Trade agreements and policy space for achieving universal health coverage (SDG target 3.8)

Achieving universal health coverage (UHC) is one of the core priorities of the Sustainable Development Goal health agenda, and much of the debates on the means to achieve this target has focused on financing and benefits models. However, little attention has been paid to the challenges related to the costs of providing UHC, such as the affordability of medicines. This paper explores the challenges countries face in negotiating trade and investment agreements that could restrict their ability to manage access to medicines and the public health systems more generally. The paper outlines the key provisions in recent trade agreements—strengthened intellectual property (TRIPS plus) requirements, government procurement, dispute settlement—that constrain policy space for implementing universal health coverage. These consequences can have particularly dramatic effects for countries that made effective use of medicines and intellectual property policies to expand access to medicines. The paper elaborates on the case of Bangladesh to illustrate these consequences.