An ISDS statement or the threat of a person could deter governments from pursuing a health and pharma policy: an effect known as “regulatory cooling.” This is partly due to the prohibitive costs associated with ISDS. The Australian government has issued about AUD 23 million to defend Philip Morris Asia`s assertion on tobacco packaging [37]. Footnote 10 If the investor wins, the rewards can also be significant: investors who deposited claims on ISDS in 2017 demanded $15 million to $1.5 billion [38]. Various procedural issues, including the ad hoc nature of decisions (arbitrators are not bound by previous decisions), the potential for conflict of interest between arbitrators and the absence of an appeal procedure [39, 40] are subject to considerable uncertainty. While recent agreements, such as the TPP, have improved some aspects of the ISDS process (such as procedural transparency), many procedural problems remain [40]. One final point: the provisions we are debating can affect countries` ability to achieve SDGs 3.8 through other means, in addition to the four main pharmaceutical objectives. To the extent that, for example, one of these provisions increases public costs with little or no improved therapeutic benefits, they become opportunity costs for achieving SDG 3.8. Many of these provisions carry a significant administrative burden on compliance with BMI rules, which have implications for human resources and infrastructure. Walls and colleagues point out that “if states do not find ways to increase their administrative regulatory capacity in terms of the negotiation, implementation and day-to-day management of ATPs [preferential trade agreements], these EPZs could lead to increased health inequalities [66]. The final step was to continue the potential impact of the provisions on the main core policy objectives mentioned in the agreements (as noted above) by analyzing possible avenues, on the disciplinary expertise and research experience of authors in the field of trade agreements and pharmaceutical policy, as well as on published research results (available and relevant). The aim was to identify possible pathways and possible effects that should be at the heart of health and human rights assessment and scientific research. Although almost all WTO agreements are binding on all members, the GPA is an exception to the “single obligation” of a multi-lateral agreement within the WTO that countries may decide whether or not to join. The forward-looking reform of the IGE is on track.

All treaties concluded in 2018 include several reforms in line with either UNCTAD`s international investment reform package or UNCTAD`s sustainable development investment policy framework.

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