Health experts excluded from trade talks

deborah-gleeson-thumb1Dr Deborah Gleeson

First published on Crikey health blog Croakey on 7 December 2012.

We have gathered in Auckland to talk to the negotiators about our concerns regarding the Trans Pacific Partnership (TPP), a large regional trade agreement involving eleven countries from around the Pacific Rim.

The concerns of public health experts are well grounded. Several leaked negotiating documents have shown that the United States is pursuing more favourable terms for its big corporations through this trade agreement. These corporations – which lobby hard to have their rights extended – include pharmaceutical companies and tobacco companies.

A key issue under discussion in the TPP negotiations is the future of schemes for subsidising medicines to make them affordable for patients, such as Australia’s Pharmaceutical Benefits Scheme (PBS) and New Zealand’s Pharmaceutical Management Agency (PHARMAC).

The Australian Government has taken the position that it will not accept any provisions in the trade agreement that would affect the sustainability of the PBS or the cost of generic medicines.

But the New Zealand Government has made no such commitments to protect PHARMAC in the negotiations. In an interview this week, NZ Trade Minister Groser indicated he was prepared to make compromises to satisfy the US Government and the pharmaceutical industry.

New Zealand’s apparent preparedness to cave in to Big Pharma’s demands signals more than just trouble for New Zealanders. PHARMAC is a highly effective model for containing pharmaceutical costs for governments at the same time as ensuring affordable access to essential medicines for patients. This is a model that governments in other countries – including Australia – would be wise to emulate. It is particularly appropriate for developing countries with limited health budgets and many people on low incomes.

What the pharmaceutical industry is seeking through the TPP is to open up the processes used in schemes like the PBS and PHARMAC for determining which drugs are subsidised and how much is paid for them. Big Pharma would like more information about decisions and how they are made, more avenues of appeal and greater involvement in decision making processes.

The ultimate outcome of making concessions to Big Pharma would inevitably be higher costs for government and for the public.

What the pharmaceutical industry is seeking – and the US government is pursuing in the TPP to satisfy the pharmaceutical industry – is diametrically opposed to the interests of the public. There is no safe middle ground here – no “reasonable compromise” that might serve both Big Pharma’s demands and the public interest.

Health and medicines policy should be a matter for domestic priority-setting. Including pharmaceutical programs in a so-called “trade” agreement – and making compromises and trade-offs to satisfy industry interests – removes the flexibility of governments to respond appropriately to the health needs of their populations.

Both Australia and New Zealand should ensure that maximum flexibility is preserved for governments to determine their own health and medicines policies and programs. Attempting to find a middle ground between public health objectives and Big Pharma’s objectives is dangerous territory indeed.

Dr Deborah Gleeson is a public health lecturer at La Trobe University.