GUEST BLOG: Dr Joshua Freeman – why TPPA hurts public health



There’s more than a little irony in the fact that the least transparent trade deal in history contains an “Annex on Transparency”. After all, before Wikileaks published it last Wednesday, the plan was to keep this draft (along with all the others) from the public for four years after the deal was signed.

But the apparent double-standard makes more sense when we consider the annex isn’t intended to apply to political leaders or profit-driven corporations, but rather to national agencies responsible for brokering the best deals possible on pharmaceuticals for the public. In other words, lack of transparency appears to be a real concern when it gets in the way of pharmaceutical industry profit, but not so much when it gets in the way of informed public debate.

Among different nations’ purchasing agencies, Pharmac stands out as being particularly effective. It’s estimated it saved NZ $5 billion dollars between 2000 and 2012 – money made available to reinvest in health that would have otherwise been pharmaceutical industry profits. But the major concern for industry – and the reason Pharmac has been described as “an egregious example” of bad practice – is that it sets a precedent for other countries to follow. For example it’s been estimated that if the Australians adopted the Pharmac model they would save $1.6 billion dollars a year. All of this has led the US trade representative to report:  “With respect to NZ, US industry has expressed serious concern about the policies and operation of NZ’s Pharmaceutical Management Agency (Pharmac), including among other things the lack of transparency, fairness and predictability of the Pharmac pricing and reimbursement regime…”

So on the face of it, the main purpose of the Transparency Annex is to undermine Pharmac, but what does the annex actually show?

On superficial reading it looks relatively benign. The “Principles” section contains lots innocent-sounding expressions like “high quality health care”, “competitive markets” and “accountable procedures”. But when all the underlying changes are added together, the picture becomes more concerning. To sum it up: Pharmac would be forced to make decisions within shorter time frames, with more intense input from industry and with more onerous requirements to release information that could then be used by industry to challenge its decisions, either through a beefed up review or appeal process or more worryingly, an investor state dispute.

Each of these changes may not seem like game changers when used alone but when systematically used in combination they have the potential to neutralise many of the features of Pharmac that have made it so successful. It would be naïve to assume that industry would not systematically leverage any new powers in order to undermine Pharmac and maximise profits. In other words, as a colleague closely familiar with Pharmac processes said to me: “don’t expect the industry to play by gentleman’s rules”.

Particularly concerning is the threat of investor state disputes (that is the initiation of multi-million dollar lawsuits against the government in an off-shore tribunal). Although state to state dispute processes have been expressly excluded by the annex, the investor to state process (ISDS) would still apply. The Australians are clearly concerned about this because they’ve proposed a clause that expressly excludes their equivalent of Pharmac from being subjected to ISDS (although it hasn’t yet been accepted). Yet for some reason NZ has not done the same, which means the threat of ISDS would loom heavily over each Pharmac decision. This would have an intimidating and restraining influence, particularly when contentious decisions are hanging in the balance.

TDB Recommends

So while it could be argued that the fundamental structure of Pharmac would remain intact, on a practical level it would make Pharmac’s operating environment much more challenging. When combined with changes in the Intellectual Property Chapter, the net result would be more of the health budget spent on medicines and more financial pressure on the NZ health system. Even if, as the Prime Minister promised, co-payments for medicines did not increase, the increased cost nationally would very likely have to be offset by cutting other areas of health spending. As a result, real patients would suffer, in particular those with the greatest health needs. This would lead to existing health inequities becoming more deeply entrenched.

It’s not too difficult to imagine that if the Transparency Annex (along with the rest of the TPP) comes into force, then before long we would be hearing that the growing cost of healthcare is making our public health system financially unsustainable. Perhaps we would be told that our expectations have become unrealistic and that we need to settle for less. Perhaps we would then be told that we need to allow multinational medical insurers to come to our rescue and cover the shortfall, opening up the way for a “two tier” health system in NZ.

That’s why it’s so important to anticipate where all this is heading before it’s too late. But in order to do this we need informed public debate. In fact, we need the same kind of “transparent … and accountable procedures” from our political representatives that the leaked annex reveals they are quite willing to concede to the Pharmaceutical Industry.




Doctors for Healthy Trade

Doctors for the Protection of Health in Trade Agreements  (known as Doctors for Healthy Trade) is a growing informal coalition of New Zealand doctors and colleagues in health in New Zealand and elsewhere with over 150 supporters.

The members of our core group are predominantly full-time clinicians, although some of us have university attachments that have allowed a little scope for research and writing on this topic. The doctors who support the protection of health in trade are clinicians in all medical specialities, with strong representation from paediatricians, public health specialist and psychiatrists. For more information see



  1. Thanks for this.
    It is consistent with the drive to privatise the public sector overall.
    It’s obvious that this government is underfunding Health as a move to force us as users into the private health sector under pressure mainly from US big pharma and health insurance corporations.
    The CEO of Waitemata DHB in a recently leaked email acknowledged that it faced an “impossible situation” trying the meet the demands of deadlines for elective surgery with insufficient funds.
    More of those funds diverted to Pharmac facing the ‘transparency’ of ISDS will as you imply gut public health and provide a boost for privatisation of health services which will become bought up by the big health multinationals.
    The reason that this is all being done in secret is that genuine ‘transparency’ would bring about such an angry public backlash this Govt wouldn’t survive until the next election.
    Time to mobilise health workers and community support to send a message to this government that we are not ready to join the contest to become another 51st state of the USA.

    • “we are not ready to join the contest to become another 51st state of the USA”

      We would continue to be less than that in their eyes.

  2. We’ve had two recent deaths due to the disgusting state of inadequate housing in this country hitting the headlines, – and the immoral neo liberal excuses trotted out in justifying the lack of action taken on steps to build more and upgrade existing state houses.

    Coupled with the exorbitant costs to thousands of families nationwide of a privatized ‘ national grid ‘.

    We wont go into the ridiculous prices of healthy food – we all know . We don’t need to be told further.

    Those same thousands of family’s that are the working poor on low / minimum wages are now to be crucified yet again by this even more immoral TTPA deal.

    The TTPA .


    That’s right . FUCK THEM.

    If they cant be arsed being straight up about things because it’d reveal their TRUE motives …. that of creating a two tier health system whereby the poorer sectors of society are left to die – YES DIE !!! – through coercion and manipulation of prices that makes medicines even more expensive and unaffordable to those who already are the vulnerable poor….

    Well we got a message for those fuckers- this aint how we do things down here in New Zealand and they better start believing it.


    And the rest of those murderous corporate bastards pushing the TTPA can go and get fucked.

    • Agree WK maybe if the TPP goes through John Key might pack up and leave, job done,its a rotton deal but his exit would be a bonus.

      • Just ask any diabetic that has non subsidised meds now how much their meds costs without this bullshit added on top.

      • Looks like Obama is going to get his way, hidden away in business section of Herald online,it states Obama is on the way to fast track,dosnt say its passed but it more or less states it will be . TPP written by the corporates for the corporates. Hints at some relief by those damaged by TPP.

  3. The TPPA is the worst.

    When I see politicians on the news guaranteeing that they will get the best deal for NZ. I die a little inside.

    That blatant lie just makes me cringe.

    Regardless of corporations, other governments etc. The fact that we think we will get a good deal is ridiculous.

    We are competing with BIG CORPORATIONS… They don’t care about their own countries…. Yet care about 4 million Kiwis.
    Money is their game. They want to win.

  4. You’d think that saving NZ $5 billion dollars between 2000 and 2012 would complete the argument for Pharmac being maintained at all cost ! That there wouldn’t even BE a discussion.
    It serves to illustrate the venality of mind-set the corporate world order has, to think secretly bargaining a system to bleed that kind of public money into their profits at cost to peoples health – is somehow human.
    Further, that a Government – raised in Parliamentary Democracy, trading sovereign Law without public vote- who surely recognize the value of 5 billion dollars handy for other purposes – must be asked “who are you ? That you could trade the health of the people you are paid to represent ? “

    • In former years it would be called for what it is :


      These days it just called ‘ doing business ‘.

      Well they can burn like a Guy Fawkes effigy for all I care.

      Sick to the back teeth of these scum bag mongrels parading round in their flash suits and ties thinking they have the public adoration for their lies and filthy bullshit.

      When are we going to get back to calling a spade a spade around this country , huh ?

      • A spade a spade ? Treason ? We are being played at so many levels I just got the bends.
        Here’s one for you.
        On June 6th, front full page TaranakiDailyNews ‘world’ section headlined : “Saudis ‘financed 9/11 US attacks’.
        sourced The TIMES. Fairfax . Murdoch.

        JohnKy was IN or had just been IN Saudi Arabia; our ‘ally’ in the Global War of Terror (GWOT), greasing the skids of his latest fkup with the un-rendered fat of 900 sheep (who paid for them?) flown in to better the deal-gone-wrong between Carter and Key and the Sheik.
        As exposed by Mathew Hooton on RadNZ ninetonoon.

        The world I grew up in, and the law I briefly Policed, had the financiers of crime, CULPABLE for that crime. Responsible.
        So, the TIMES was telling me SaudiArabia was/is responsible for the crime of 911 .
        Is this not Calumny !!? ‘Dichotomy ?! Treason ? While our PM was making servile trade ‘with’…..While ‘our boys’ are busy chasing CIA created alQaeda/alNosra/ISIS in Iraq quagmire’ because of’ …While our ‘allies’, Saudi Arabia, bloated with US arms, commit egregious war crimes in Yemen and False flag attacks in Syria to no US opprobrium what-so-ever….the point is. USAMO – and by extension the 5th eye ‘NZ’ – are at war everywhere in the world because of GWOT 911 . Which the TIMES now tells us was financed by our ALLIES and trading partners in the GWOT,
        the ‘Saudis’ ??

        I can assure you. unless life itself is a dream, this is not one.

Comments are closed.