During the COVID-19 pandemic, a key area of focus in international and domestic politics was the potential barriers that intellectual property rights could impose to the equitable distribution of medicines and vaccines. Civil society organisations (CSOs) and policymakers in the Global South were particularly vocal about the concentration of medical technologies in high-income countries, which exacerbated the effects of the pandemic in the rest of the world. Drawing on previous lessons on the inequitable distribution of medicines during the HIV/AIDS health crisis, several initiatives were proposed worldwide to revise domestic intellectual property rights (IPRs) legislation and enable access to medicines and vaccines.
Changing IPRs regulation is a politically contentious endeavour. IPRs are established in multilateral and bilateral trade agreements, and trade dynamics and economic dependency often dictate the terms of these agreements. Consequently, if a country decides to amend its IP law, even within the legal scope of international agreements, it will likely face strong opposition from its trade partners (most notably the United States and the European Union) and transnational firms (especially pharmaceutical firms). Despite these political hurdles, some countries successfully amended their IP legislation to promote access to medicines during the pandemic.
Drawing on a qualitative analysis of policy documents and interviews with policymakers, industry representatives, and activists, this paper investigates the role of coalitions in enabling policy changes in Latin America. This paper argues that successful attempts to change IPRs regulation can be explained by the synergy of interests and collaboration across three sectors: government, civil society, and industry. In particular, this paper argues that most initiatives failed once one of these three sectors was not engaged in coalitions. This paper also argues that these coalitions are ad-hoc, issue-specific, and not robust enough to promote substantive changes to the IPRs system.
This research contributes to the growing literature on the politics of IPRs and access to medicines and provides insights into how to promote policy and regulatory change in a world where health crises are becoming more common.

A review of the 12-party Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) is currently underway by its Parties. Among the review objectives are identifying provisions that can be revised or updated to ensure Agreement remains relevant to contemporary issues and challenges. This paper argues that the review provides an opportunity to update the CPTPP’s Intellectual Property (IP) Chapter to completely remove certain provisions that are not currently being implemented but which remain in a state of “suspended animation”. These provisions were negotiated in the context of the US-led Trans Pacific Partnership (TPP) but were suspended when most of the remaining provisions from the TPP were incorporated into the CPTPP, following the withdrawal of the USA.

The paper reviews the suspended provisions and makes an evidence-based case for their abolishment from the CPTPP based on (i) research evidence of their likely damaging effects on public health and access to medicines; (ii) evidence emerging during the COVID-19 pandemic that suggests the global IP regime needs a major realignment; and (iii) changes in the political environment that render the suspended provisions obsolete.

The CPTPP’s suspended IP provisions include several “TRIPS-Plus” provisions – IP provisions beyond the requirements of the multilateral Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Since the CPTPP was finalised, two systematic reviews concluded that TRIPS-Plus provisions negatively impact access to medicines, and a further study demonstrated likely deleterious impacts on treatment programs in Southeast Asia. Persistent lack of access to COVID-19 vaccines and treatments in low and middle-income countries has highlighted major problems with TRIPS. Furthermore, the more recently concluded agreement between the United States, Mexico and Canada has diverged significantly from the TPP’s TRIPS-Plus agenda, suggesting that even if the USA were to join the CPTPP, it would be unlikely to seek such strong IP protections.

Uruguay is an emerging economy, and the government has prioritized attracting foreign investment as part of its economic development strategy. Bilateral investment treaties (BITs) are one of the strategies implemented by the country to attract foreign investment. In 2010, the Investment-State Dispute Settlement (ISDS) case filed by Philip Morris under the Switzerland-Uruguay BIT to stop Uruguay’s new tobacco control regulation has shown that BITs can be a threat to states' regulatory and policy space. Studies suggest that governments might learn from such ISDS cases, increasing the likelihood of adopting health safeguards in future BITs. However, there is very little evidence available on whether this was indeed the case. Our objectives were to: (i) analyze how Uruguay approaches the inclusion of health safeguards in BITs, and (ii) identify barriers and facilitators for the uptake of health safeguards from stakeholders' perspective. The study relied on a combination of documentary analysis of 39 BITs and semi-structured interviews with 11 key stakeholders. The inclusion of these clauses became more frequent in the early 2000s, reaching 100% in the BITs signed from 2010. Interviewees' accounts suggest that this progress was mainly motivated by international recommendations and an increased leadership of the Ministry of Economy in the negotiation of investment agreements, and it had to do less with the Philip Morris case or Uruguay’s commitment to protecting its regulatory space. While Uruguay has not faced challenges in including health safeguards in recent BITs, the renegotiation of old generation BIT agreements with developed countries has proven to be difficult. Power imbalance, the need to provide stable conditions to foreign investment and to preserve diplomatic relationships were identified as key barriers for renegotiation. Results from the present work suggest the need to develop strategies to support countries in the renegotiation of old generation BITs to safeguard public health.

International cooperation has become a key tool to advance the objectives of national and international agendas. Countries collaborate through international organizations and treaties that provide technical or financial cooperation to foster the development and well-being of nations, supporting the integration process and achievement of their goals. At the end of 2022, Chile and the European Union (EU) signed a Free Trade Agreement (FTA) that included a chapter on cooperation in sustainable food systems (SFS), this could imply that progress towards healthy and sustainable diets is a common goal across the countries involved in this agreement. The aim of this study is to explore the origins, justifications, and conditions that led to the inclusions of a cooperation chapter in SFS in the FTA between Chile and EU. We will present data on publicly available literature and results of semi-structured interviews with key stakeholders involved in relevant FTA decision-making from the government, civil society and the private sector. The data obtained will be analysed deductively based on a theory-informed analytical framework, followed by inductive analysis. We expect to gather critical information on the motivations and the conditions that led to inclusion of this chapter. We will particularly test the hypothesis that the inclusion of this chapter may promote bilateral cooperation in this area and enable Chile to move towards a more sustainable agenda in terms of food systems. Inclusion of SFS in FTA might be a way of promoting international cooperation by incorporating new standards and technical/financial assistance across countries.

Keywords: Chile, European Union, International Cooperation, Sustainable Food Systems.

Project nº: 201233

Cambodia is classified by the United Nations (UN) as a least developed country (LDC) however it may graduate from LDC status as early as 2027. Given its membership in the World Trade Organization, graduation will require Cambodia to provide patent protection for medicines that meet standard criteria. This qualitative policy analysis examines Cambodia’s readiness for LDC graduation in terms of protecting access to medicines and explores how it can prepare to mitigate the impact of graduation on access to medicines.

The study employed a single case study design that included analysis of key informant interviews and documents retrieved from a targeted literature review and website scans. The Health Policy Triangle framework informed the research design, methods, data collection and analysis.

While Cambodia has established structures and processes to facilitate preparations for LDC graduation and has engaged with UN agencies that support the sustainable graduation of LDCs, there has been little focus on the implications of graduation for access to medicines.

To prepare for LDC graduation Cambodia will need technical assistance to reform its patent-related laws and policies. Agencies tasked with supporting LDC graduation need to be able to provide this assistance to protect access to medicines.

Despite accumulating evidence of the implications of trade policy for public health, trade and health sectors continue to operate largely in silos. Numerous barriers to advancing health have been identified, including the dominance of a neoliberal paradigm, powerful private sector interests, and constraints associated with policymaking processes. Scholars and policy actors have recommended improved governance practices for trade policy, including: greater transparency and accountability; intersectoral collaboration; the use of health impact assessments; SouthSouth networking; and mechanisms for civil society participation. These policy prescriptions have been generated from specific cases, such as the World Trade Organization’s Doha Declaration on TRIPS and Public Health or specific instances of trade-related policymaking at the national level. There has not yet been a comprehensive analysis of what enables the elevation of health goals on trade policy agendas. This narrative review seeks to address this gap by collating and analysing known studies across different levels of policymaking and different health issues.

Results: Sixty-five studies met the inclusion criteria and were included in the review. Health issues that received attention on trade policy agendas included: access to medicines, food nutrition and food security, tobacco control, non-communicable diseases, access to knowledge, and asbestos harm. This has occurred in instances of domestic and regional policymaking, and in bilateral, regional and global trade negotiations, as well as in trade disputes and challenges. We identified four enabling conditions for elevation of health in trade-related policymaking: favourable media attention; leadership by trade and health ministers; public support; and political party support. We identified six strategies successfully used by advocates to influence these conditions: using and translating multiple forms of evidence, acting in coalitions, strategic framing, leveraging exogenous factors, legal strategy, and shifting forums.

Conclusion The analysis demonstrates that while technical evidence is important, political strategy is necessary for elevating health on trade agendas. The analysis provides lessons that can be explored in the wider commercial determinants of health where economic and health interests often collide.

International standardising bodies such as the Codex Alimentarius Commission, the International Organization for Standardization, and their regional equivalents such as the East African Standards Committee and CARICOM Regional Organization for Standards and Quality play a significant role in many areas of public health, including food safety, the regulation of food and beverage contents, and the regulation of packaging and labelling of food, alcohol, and non-alcoholic beverages. Such bodies typically have a dual role – to ensure health and safety while harmonising standards at a regional or international level in order to facilitate cross-border trade in goods.

However, these dual roles are often in tension with each other. The importance of technical standards to international trade agreements such as the World Trade Organization’s Technical Barriers to Trade Agreement and regional economic integration agreements mean that private sector entities take a close interest in the work of standardising bodies. In recent years, there have been a number of examples of unhealthy commodity industries and exporting countries using international or regional standards to oppose or neutralise regulation. At the same time, the role of standardising bodies in harmonising regulation mean that they can be a powerful way to accelerate the adoption of public health regulations.

This presentation aims to review the role of international and regional standardising bodies as both a facilitator and barrier to public health regulation. Using examples drawn from the regulation of noncommunicable disease risk factors, including front-of-pack food labelling and tobacco control, it looks at how standards interact with international trade instruments, the role of industry and public health bodies in the governance of standards, and examples of the role that standards can play in accelerating or blocking action on NCD risk factor regulation. The presentation argues that public health practitioners must make engaging with the work of standardising bodies a priority.

When the Thai government expressed to the public on its interest to join the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) in 2018, the news attracted significant attention from all sectors, with a polarised debate on the potential impacts on social welfare of the country. The trade sector strongly advocated Thailand to join the CPTPP, while the health sector and the public had an opposite view as they highly concerned about negative impacts of this Agreement, especially on access to medicine and national drug security. The Thai government, in response, conducted an extensive and continuous consultation process through various mechanisms during 2018-2022 to solve issues of concerns raised by relevant stakeholders. As there were several challenges to overcome, the country was thus not able to make a decision to join the CPTPP before a change to the new government.
This study aimed to understand the landscape of the CPTPP negotiation process in Thailand, including stakeholders, their concerns and their influences and to provide recommendations to the current government to overcome challenging issues if decided to join the CPTPP. It was found that access to medicine and drug security, plant varieties protection, and remanufactured medical devices were the most concerning issues raised by health stakeholders. The study also revealed significant engagement from both state and non-state trade and health actors and mechanisms established by these actors. Each actor strived to build connection with other agencies to gain their power and advocate their position. Effectiveness and quality of participation in the public consultations were questionable and need attention from responsible organizations of the mechanism and policy makers. The study strongly suggested a tailored made approach for a particular group of stakeholders to advocate them and additional in-depth research on the most concerning health issues to quantify positive and negative impacts and strategically communicate to the public to gain their support.

Humanity faces three massive systemic polycrises - climate change, economic inequities and poor health and wellbeing. These crises are linked by common drivers including energy and finance systems. Investment patterns shape the global energy system which, in turn, conditions patterns of economic, social, and human development. Export credit agencies (ECA) are key actors in global energy infrastructure investment – G20 ECAs accounted for over $1 trillion USD in fossil fuel-related financing from 2006-2022 – and play a critical role in enabling energy trade and facilitating carbon lock-in. In this paper we examine the drivers of ECA investment decisions for different types of energy infrastructure and consider how these investments influence economic inequities and human health and wellbeing.

The COVID-19 pandemic started as a health emergency but impacted both the people and the planet in multiple ways. Its social and economic consequences are more obvious as the lives of individuals, families and communities across the globe were affected. The pandemic hit certain Sustainable Development Goals (SDGs) more directly but impacted every SDG in some way because of interfaces among the SDGs. As SDGs are interconnected, disruption of one goal affects other goals.
This paper explores the impact of the COVID-19 pandemic on health-related Sustainable Development Goals (SDGs). This paper then considers the intellectual property law dimensions of the pandemic in the context of two specific issues: the right to repair medical devices; and access to COVID-19 vaccines, therapeutics and diagnostics. It also makes suggestions for a sustainable recovery and calls for policy reforms aimed at building more resilient health systems, food systems, societies and economies. The conclusion maintains that the framework for recovery should be based on the principles of equity, inclusion, solidarity and multilateralism.
Keywords: COVID-19; Intellectual property; Sustainable development; Patents; WHO; WTO; TRIPS waiver; Right to repair; Pandemic treaty

The inequitable rollout of COVID-19 vaccines, diagnostics, and therapeutics resulted in a vast gap in response measures in low- and middle-income countries. Inequities in access to vaccines, diagnostics, and therapeutics allowed COVID-19 to disproportionately impact the lives and livelihoods of people. The Marrakesh Agreement Establishing the World Trade Organization (WTO) allows WTO Members to agree to temporarily waive obligations under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement). However, the TRIPS Decision adopted by the 12th WTO Ministerial Conference in June 2022, after lengthy and protracted negotiations lasting for 20 months in the middle of a pandemic, allowed only a fragment of the waiver proposal submitted by India and South Africa. Moreover, since the adoption of the Decision there has been an impasse in the WTO about extending the Decision to COVID-19 diagnostics and therapeutics even though the WTO Members were mandated by the Decision to decide on this matter within six months of the Decision. There is no legal barrier in extending the Decision beyond vaccines to cover diagnostics and therapeutics. There is a need to immediately and unconditionally extend the Decision to these tools. The obligations under the TRIPS Agreement should not hinder the necessary actions of WTO Members in response to the pandemic. Global supply of COVID-19 diagnostics and therapeutics should not depend on voluntary measures and optional goodwill of patentee corporations.
Keywords: COVID-19, pandemic, TRIPS waiver, public health flexibilities, diagnostics, therapeutics