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Gleeson D, Lexchin J, Labonté R, Townsend B, Gagnon MA, Kohler J, Forman L, Shadlen KC. Analyzing the impact of trade and investment agreements on pharmaceutical policy: provisions, pathways and potential impacts. Global Health 2019; 15:78. [PMID: 31775767 PMCID: PMC6882307 DOI: 10.1186/s12992-019-0518-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Trade and investment agreements negotiated after the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the large body of literature on intellectual property and access to affordable medicines, the ways in which other provisions in trade agreements can affect pharmaceutical policy and, in turn, access to medicines have been little studied. There is a need for an analytical framework covering the full range of provisions, pathways, and potential impacts, on which to base future health and human rights impact assessment and research. A framework exploring the ways in which trade and investment agreements may affect pharmaceutical policy was developed, based on an analysis of four recently negotiated regional trade agreements. First a set of core pharmaceutical policy objectives based on international consensus was identified. A systematic comparative analysis of the publicly available legal texts of the four agreements was undertaken, and the potential impacts of the provisions in these agreements on the core pharmaceutical policy objectives were traced through an analysis of possible pathways. Results An analytical framework is presented, linking ten types of provisions in the four trade agreements to potential impacts on four core pharmaceutical policy objectives (access and affordability; safety, efficacy, and quality; rational use of medicines; and local production capacity and health security) via various pathways. Conclusions The analytical framework highlights provisions in trade and investment agreements that need to be examined, pathways that should be explored, and potential impacts that should be taken into consideration with respect to pharmaceutical policy. This may serve as a useful checklist or template for health and human rights impact assessments and research on the implications of trade agreements for pharmaceuticals.
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Affiliation(s)
- Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Joel Lexchin
- School of Health Policy & Management, York University, Toronto, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Belinda Townsend
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Marc-André Gagnon
- School of Public Policy & Administration, Carleton University, Ottawa, Canada
| | - Jillian Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kenneth C Shadlen
- Department of International Development, London School of Economics and Political Science, London, UK
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Hamid AA, Mohamed Ibrahim MI. A Systematic Scoping Review of the State of Pharmacovigilance and Governance in the MENA Region: Challenges and Opportunities. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Moscou K, Kohler JC. Matching safety to access: global actors and pharmacogovernance in Kenya- a case study. Global Health 2017; 13:20. [PMID: 28335786 PMCID: PMC5363016 DOI: 10.1186/s12992-017-0232-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/12/2017] [Indexed: 11/11/2022] Open
Abstract
Background The Kenyan government has sought to address inadequacies in its National Pharmaceutical Policy and the Pharmacy and Poisons Board’s (PPB) medicines governance by engaging with global actors (e.g. the World Health Organization). Policy actors have influenced the way pharmacovigilance is defined, how challenges are understood and which norms are requisite to address drug safety issues. In this paper, we investigate the relationship between specific modes of engagement among global (exogenous) and domestic actors at the national and sub-national level to identify the positive or negative effect on pharmacovigilance and pharmacogovernance in Kenya. Pharmacogovernance is defined as the manner in which governing structures; policy instruments; institutional authority (e.g., ability to act, implement and enforce norms, policies and processes) and resources are managed to promote societal interests for patient safety and protection from adverse drug reactions (ADRs). Qualitative research methods that included key informant interviews and document analysis, were employed to investigate the relationship between global actors’ patterns of engagement with national actors and pharmacogovernance in Kenya. Results Global actors’ influence on pharmacogovernance and pharmacovigilance priorities in Kenya (e.g., legislation and adverse drug reaction surveillance) was positively perceived by key informants. We found that global actors’ engagement with state actors produced positive and negative outcomes. Engagement with the PPB and Ministry of Health (MOH) that was characterized as dependent (advocacy, empowerment, delegated) or interdependent (collaborative, cooperative, consultative) was mostly associated with positive outcomes e.g., capacity building; strengthening legislation and stakeholder coordination. Fragmentation (independent engagement) hindered risk communication between public, private, and NGO health programs. Conclusion A framework for assessing pharmacogovernance would support policy makers’ evidence-based decision making regarding investments to strengthen capacity for pharmacovigilance and guide policies regarding the state and exogenous actor relationship pertaining to pharmacogovernance. Ideally, dependency on exogenous actors should be reduced while retaining consultative, collaborative, and cooperative engagement when inter-dependency is appropriate. The use of global actors to address Kenya’s pharmacovigilance inadequacies leaves the country vulnerable to 1) ad hoc drug surveillance; 2) pharmacovigilance fragmentation; 3) shifting priorities; and 4) cross purpose interests.
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Affiliation(s)
- Kathy Moscou
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. .,WHO Collaborating Centre for Governance, Accountability and Transparency for the Pharmaceutical Sector, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. .,School of Health Policy and Management, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Jillian C Kohler
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Munk School of Global Affairs1 Devonshire Place (At Trinity College), Toronto, ON, M5S 3K7, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,WHO Collaborating Centre for Governance, Accountability and Transparency for the Pharmaceutical Sector, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada
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Lexchin J, Gleeson D. The Trans Pacific Partnership Agreement and Pharmaceutical Regulation in Canada and Australia. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:597-613. [PMID: 27516183 DOI: 10.1177/0020731416662612] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Trans Pacific Partnership Agreement (TPP) is a large regional trade agreement involving 12 countries. It was signed in principle in February 2016 but has not yet been ratified in any of the participating countries. The TPP provisions place a range of constraints on how governments regulate the pharmaceutical sector and set prices for medicines. This article presents a prospective policy analysis of the possible effects of the TPP on these two points in Canada and Australia. Five chapters of relevance to pharmaceutical policy are analyzed: chapters on Technical Barriers to Trade (Chapter 8), Intellectual Property (Chapter 18), Investment (Chapter 9), Dispute Resolution (Chapter 28), and an annex of the chapter on Transparency and Anti-Corruption (Chapter 26, Annex 26-A). The article concludes that the TPP could have profound effects on the criteria these countries use to decide on drug safety and effectiveness, how new drugs are approved (or not) for marketing, post-market surveillance and inspection, the listing of drugs on public formularies, and how individual drugs are priced in the future. Furthermore, the TPP, if ratified and enforced, will reduce future policy flexibility to address the increasing challenge of rising drug prices.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Victoria, Australia
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