Health officials, experts and advocates in the United States, Europe and elsewhere have become a powerful voice opposing new regional trade agreements — the Trans-Pacific Partnership and its European counterpart, the Transatlantic Trade and Investment Partnership.
In Britain, doctors have lobbied against the TTIP warning that it could threaten the country’s National Health Service. In the United States, the public-interest think tank Public Citizen argues that the TPP could jack up the cost of medicines.
International humanitarian organization Medecins Sans Frontieres, known as Doctors Without Borders, argues that the TPP would cut the lifeline of affordable medicines that save lives for the millions suffering from HIV/AIDS, tuberculosis and other global diseases.
What has health got to do with trade agreements?
The most contested issue has been the intellectual property provisions that strengthen and lengthen patents, giving pharmaceutical corporations new monopoly rights to charge high prices.
For example, they include provisions that would mandate patenting of new uses of existing medicines (“evergreening”), disallow data from clinical trials to be used in registering generic equivalents, and impose lengthy data exclusivity obligation for biologics. Such measures delay generic competition to pharmaceutical markets and maintain monopoly pricing, adding to the pressure of escalating prices.
The potential consequences on health go well beyond intellectual property and the affordability of medicines.
The wide-ranging measures — state-investor dispute settlement, food safety measures, state enterprises, public procurement and more — impose standards in numerous areas of economic and social policy, reducing the scope of choice policymakers have in formulating national policies to fit their priorities and conditions.
The Investor-State Dispute Settlement (ISDS) provision sets up special tribunals outside of national legal systems for foreign corporations to sue governments for health policy that get in the way of future profits.
Globally, such provisions of new trade agreements could reduce the ability of governments to address some of the most urgent public health priorities of the day.
Escalating prices of branded medicines to treat cancer, Hepatitis C and other widespread life-threatening conditions are straining budgets of governments, insurance companies and households, and leaving many patients without access in low-, middle- and high-income countries.
The new trade agreements entrench the current model of intellectual property monopolies and high prices that do little to provide incentives for innovation to address top global health priorities such as the development of new antibiotics in the face of growing antimicrobial resistance, new global threats such as Zika and emergencies such as Ebola.
Patents do not create an incentive for investing in such diseases because the market would not tolerate high prices.
These are some of the reasons why the U.N. High Level Panel on Access to Medicines was set to remedy the “incoherence” between the right to health and trade agreements.
The report of the panel, of which I was privileged to be a member, released in September recommends future trade agreements should not include patent rights without true innovation and other measures that lengthen monopoly rights. We also recommend countries undertake rigorous health impact assessments in negotiating and signing trade deals.
As the TPP is under debate for approval in Japan, debates have focused on concerns about agriculture, the key issue that has driven controversies about free trade over the 20th century. But times have changed and this 21st-century agreement is less about trade and opening consumer markets than about investments.
The majority of its 30 chapters and multiple annexes set standards in broad areas of economic regulation. These regulations reduce the scope of choice that national governments have in important areas for the national health care system of countries such as in regulating prices, service standards, public hospitals and more.
This is a critical issue for Japan that has one of the most effective health care systems in the world. Former Japan Medical Association President Katsuyuki Haranaka has already cautioned that the TPP could lead to unraveling of the country’s universal health care system.
The national health system has been a core source of strength for the Japanese people and economy, delivering universal coverage with low costs and high-quality service. It was a source not only of the longest life expectancy in the world but also economic dynamism and shared prosperity in the 20th century. A rigorous study of the economic benefits and costs, and the health consequences of the TPP is needed to inform broad public debates before the Diet votes.
(Sakiko Fukuda-Parr is a professor of international affairs at the New School in New York. She is a development economist concerned with global poverty and inequality, exploring these problems from the perspective of human development and human rights.)