Adopted by the 200th WMA Council Session, Oslo, April 2015
Trade agreements are sequelae of globalization and seek to promote trade liberalization. They can have a significant impact on the social determinants of health and thus on public health and the delivery of health care.
Trade agreements are designed to produce economic benefits. Negotiations should take account of their potential broad impact especially on health and ensure that health is not damaged by the pursuit of potential economic gain.
Trade agreements may have the ability to promote the health and wellbeing of all people, including by improving economic structures, if they are well constructed and protect the ability of governments to legislate, regulate and plan for health promotion, health care delivery and health equity, without interference.
There have been many trade agreements negotiated in the past. New agreements under negotiation include the Trans Pacific Partnership (TPP), Trans Atlantic Trade and Investment Partnership (TTIP) the Trade in Services Agreement (TiSA) and the Comprehensive Economic and Trade Agreement (CETA).
These negotiations seek to establish a global governance framework for trade and are unprecedented in their size, scope and secrecy. A lack of transparency and the selective sharing of information with a limited set of stakeholders are anti-democratic.
Investor-state dispute settlement (ISDS) provides a mechanism for investors to bring claims against governments and seek compensation, operating outside existing systems of accountability and transparency. ISDS in smaller scale trade agreements has been used to challenge evidence-based public health laws including tobacco plain packaging. Inclusion of a broad ISDS mechanism could threaten public health actions designed to effect tobacco control, alcohol control, regulation of obesogenic foods and beverages, access to medicines, health care services, environmental protection/climate change and occupational / environmental health improvements. This especially in nations with limited access to resources.
Access to affordable medicines is critical to controlling the global burdens of communicable and non-communicable diseases. The World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) established a set of common international rules governing the protection of intellectual property including the patenting of pharmaceuticals. TRIPS safeguards and flexibilities including compulsory licensing seek to ensure that patent protection does not supersede public health.
TiSA may impact on eHealth provision by changing rules in licensing and telecoms. Its impact on the delivery of eHealth could be substantial and damage the delivery of comprehensive, effective, cost-effective efficient health care.
The WMA Statement on Patenting Medical Procedures states that patenting of diagnostic, therapeutic and surgical techniques is unethical and “poses serious risks to the effective practice of medicine by potentially limiting the availability of new procedures to patients.”
The WMA Statement on Medical Workforce states that the WMA has recognized the need for investment in medical education and has called on governments to “…allocate sufficient financial resources for the education, training, development, recruitment and retention of physicians to meet the medical needs of the entire population…”
The WMA Declaration of Delhi on Health and Climate Change states that global climate change has had and will continue to have serious consequences for health and demands comprehensive action.
Therefore the WMA calls on national governments and national member associations to:
- Advocate for trade agreements that protect, promote and prioritize public health over commercial interests and ensure wide exclusions to secure services in the public interest, especially those impacting on individual and public health. This should include new modalities of health care provision including eHealth, Tele-Health, mHealth and uHealth.
- Ensure trade agreements do not interfere with governments’ ability to regulate health and health care, or to guarantee a right to health for all. Government action to protect and promote health should not be subject to challenge through an investor-state dispute settlement (ISDS) or similar mechanism.
- Oppose any trade agreement provisions which would compromise access to health care services or medicines including but not limited to:
– Patenting (or patent enforcement) of diagnostic, therapeutic and surgical techniques;
– “Evergreening”, or patent protection for minor modifications of existing drugs;
– Patent linkage or other patent term adjustments that serve to as a barrier to generic entry into the market;
– Data exclusivity for biologics;
– Any effort to undermine TRIPS safeguards or restrict TRIPS flexibilities including compulsory licensing;
– Limits on clinical trial data transparency.
- Oppose any trade agreement provision which would reduce public support for or facilitate commercialization of medical education.
- Ensure trade agreements promote environmental protection and support efforts to reduce activities that cause climate change.
- Call for transparency and openness in all trade agreement negotiations including public access to negotiating texts and meaningful opportunities for stakeholder engagement.
 TPP negotiations currently include twelve parties: the United States, Canada, Mexico, Peru, Chile, Australia, New Zealand, Brunei, Singapore, Malaysia, Japan and Vietnam.
 TTIP negotiations currently include the European Union and the United States.
 CETA negotiations currently include European Union and Canada.
 See World Trade Organization, Declaration on TRIPS and Public Health (“Doha Declaration”) (2001)