Trade, power, and public health: a political economy analysis of Thailand's CPTPP negotiation process.

BACKGROUND

The Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) has generated intense debate in Thailand, concerning its implications for public health, particularly intellectual property, and access to medicines. During 2018-2022, Thailand undertook an extended in-country process to provide evidence on its economic opportunity and public health challenges for the Cabinet decision. However, there is no evidence indicating whether Thailand has decided to join the CPTPP. This study examines Thailand's CPTPP negotiation process using a political economy framework, focusing on the institutional and actor landscape that shaped the negotiations.

METHODS

This study employed a qualitative research design grounded in political economy theory, integrating state-centred and power-centred analytical frameworks. Data collection comprised a document review and in-depth interviews with 31 stakeholders from the health and trade sectors, covering state officials, academics, the private sector, and civil society representatives.

RESULTS

The findings demonstrate critical public health concerns centred on pharmaceutical access, plant variety protection, and medical device regulatory standards. The findings also reveal a complex landscape of stakeholder dynamics and power asymmetries in Thailand's CPTPP negotiation process. Although both state and non-state actors played influential roles in shaping public discourse and decision-making, the decision-making was dominated by state trade actors, as the lead negotiating authority, marginalising health sector perspectives despite their active engagement. While civil society leveraged collaborative power to exert political pressure, structural imbalances and a lack of transparency persisted. In addition, intra-sectoral differences also existed and were influenced by institutional positioning.

CONCLUSION

The study highlights the need for stronger institutional mechanisms to promote inclusive stakeholder participation and greater policy coherence between trade and public health objectives in future trade negotiations.

CLINICAL TRIAL NUMBER: Not applicable.