Defending access to medicines in regional trade agreements: lessons from the Regional Comprehensive Economic Partnership – a qualitative study of policy actors’ views

Abstract

Background The Regional Economic Partnership Agreement (RCEP) is a mega regional trade agreement signed by fifteen countries on 15 November 2020 after 8 years of negotiation. Signatories include the ten members of the Association of South East Asian Nations (ASEAN) plus China, New Zealand, Japan, South Korea and Australia. India was a negotiating party until it withdrew from the negotiations in November 2019. The RCEP negotiations were initially framed as focused on the needs of low income countries. Public health concerns emerged however when draft negotiating chapters were leaked online, revealing pressures on countries to agree to intellectual property and investment measures that could exacerbate issues of access to medicines and seeds, and protecting regulatory space for public health. A concerted Asia Pacific civil society campaign emerged in response to these concerns, and in 2019, media and government reporting suggested that several of these measures had been taken off the table, which was subsequently confirmed in the release of the signed text in November 2020. Results This paper examines civil society and health actors’ views of the conditions that successfully contributed to the removal of these measures in RCEP, with a focus on intellectual property and access to medicines. Drawing on twenty semi-structured qualitative interviews with civil society, government and legal and health experts from nine countries participating in the RCEP negotiations, the paper reports a matrix of ten conditions related to actor power, ideas, political context and specific health issues that appeared to support prioritisation of some public health concerns in the RCEP negotiations. Conclusions Conditions identified included strong low and middle income country leadership; strong civil society mobilisation, increased technical capacity of civil society and low and middle income negotiators; supportive public health norms; processes that somewhat opened up the negotiations to hear public health views; the use of evidence; domestic support for health issues; and supportive international public health legislation. Lessons from the RCEP can inform prioritisation of public health in future trade agreement negotiations.

Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy

“…The formal and informal policy processes of trade negotiations, for example, can enable or constrain health advocacy [10,13,23], as can the structures of government coordination [38,40]. We added a further category for 'issue characteristics' -drawing on Shiffman & Smith's [48] framework of political prioritisation in global health, which has been applied in studies of trade and health [23,49] -to capture the potential influence of particular characteristics of health issues, such as the strength of the evidence base.…”

“…Leadership by trade and health ministers (or their equivalents) was also found to be crucial for elevating health goals in trade-related policymaking in eighteen studies [69], in trade negotiations [49] and at the WTO [67]. Leadership by health ministers was found to be key in several studies for strengthening trade negotiators' positions in trade negotiations and in prioritising health in domestic trade-related policy [23,31,60,63,64,[68][69][70][71].…”

Protecting noncommunicable disease prevention policy in trade and investment agreements

“… 9 , 23 , 48 For example, the strength of governmental and nongovernmental health sector actors contributed to the removal of proposed intellectual property and investment provisions in the Regional Comprehensive Economic Partnership in Asia and the Pacific region that could have limited access to medicines. 49 The literature shows that trade negotiations need to provide formal opportunities for health sector engagement and should be more transparent. Increased engagement by the health sector could provide a clear understanding of the health sector’s requirements for specific inclusions in trade and investment agreements (to inform negotiations) and could ensure that the implications of a proposed agreement are thoroughly analysed.…”

Peran Strategis Kerjasama IA-CEPA Terhadap Pemulihan Ekonomi Indonesia di Masa Pandemi COVID-19

“…Demi tercapainya rencana pembangunan ekonomi nya yang pretensius, Indonesia membutuhkan lebih banyak investasi asing yang bergerak pada sektor prioritas seperti energi dan infrastruktur. Sementara itu, Australia merupakan tetangga sekaligus mitra yang memiliki kapabilitas pada sektor ini memberikan kepastian dan perlindungan bagi investor dan investasi Australia di Indonesia (Townsend, 2021;Townsend et al, 2016). Australia memiliki kapasitas untuk menyediakan keuangan publik sebagai penerbit mata uang berdaulat, keuangan swasta, mempertajam insentif, serta membawa teknologi, ide baru, dan model bisnis ke lokal (Gibson-Graham, 2011).…”