Factors influencing the prioritisation of access to medicines in trade-related intellectual property policymaking in Thailand

Thailand is facing ongoing trade-related challenges that threaten access to an affordable and sustainable supply of medicines. Despite Thailand's history of balancing trade pressures and public health priorities, little is known about the factors that enable or constrain a focus on access to medicines in trade-related intellectual property (IP) decision making. Using document analysis and qualitative interviews, and drawing on Kingdon's Multiple Streams Framework, this qualitative study examines the factors that have enabled or constrained Thailand from focusing on access to medicines in three case studies of trade-related IP policy: Thailand's patent law and its amendments; its issuance of compulsory licences; and its decision-making about TRIPS-plus trade agreements including potential membership of the Comprehensive and Progressive Agreement for Trans-Pacific Partnership. The degree to which access to medicines has been prioritised in Thailand's trade-related IP policymaking has varied across different types of policymaking and over time. Integral to its successes has been the involvement of the Ministry of Health and sustained advocacy by access to medicines coalitions which exert political pressure, generate evidence, and provide technical assistance to support evidence-based policy reform. In addition, Thailand's compulsory licencing was made possible by a policy entrepreneur with the motivation and authority to implement policy change. Constraints to Thailand's focus on access to medicines have included its trade dependence on the United States (US), ongoing US trade pressure to implement TRIPS-plus measures, and intense lobbying from Pharmaceutical Research and Manufacturers of America, the organisation representing US-based major pharmaceutical companies, to increase IP protection for pharmaceuticals in Thailand. Through the use of Kingdon's framework, this study's focus on three different types of trade-related IP policymaking has provided a detailed picture of the factors that have influenced the prioritisation of access to medicines and how these have played out in Thailand. Thailand's mixed history with regard to the prioritisation of access to medicines could provide lessons for other low- and middle-income countries facing similar challenges to access to medicines by ensuring that the conditions are right in each of the three streams for windows of opportunity to emerge.