Co-authored by Joe Brenner, Joshua Yang, Donald Zeigler



Two recent high-profile statements attempt to drum up support for the unpopular Trans Pacific Partnership (TPP) based on faulty analyses of provisions that greatly concern public health: tobacco control, and access to medicines.

The U.S. electorate is massively opposed, across the political spectrum, to the proposed TPP. Hatched during the market triumphalism of the 1980s, modern era trade agreements like the TPP have contributed to the most lopsided inequality in income distribution since the Great Depression. They created the commercial and legal framework for outsourcing living-wage jobs, escalating the prices of critical medicines, and assigning corporate privileges globally that undermine national and local government laws and regulations on climate and the environment, labor standards and occupational safety and health, controls on tobacco, alcohol and obesogenic foods and beverages, and privatizing services such as health, education, social services, water, and corrections.

The TPP would continue and extend these policies, which significantly undermine the social and economic determinants of the public's health. In fact, even the recent analysis by the usually complacent International Trade Commission concedes that the TPP would add virtually nothing to U.S. economic growth, while further eroding jobs in 16 out of 25 U.S. economic sectors in agriculture, manufacturing, and services. Public health must not collude with efforts to resuscitate the TPP.



Tobacco control: The American Cancer Society is urging Congress to support the TPP for one reason: because it offers limited protection for tobacco control regulations from a uniquely corporate-friendly trade mechanism known as the investor-state dispute system (ISDS). Multinational tobacco corporations have invoked ISDS to challenge effective public health protections like requiring plain packaging for cigarettes to discourage marketing to youths. But the TPP's proposed fix is tantamount to a half-dose of antibiotics: relief if any is likely limited and short lived, while the surviving infection can mutate to roar back more powerfully.

The TPP offers each country an option to assert individually that its tobacco control measures will not be subject to pending or possible future ISDS trade challenges from corporations, rather than providing uniform protection to all TPP countries. This means that in order to exercise an "opt out," each country must prioritize and mobilize the necessary resources to resist the inevitable tobacco industry lobbying campaigns that will oppose such efforts. Local and state governments would have no authority to opt-out.

Tobacco use is the leading preventable cause of death, worldwide. But the rest of the TPP still treats tobacco like other products, including for requirements that have proven problematic for public health in the past such as regulatory coherence. Tariffs on tobacco and tobacco products are reduced or eliminated, making cigarettes cheaper and increasing deadly consumption.



And the TPP welcome mat remains available to corporate ISDS challenges to virtually any other real or imagined infringement on corporate rights.



Access to medicines: There is ample analytical as well as ground-level evidence that trade provisions such as patents, and brand name companies' control of clinical trial data (known as "data protections"), create and perpetuate monopolies that drive up drug prices. Trade-related restraints on access to medicines for HIV/AIDS have been well-documented and have sparked global campaigns since the late 1990s.

But a Washington Post editorial declared the TPP a "healthy agreement," based on one report that increases in overall national spending on pharmaceuticals have been no higher in countries that already have trade agreements similar to the TPP, compared with countries that have no such agreements. In contrast to this study, the drug industry recognizes that countries vary widely in regulatory environments for drug approval and pricing, as well as income levels, and targets objectives for trade agreements accordingly.

The fact is that the unrestrained U.S. pharmaceutical market is far and away the largest and highest-priced profit center for prescription drugs in the world. Propping up U.S. prices is always the primary objective. Drug companies fight fiercely for trade rules that protect or even improve this status quo. These drug industry protections are significant barriers to access to medicines and jeopardize public health.

Studies of the effects of free trade agreements on Jordan and Guatemala did find "higher prices on patented and branded medicines, resulting from delayed competition with low-cost generics." Equally interestingly, according to a recent IMS report "[a]fter a sharp drop in 2012, [U.S.] spending [on pharmaceuticals in 2015] grew 8.5%, driven by a wave of innovative specialty medicines ... for hepatitis, autoimmune diseases, and oncology." The vast majority of the 90 drugs currently listed as data-protected in Guatemala treat these same conditions. According to Brook Baker, the TPP would further threaten access to affordable medicines both in the U.S. and abroad.



Another world is possible. The 12-nation TPP, finalized in February, 2016, is now subject to approval by those 12 governments. In the U.S., each presidential candidate says they oppose it, as do majorities in the House and the Senate. Empty promises of a glittering 21st century trade agreement are no substitute for meaningful policies that shape a healthy global economy.

The TPP would exacerbate income inequality, entrench unaffordable prices for prescription drugs, undermine and endanger public health protections for the environment, tobacco and alcohol control, food safety, and data privacy, and generally elevate corporate rights over the public's interest. It is on a glide path to defeat. Public health should promote its demise and replacement with international agreements that give priority to ensuring and strengthening the social determinants that improve health for all.