known as Trikafta, and the patenting strategies pursued in different countries around the world by the company.

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