Trade, Power, and Public Health: A Political Economy Analysis of Thailand’s CPTPP Negotiation Process

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Thailand undertook an extended in-country process to provide evidence on its economic opportunity and public health challenges for the cabinet decision during 2018–2022. 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. Results The findings demonstrate that both state and non-state actors played influential roles in shaping public discourse and decision-making. The Ministry of Commerce emerged as the lead negotiating authority, while the health sector’s influence remained limited despite its active engagement. Key stakeholder concerns centred on pharmaceutical access, plant variety protection, and medical device regulatory standards. 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. CPTPP trade negotiation political economy stakeholder engagement access to medicines Thailand public health policy coherence Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Between 2018 and 2022, the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) received significant attention in Thailand across various sectors. As the agreement has been fully negotiated, countries seeking accession are required to accept the existing text in its entirety, without amendment. Previous studies indicate that the CPTPP may negatively affect public health, particularly access to medicines. ( 1 – 3 ) The CPTPP comprises 30 chapters and covers a wide range of trade-related issues with implications for health, notably intellectual property protection and environmental safeguards. As of 15 December 2024, the agreement had been signed and entered into force for 12 member countries: Australia, Canada, Japan, Mexico, New Zealand, Singapore, Vietnam, Peru, Malaysia, Chile, Brunei, and the United Kingdom.( 4 ) Four of these members are located in Southeast Asia and have economic structures comparable to Thailand. Given that most CPTPP members are economically advanced economies, the agreement is considered one of the world’s largest free trade agreements, collectively accounting for approximately 15% of global GDP. ( 5 ) The CPTPP accession process for Thailand consists of two main stages. The first involves the in-country preparation, including impact assessments, public consultations, compilation of findings, and submission of a consolidated report to the Cabinet for decision-making prior to the issuance of a formal letter of intent to join the agreement. ( 6 ) The second stage covers negotiations with existing members, followed by signing and ratification. ( 7 , 8 ) This study focuses on the first stage of the CPTPP negotiation process. Thailand informally expressed interest in joining the CPTPP as early as 2018. ( 9 , 10 ) However, since the initiation of discussions, the agreement has generated intense domestic debate due to its potential economic benefits alongside its contentious implications for public health. Although accession offers increased access to a large regional trading bloc, substantial concerns have been raised regarding access to medicines, expanded intellectual property rights,( 11 ) mandatory adherence to the UPOV 1991 Convention on Plant Variety Protection, and regulatory standards for medical devices. ( 12 – 14 ) Concerns Regarding Access to Medicines and Pharmaceutical Security A primary concern involves the impact of CPTPP provisions on intellectual property rights, particularly those affecting compulsory licensing (CL) and patent linkage. Thailand has previously exercised CL under the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which permits state agencies to produce or import essential medicines for public, non-commercial use. ( 15 ) However, many stakeholders have expressed concern that CPTPP provisions, such as Article 9.8( 5 ) and Annex 9-B, could allow private investors to initiate investor–state dispute settlement (ISDS) claims against the government. This potential exposure may discourage the future use of CL, even when such measures are necessary to protect public health. This interpretation is, however, in contrast with Article 18.6 that “ affirm their commitment to the Declaration on TRIPS and Public Health ”. ( 16 ) Patent linkage provisions present further risks to access to medicines. These provisions require drug regulatory authorities to verify patent status prior to approving the registration of generic medicines, which may delay the market entry of more affordable alternatives. ( 17 ) Thailand’s current regulatory framework allows for the registration of generic medicines prior to patent expiration, facilitating timely public access. Without an integrated system linking the patent office and drug regulatory authorities, implementing patent linkage could create legal uncertainty and administrative delays. Furthermore, CPTPP provisions requiring a “reasonable period” for patent holders to seek legal redress may further extend generic approval timelines, with possible negative consequences for public health. Concerns Regarding Plant Variety Protection under UPOV 1991 The CPTPP requires member countries to accede to the 1991 International Convention for the Protection of New Varieties of Plants (UPOV 1991) ( 16 ). Stakeholders have expressed concern that accession could facilitate seed monopolisation and increase production costs for farmers, particularly smallholders. ( 18 , 19 ) UPOV 1991 restricts farmers’ ability to save, reuse, or exchange seeds of protected varieties, potentially undermining established agricultural practices and agrobiodiversity. ( 20 ) These provisions may also increase dependence on multinational seed companies, reduce crop diversity, and weaken local food sovereignty.( 21 – 24 ) Concerns Regarding Remanufactured Medical Devices Stakeholders also expressed concerns regarding the harmonisation of standards for remanufactured medical devices under the CPTPP. There were fears that CPTPP commitments could weaken national regulatory standards, allowing lower-quality or insufficiently verified medical devices to enter the Thai market. Given Thailand’s current limitations in technical infrastructure and regulatory capacity, these developments could pose significant risks to patient safety. ( 25 ) Furthermore, strengthened intellectual property protections may restrict the ability to reverse-engineer or locally reproduce medical devices, particularly those with patented components, potentially limiting domestic innovation and access.( 26 ) Implications for Regulatory Autonomy and Decision-Making Collectively, these concerns reflect broader apprehension that CPTPP membership could limit Thailand’s regulatory autonomy in safeguarding public health, food security, and local innovation. ( 27 , 28 ) Despite extensive consultations, including deliberations in the House of Representatives to facilitate stakeholder engagement and consensus-building, no common position was reached after nearly five years of discussion. Consequently, the Thai government has not made a final decision regarding participation in the CPTPP. Study Objectives Thailand’s CPTPP negotiation process has been shaped by the interaction of political interests, economic priorities, and diverse stakeholder perspectives. This study examines the evolution of CPTPP-related discourse in Thailand, the roles and influence of different actors in the negotiation process, and the implications for coherence between trade and public health policies. Employing a political economy framework, the analysis highlights structural power asymmetries and challenges to effective participation within Thailand’s international trade policy landscape. The specific objectives of the study were to: Identify the key concerns raised by stakeholders regarding CPTPP accession. Examine the landscape and modalities of stakeholder engagement in Thailand’s CPTPP negotiation process. Analyse power relations shaping stakeholder participation and influence; and Propose policy recommendations to strengthen inclusive, coherent, and health-sensitive trade policymaking. Conceptual framework This analysis was guided by a hybrid political economy framework combining power-centred and state-centred approaches ( 29 ). The power-centred perspective emphasises how non-state actors exercise influence through agenda-setting, coalition-building, and strategic framing to shape negotiation processes. In contrast, the state-centred approach conceptualises the state as a semi-autonomous actor, operating according to its own institutional logics, policy mandates, and strategic priorities. By integrating these lenses, this framework uniquely addresses both horizontal and vertical power dynamics, offering fresh insights into Thailand's trade negotiations beyond conventional singular approaches. (Fig. 1 ) Together, this integrated framework enables examination of both the horizontal dimensions of power—among state and non-state actors—and the vertical dimensions of influence within the state apparatus itself. This approach provides a nuanced understanding of how interests, institutions, and power relations interact to shape Thailand’s CPTPP negotiation process. Methods Study Design This study employed a qualitative research design grounded in political economy theory, integrating both power-centred and state-centred analytical frameworks. This approach enabled the study to capture the complexities of power dynamics, stakeholder participation, and public health considerations within the context of Thailand’s CPTPP negotiation process. Data Collection Two primary data sources were used to enhance analytical depth and ensure triangulation of findings: document review and in-depth interviews. Document Review A systematic review of 37 relevant documents published between 2018 and 2023 was conducted. These documents included reports of the Cabinet meeting on the appointment of the CPTPP Commission, minutes of the CPTPP Commission and health-related sub-commission meetings, reports of the CPTPP Commission, reports of the Commission appointed by the International Economic Policy Committee, and research and academic papers focusing on Thailand’s involvement in the CPTPP negotiation process. The 37 documents can be categorised as 17 technical articles, one research report, five peer-reviewed articles, one commissioned report, and 13 media and social media archives. These documents were retrieved from the website of government agencies affiliated by the Ministry of Public Health, the Ministry of Commerce, the Ministry of Industry, the Bank of Thailand, the Parliament, non-governmental organizations, including FTA Watch and iLaw as well as online press and media. In addition, the website of the private consultant Bolliger & Company (Thailand) was also a source for related documents, whereas the Thai Journals Online website was the source for research and academic papers. The document search was conducted in July-September 2022. The search keywords of ‘CPTPP Thailand’, ‘CPTPP negotiation process’, ‘Thailand joining CPTPP’, ‘impacts of Thailand joining CPTPP’, and ‘CPTPP trade and health’ were used. Documents with these keywords were all included. The documents and information retrieved from these data sources were printed out for reading and understanding by the research team. The documents were analysed to identify key stakeholders, map the evolution of the CPTPP negotiation process, and triangulate findings from the interview data. The detailed list of the included documents and their citations are in Annex 1. In-depth Interviews Thirty-one key informants were purposively selected to represent a diverse range of stakeholders involved in or affected by the CPTPP negotiations. Interviewees were categorised into two groups: representatives from the health sector and representatives from the trade sector (Fig. 2 ). Eight health sector key informants were from government agencies (state) (e.g., Ministry of Public Health, FDA, Government Pharmaceutical Organisation), seven from Civil Society Organisations or academia. For the trade sector, four informants were from government (state), 11 from non-state entities (e.g., private sector, business associations), and 1 international observer Interviews followed a semi-structured guide that explored participants’ views on CPTPP provisions, mechanisms for stakeholder engagement, perceived power asymmetries, and the anticipated risks and benefits associated with CPTPP accession. Interviews were conducted both face-to-face and online, audio-recorded with participants’ consent, and transcribed verbatim for analysis. For informants who declined audio recording, two researchers independently took detailed contemporaneous notes to ensure accuracy and reliability. Data Analysis Data were analysed using thematic analysis guided by the Framework Analysis approach. The process involved five steps: (i) familiarisation with interview transcripts and documents; (ii) development of an analytical framework grounded in political economy concepts and recurrent themes; (iii) indexing and coding texts into thematic categories, such as stakeholder roles, institutional power dynamics, and concerns related to TRIPS-plus provisions; (iv) charting data into thematic matrices to facilitate comparison across stakeholder groups; and (v) mapping and interpreting actor relationships, negotiation processes, and policy outcomes. Microsoft Excel was used as the primary tool for data management, coding, and matrix construction. Key issues from the included documents and interview transcripts were systematically organised within Excel spreadsheets. Coding was conducted by indexing text segments into thematic categories. Charting involved constructing thematic matrices to enable comparison across stakeholder groups and data sources. Excel also facilitated iterative refinement of themes and transparent tracking of analytical decisions throughout the analysis process To enhance analytical rigour, findings were validated through internal triangulation across data sources and peer debriefing within the research team. Ethical approval for the study was obtained from Thailand’s Institute for the Development of Human Research Protections (IHRP) (Protocol No. IHPR2023056). Findings The study reveals a complex landscape of stakeholder involvement and power dynamics in Thailand’s CPTPP negotiation process (Fig. 3). Using the political economy framework, five key thematic findings emerged: ( 1 ) the dominance of state trade actors, ( 2 ) a fragmented yet formally inclusive consultation landscape, ( 3 ) asymmetric power relations among stakeholders, ( 4 ) substantive public health–related concerns, and ( 5 ) politicisation and institutional fragility in decision-making processes. Dominance of State Trade Actors and Limited Health Sector Influence The process of considering Thailand's accession to the CPTPP was predominantly led by state trade agencies, most notably the Department of Trade Negotiations (DTN) under the Ministry of Commerce, and later the Department of International Economic Affairs under the Ministry of Foreign Affairs. ( 30 ) These agencies played a central role in policy formulation, coordination of impact studies, organisation of stakeholder consultations, and consolidation of findings for submission to the Cabinet ( 31 ) While trade agencies primarily focused on economic and trade priorities, some trade officials recognised the importance of public health considerations and voiced concerns regarding potential impacts on access to medicines and other health-related issues. “In terms of the Department itself, the issues we have discussed most extensively are the impacts of Thailand’s continued use of compulsory licensing (CL), the establishment of a patent linkage system…These are the issues that have been debated quite intensively (TS3) “On the issues that everyone in the public health sector is concerned about, we share the same concerns. We are users as well, we care about our health, and of course we want affordable products.”(TS3) “As negotiators, we, of course, safeguard the national interests. We will never concede on critical issues—especially those related to health and public health.” (TS3) This acknowledgment highlighted a more nuanced perspective within trade circles, suggesting a willingness to consider public health alongside economic objectives. Although public health institutions—including the Ministry of Public Health (MoPH), the National Health Security Office (NHSO), and the Government Pharmaceutical Organization (GPO)—were actovely involved in consultation processes, they did not possess formal decision-making authority as the authority is with the Ministry of Commerce or the Ministry of Foreign Affairs, as well as the International Economic Policy Committee. ( 30 , 31 ) MOPH Ministry of Public Health MOC Ministry of Commerce GPO Government Pharmaceutical Organization DTN Department of Trade Negotiations DDC Department of Disease Control DIP Department of Intellectual Property FDA Food and Drug Administration MFA Ministry of Foreign Affairs DHSS Department of Health Services Support MOAC Ministry of Agriculture and Cooperatives DTAM Department of Traditional and Alternative Medicine BOI Board of Investment NCITHS National Commission on International Trade JSCCIB Joint Standing Committee on Commerce, and Health Studies Industry and Banking NHSO National Health Security Office FTI Federations of Thai Industries Figure 3 Landscape of stakeholders' engagement in the CPTPP negotiation process Key informants also noted that trade officials tended to frame public health concerns as technical or implementation issues that could be managed or mitigated, rather than as central considerations influencing core policy decisions. This framing effectively marginalised health-sector perspectives and reinforced existing power asymmetries, with trade imperatives prioritised over public health objectives in shaping Thailand’s CPTPP negotiation stance. Fragmented but Formally Inclusive Stakeholder Engagement The CPTPP negotiation process incorporated a range of formal and informal mechanisms for stakeholder engagement. Government-led consultations included public hearings, expert focus groups, commissioned impact studies, and inter-ministerial working groups ( 32 , 33 ). Civil society organisations (CSOs)—such as FTA Watch, AIDS Access, and BioThai—were actively involved in articulating concerns and advocating for public interest perspectives. Academic institutions and international organisations also contributed technical evidence and policy analysis.( 26 , 34 , 35 ) Despite the breadth of participation, many stakeholders perceived the consultation process as largely symbolic or “procedural,” rather than substantively deliberative. “It feels more like a ritual—something done just to tick the boxes so it can be claimed that it was done. This is the problem with the public consultation process.” (TN11) Public hearings were frequently described as poorly facilitated, offering limited opportunities for meaningful dialogue or engagement with competing viewpoints. “We began to express our views that it would have an impact on the public, and we called on the government to listen to these opinions. But at that time, there was no law requiring state agencies or the government to listen to such views at all. We hardly had any participation, apart from organizing forums together with local residents in different areas—that was all.” (HN5) Health-sector actors, in particular, reported that their inputs were not systematically incorporated into policy deliberations, with trade agencies retaining control over agenda-setting and the interpretation of evidence. While political leadership within advisory bodies such as the National Commission on International Trade and Health Studies (NCITHS) was perceived as relatively inclusive and balanced between health and trade sectors, the commission lacked formal decision-making authority.( 36 ) As a result, its recommendations carried limited weight in shaping final policy outcomes, reinforcing existing power asymmetries within the negotiation process. Power Relations Among Stakeholders in Thailand’s CPTPP Negotiation The debate surrounding Thailand’s potential accession to the CPTPP reveals a complex configuration of power relations among both governmental and non-governmental actors, particularly across the trade and health sectors. These dynamics can be analytically understood along two interrelated dimensions: structural power and collaborative power (Fig. 4). Note PM Prime Minister DPM Deputy Prime Minister M Minister MOC Ministry of Commerce MFA Ministry of Foreign Affairs MOPH Ministry of Public Health IEPC International Economic Policy NCITHS National Commission on International Committee Trade and Health Studies Other abbreviations are the initials (names) of the key actors who are publicly known. Figure 4 Timeline of key events and key actors who influenced the CPTPP process in Thailand Structural Power: “Power Over” Decision-Making State trade agencies, together with affiliated private-sector actors, generally supported CPTPP accession, framing it as a strategic opportunity for economic growth and regional integration. In contrast, health-sector actors—spanning public institutions and civil society organisations—largely opposed accession due to concerns regarding potential adverse public health consequences.( 37 ) Despite sustained efforts to build consensus through commissioned studies, public consultations, and multi-sectoral committees, no shared position ultimately emerged. Trade interests benefited from higher levels of coordination and institutional backing, with state agencies exercising control over agenda-setting, commissioning impact assessments, and determining how evidence was presented and interpreted during consultation. However, informants highlighted that limited transparency, particularly restricted public access to consultation outcomes and analytical reports, undermined trust in the negotiation process. “…it was wondering whether the information we have provided—our concerns, documents, and evidence—would actually be used in decision making, or is this merely a consultation arranged to ease concerns and reduce social friction?...” (HN6) “The issue is that this results in a lack of openness and transparency, and there is no longer a role for Parliament or the legislative branch to ensure that sensitive issues are properly protected or genuinely negotiated.” (HN1) “As a result, we do not trust the process. Even if there are public consultations, we still do not trust it. The research they conducted was based on exaggerated assumptions, and even the parliamentary committee’s report pointed out that those assumptions were invalid. So you could say we did participate, but it was participation filled with mistrust—there was no trust between the parties.” (HN1) While health-sector actors conducted parallel studies to articulate public health risks ( 17 , 38 ), no single body possessed the authority to reconcile competing evidence or definitively establish a shared understanding of the national interest, further entrenching structural imbalances in influence. Collaborative Power: “Power With Others” Civil society actors, most notably FTA Watch, mobilised collaborative power by leveraging public legitimacy to highlight the CPTPP’s potential risks to access to medicines and sustainable development. These actors used a range of strategies, including public forums, media engagement, academic publications, and social media advocacy, most visibly through campaigns such as #NoCPTPP. Collectively, these efforts elevated public awareness and sustained political pressure on decision-makers. Such mobilisation contributed to tangible political responses, including the establishment of a parliamentary committee to review the potential impacts of CPTPP accession. In addition, FTA Watch also submitted a petition opposing the agreement to the Prime Minister, reportedly supported by more than 400,000 signatures. These actions illustrate how collaborative networks among civil society, academics, and advocacy groups were able to shape the policy agenda, even without formal decision-making authority. Overall, the CPTPP debate in Thailand involved multiple actors with varying degrees of influence. No single actor held overriding power; rather, stakeholders leveraged alliances and public legitimacy to advance their positions. This collective engagement influenced decision-making and reflected the contested nature of Thailand’s trade-health policy space. Critical Public Health Concerns Consistently Raised by Stakeholders Across interviews and documentary analysis, three recurring public health concerns were consistently articulated by stakeholders. Access to Medicines and Pharmaceutical Security Provisions related to intellectual property protection, particularly patent linkage and potential constraints on compulsory licensing, were widely viewed as risks to Thailand’s capacity to issue government-use licenses for essential medicines. Stakeholders expressed concern that these measures could delay the market entry of generic medicines, increase pharmaceutical prices, and constrain public procurement mechanisms, undermining access to affordable treatments. “…civil society may be very worried about the impact [of the CPTPP], but we [the Joint Standing Committee on Commerce, Industry and Banking] are actually concerned about everything, including medical equipment, waste, and things to be imported in terms of capital that will compete with the procurement service sector, compulsory licenses, and medicine. The local pharmaceutical company was also concerned, especially the Thai Pharmaceutical Manufacturers Association ... If they can't compete (with international manufacturers), people would not afford costly medicines …” (HN3) “It means that the generic drug industry would not have the right to use the data that has been developed as supporting information for drug registration…This is another major issue—an extremely big one—because it will affect our ability to produce new generic drugs to replace expensive medicines. And at this point, this issue is still in a vacuum; no one is talking about it.” (HN4) Plant Variety Protection under UPOV 1991 Stakeholders from the health and agricultural sectors raised concerns that CPTPP accession would require Thailand to comply with the 1991 Act of the International Union for the Protection of New Varieties of Plants (UPOV 1991). Civil society organisations feared this would facilitate seed monopolisation, restrict traditional seed-saving and exchange practices, reduce agricultural biodiversity, and increase farmers’ dependence on commercial seed companies. “…if we were to join the CPTPP, I think that the provisions on seed protection would have a fairly significant impact on our farmers.” (HS6) “This is something we are very concerned about: that access to the original varieties of medicinal plants will be restricted for farmers, and if farmers are required to purchase them, the cost of producing medicines will increase.” (HS6) Such changes were seen as risks to food and nutritional security, particularly for small-scale farmers. Regulation of Remanufactured Medical Devices Concerns were also raised regarding the harmonisation of regulatory standards for remanufactured medical devices under the CPTPP. Stakeholders warned that weakened or insufficiently adapted regulatory requirements could compromise quality control ( 39 ). Given Thailand’s limited capacity to monitor and verify such devices, health professionals highlighted potential risks to patient safety . “If they [remanufactured devices] don’t come with that technology, they can end up being like discarded waste—and waste that directly affects people’s lives, which can be dangerous.” (HN2) In addition, strengthened intellectual property protections were perceived as possible barriers to reverse engineering, repair, and local adaptation of medical devices. ( 40 ) “Regarding medical devices, there is concern that reused devices might be refurbished and then put back into use. At present, Thai law does not allow this. The worry is that if we were to participate and become part of such agreements, they might open the door to this practice. Therefore, there is considerable concern among medical device manufacturers. We should also be promoting our domestic industry.” (HN3) Politicisation and Institutional Weakness Impeded Decision-Making Despite broad-based stakeholder participation and sustained public interest, the Thai government was unable to reach a decision on CPTPP accession over the five-year study period. Two interrelated factors were identified as central to this policy stalemate. Institutional Ambiguity Legal authority over trade policy formulation and decision-making was fragmented across multiple bodies. While the Department of Trade Negotiations (DTN) was responsible for leading technical preparations and stakeholder consultations, ultimate decision-making authority rested with the Cabinet. ( 31 ) In practice, Cabinet deliberations were repeatedly deferred, reflecting institutional ambiguity and sensitivity surrounding the political implications of CPTPP accession. ( 41 ) Political Timing and Risk Aversion During 2022–2023, the government approached the end of its term, contributing to reluctance among political leaders to pursue highly contested policy decisions. Informants noted that CPTPP accession was closely tied to broader foreign policy and investment objectives, yet simultaneously associated with politically sensitive domestic issues—particularly access to medicines and agricultural autonomy. “Working on the CPTPP provisions is beneficial in terms of the investment chapter. You’ll notice that the investment provisions provide extensive protection…When we look at the conditions for protection, they’re quite good, excellent even.” (TN4) This convergence of external economic pressures and internal political risks reinforced a cautious, non-decisive stance. As a result, the CPTPP accession process became a contested policy arena where competing interests among economic actors, public health advocates, and political leaders intersected without resolution. ( 41 ). ‘’… The Thai government had the ‘available options’ to convince stakeholders, but may find ‘different support from stakeholders’…” (TI1) This impasse underscores the limitations of existing institutional arrangements in managing complex trade and health policy trade-offs. Discussion This study provides a critical examination of Thailand’s CPTPP negotiation process through a political economy and policy coherence lens. It identifies three interrelated challenges: the institutional dominance of trade actors, the limited integration of public health perspectives into trade policymaking, and fragmented mechanisms of stakeholder engagement. Together, these dynamics help explain the prolonged indecision surrounding Thailand’s potential accession to the CPTPP. Trade Dominance and Power Asymmetry Consistent with a power-centred political economy framework, trade agencies exercised disproportionate influence over agenda-setting, evidence interpretation, and the formulation of policy recommendations. ( 42 ) Although health-sector actors were formally consulted, trade and investment priorities ultimately shaped the negotiation discourse. Public health concerns were frequently reframed as technical or implementation issues, rather than treated as core determinants of national welfare and policy choice. These findings align with global evidence indicating that health ministries often face structural disadvantages in intersectoral trade negotiations ( 43 – 45 ). Such disadvantages include weaker political capital, limited technical capacity in trade-related matters, and marginal positioning within national economic policymaking institutions.( 46 – 48 ) As a result, health interests are frequently subordinated to economic objectives in trade policy processes. Symbolic Inclusion Versus Substantive Participation Thailand’s CPTPP experience illustrates a broader challenge in global trade governance - the gap between formal inclusivity and substantive participation. While the consultation process was procedurally inclusive, engaging civil society organisations, academics, and health professionals through public hearings and working groups, these actors exerted limited influence over decision-making outcomes. ( 49 , 50 ) Trade officials often characterised health-related critiques as “misunderstandings” or “over-interpretations” of the CPTPP provisions, reflecting a technocratic orientation that tended to marginalise social and public health perspectives.( 51 ) This pattern aligns with broader academic critiques of the democratic deficit in global trade, where public engagement is often treated as a procedural requirement rather than a meaningful opportunity to influence policy. ( 52 , 53 ) Policy Coherence Between Trade and Health Remains Elusive Thailand’s efforts to promote policy coherence through intersectoral mechanisms such as the National Commission on International Trade and Health Studies (NCITHS) represent an important institutional innovation( 36 ). NCITHS provided a rare multisectoral forum for dialogue between trade and health actors. However, its limited mandate and lack of binding authority constrained its capacity to influence national negotiation positions. The absence of a decision on CPTPP accession after five years reflects the absence of institutional reforms. Consequently, trade policymaking is likely to continue privileging economic integration over public health objectives, hence prolonging structural incoherence. As highlighted in previous research, achieving policy coherence between trade and health requires more than cross-sectoral dialogue. It requires institutionalised mechanisms for health impact assessment, ex ante review of trade commitments, transparency in evidence use, and strengthened authority for health ministries within trade policymaking processes. ( 2 , 46 , 51 , 54 ) Without such reforms, tensions between economic integration and public health protection are likely to persist. Implications for Future Negotiations Thailand’s experience with the CPTPP offers important lessons for countries engaging in trade negotiations with significant public health implications. First, the presence of an active civil society and a well-informed health sector served as a critical counterbalance to rapid policy shifts driven by economic considerations. Such actors played a key role in scrutinising trade commitments and elevating public health concerns within national debates. Second, the prolonged indecision surrounding CPTPP accession underscores the absence of a centralised and authoritative mechanism to reconcile tensions between trade and health objectives. This highlights the need for clearer legal and institutional mandates for systematic consideration of health impacts in trade policymaking. Recommendations This study has offered several recommendations for policymakers, the trade negotiation process, the public, and future research to enhance policy coherence between trade and health in Thailand. For Policymakers As the CPTPP accession negotiations will be more complex, the traditional mechanism of health engagement in trade negotiations would no longer suffice to advocate health interests in the new context of trade negotiations. Government authorities are recommended to enhance policy communication and transparency in trade decision-making with clear, timely, and accessible communication about the objectives, risks, and potential health implications of trade agreements to build public trust and reduce misinformation. Policymakers are also recommended to ensure transparency in decision-making, including publishing impact assessments, negotiation rationales, and relevant dissenting views. For the Trade Negotiation Process Engagement strategies should be tailored to specific stakeholder groups, acknowledging differences in technical capacity, institutional influence, and access to policymaking forums. It is strongly recommended that sufficient and realistic timeframes should be allocated for commissioned studies, public hearings, and intersectoral review. For Public Engagement Improving public understanding of complex trade provisions, such as intellectual property rights or regulatory standards, can reduce reliance on polarised narratives and enhance public debate. Public engagement should be facilitated through systematic education and access to reliable information on trade and health issues.. Individuals or groups are also recommended to participate in all public consultations and hearings to express their concerns and their continuous engagement with strong articulation could influence policy deliberation. For Further Research This study is limited to a formal process to assess the impact of the CPTPP on health. The further research should conduct in-depth, issue-specific analyses of the most significant health concerns related to CPTPP accession, including access to medicines, pharmaceutical policy space, and plant variety protection. Quantitative and mixed-methods studies are also suggested to quantify positive and negative health impacts, complementing the qualitative insights of this study. Investment in interdisciplinary research teams and institutional platforms can support the independent generation of policy-relevant evidence to inform trade negotiations and public discourse. Strengthening national research capacity on trade and health is therefore strongly recommended. Conclusions Since 2018, Thailand has expressed interest in acceding to the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP). However, this initiative has encountered sustained opposition from multiple sectors, including the Ministry of Public Health, driven by concerns over potential adverse impacts on food security, biodiversity, and the public health system. Despite extensive and formally inclusive consultation processes conducted through various multiple platforms, including parliamentary mechanisms, the government was unable to reach a consensus on CPTPP accession after nearly five years of deliberation between 2018 and 2022. Throughout the negotiation process, a diverse array of stakeholders from both trade and health sectors, encompassing governmental and non-governmental actors, actively engaged in the policy debate. These actors exercised varying degrees of influence depending on their perceived interests and potential gains or losses from the agreement. While no single government agency exerted absolute control over the process, actors sought to legitimise their positions through coalition-building with like-minded partners. This collective mobilisation contributed to heightened political scrutiny, including the establishment of a Senate subcommittee to further examine the CPTPP and its implications. Overall, the CPTPP debate in Thailand illustrates a dynamic interplay of institutional power in which legitimacy was constructed less through formal authority than through alliances, sustained engagement, and strategic framing. Rather than converging around a shared conception of the national interest, the process remained shaped by competing sectoral priorities and contested interpretations of policy evidence. Looking ahead, Thailand’s experience highlights the need for stronger institutional arrangements to support evidence-informed and transparent trade policymaking. For future trade negotiations, Thailand should consider establishing an independent research institute to generate academically rigorous, policy-relevant evidence; ensuring sufficient timelines to allow for high-quality research and inclusive public consultations; and developing clear, actionable mechanisms to support, mitigate, and compensate sectors and populations adversely affected by trade agreements. Such reforms would strengthen policy coherence, enhance public trust, and better align trade objectives with public health and social protection goals. Abbreviations BOI Board of Investment CL Compulsory licensing CPTPP Comprehensive and Progressive Agreement for Trans-Pacific Partnership CSO Civil society organisations DDC Department of Disease Control DHSS Department of Health Services Support DIP Department of Intellectual Property DPM Deputy Prime Minister DTAM Department of Traditional and Alternative Medicine DTN Department of Trade Negotiations FDA Food and Drug Administration FTI Federation of the Thai Industries GDP Gross Domestic Product GPO Government Pharmaceutical Organization IEPC International Economic Policy Committee JSCCIB Joint Standing Committee on Commerce, Industry and Banking MFA Ministry of Foreign Affairs MOAC Ministry of Agriculture and Cooperatives MOC Ministry of Commerce MOPH Ministry of Public Health NCITHS National Commission on International Trade and Health Studies NHSO National Health Security Office PM Prime Minister TRIPS Agreement on Trade-Related Aspects of Intellectual Property Rights UPOV International Convention for the Protection of New Varieties of Plants Declarations Data availability The qualitative interview data in this study are not publicly available. However, data from document review can be available from the corresponding author on reasonable request. Acknowledgement The authors are grateful to the Enhancing Leadership in Global Health Thailand (EnLIGHT), under the International Health Policy Program Foundation, for funding support. Author contributions CP, ST, TM contributed to conceptualisation, methodology, data collection and analysis, writing, review and editing. PC, SS, NY contributed to project administration, data collection, and analysis. CP drafted the manuscript with reviews and edits provided by ST, TM, PC, SS, NY. Ethical Declarations Ethics Approval and Consent The study was approved by the Institute for the Development of Human Research Protection (IHRP), Thailand (Protocol No. IHPR2023056). Participants provided written informed consent. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (IHRP) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Clinical trial number Not applicable Funding The study was funded by the Enhancing Leadership in Global Health Thailand (EnLIGHT) Program, under the International Health Policy Program Foundation, Thailand. References Gleeson D, Lopert R, Reid P. How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand. Health Policy. 2013;112(3):227–33. Friel S, Gleeson D, Thow A-M, Labonte R, Stuckler D, Kay A, et al. A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement. Globalization Health. 2013;9(1):46. Ruckert A, Schram A, Labonté R, Friel S, Gleeson D, Thow A-M. Policy coherence, health and the sustainable development goals: a health impact assessment of the Trans-Pacific Partnership. Crit Public Health. 2017;27(1):86–96. Department of Foreign Affairs and Trade. A. Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) 2025. Available from: https://www.dfat.gov.au/trade/agreements/in-force/cptpp/comprehensive-and-progressive-agreement-for-trans-pacific-partnership World Economic Forum. The United Kingdom is set to join the trans-Pacific free trade pact. Here's what you need to know 2023. Available from: https://www.weforum.org/stories/2023/04/cptpp-trade-tariff-brexit-uk/#:~:text=Three%20years%20after%20leaving%20the,the%20UK%20keen%20to%20join ?. InfoQuest. The 12 steps of accessing the CPTPP. 2020. New Zealand Foreign Affairs and Trade, Comprehensive, and Progressive Agreement for Trans-Pacific Partnership (CPTPP). : Accession Process 2019. Available from: https://www.mfat.govt.nz/assets/Trade-agreements/CPTPP/Accession-Process.pdf Schott JJ. Joining the CPTPP is a long process and needs consensus among existing members. 2021. Available from: https://www.piie.com/research/piie-charts/joining-cptpp-long-process-and-needs-consensus-among-existing-members Bangkok Post. Somkid: Thailand eyes becoming CPTPP member 2021. Available from: https://www.bangkokpost.com/business/general/1437386/somkid-thailand-eyes-becoming-cptpp-member Bangkok Post. DPM Somkid backs Thailand to join ex-US TPP. 2021. Leelaprathuang N. The Impact of CPTTP on Accessing Medicine in Thailand. J Humanit Social Sci Suratthani Rajabhat Univ. 2021;13(1):172–89. Thailand Consumers Council, No. CPTPP2021. Available from: https://www.tcc.or.th/policies/consumer-cptpp/?utm_source=chatgpt.com Isra News Agency. Dean of the Faculty of Pharmacy, Chulalongkorn University, indicates CPTPP accession could raise medicine costs and reduce domestic industry share2020. Available from: https://www.isranews.org/article/isranews-short-news/90440-cptpp-2.html?utm_source=chatgpt.com Health Focus. CPTPP’s potential risks to health system and medicine access in the Thai context2020. Available from: https://www.hfocus.org/content/2020/05/19203?utm_source=chatgpt.com World Trade Organization. Agreement on Trade-Related Aspects of Intellectual Property Rights. 1995. CPTPP Portal APFoC. Chapter 18 – Intellectual Property2025. Available from: https://apfccptppportal.ca/agreement/20 Health Focus. Chulalongkorn University pharmacy researchers reveal CPTPP will increase pharmaceutical expenditure2020. Available from: https://www.hfocus.org/content/2020/07/19788 Chanwichi P. The effect of CPTPP on the farmers' rights in Thailand. Interdisciplinary Sripatum Chonburi J. 2020;6(2):14–22. FTA Watch. FTA Watch warns the Cabinet not to trust Somkid’s push to submit a letter of intent to join the CPTPP2020. Available from: http://www.ftawatch.org/node/50425 Global Agriculture. Seeds and Patents on Life2020. Available from: https://www.globalagriculture.org/topics/seeds-patents-life/ TCIJ. Academics worry that joining the CPTPP and the Plant Variety Protection Convention will disadvantage farmers. 2020. Available from: https://www.tcijthai.com/news/2020/10/current/11021 The Momentum. As CPTPP progresses, a call to revisit intellectual property and patent issues2020. Available from: https://themomentum.co/what-are-the-concerns-regarding-comprehensive-and-progressive-agreement-for-trans-pacific-partnership/ Thai Publica. CPTPP (Final Part): Untangling three major concerns — seed-saving rights, pharmaceutical CLs, and government procurement2021. Available from: https://thaipublica.org/2021/07/cptpp-and-thailand-stance-01/ Third World Network. Stringent plant variety protection may impinge on right to food. TWN Info Service on Biodiversity and Traditional Knowledge [Internet]. 2014. Available from: https://twn.my/title2/biotk/2014/btk141008.htm?utm_source=chatgpt.com SDG Move, Insights SDG. Viewing the CPTPP through the SDGs lens — Uneven development2021. Available from: https://www.sdgmove.com/2020/04/28/cptpp-through-sdgs-lens-unbalanced-development/ FTA Watch. FTA Watch examines 13 key CPTPP issues proposed by the Ministry of Commerce to the Deputy Prime Minister. 2019. Department of Trade Negotiation MoC, Thailand. ‘Commerce Ministry’ holds public hearing on the CPTPP; ‘private sector’ supports accession, while ‘civil society’ urges further studies and inclusive participation2019. Available from: https://www.dtn.go.th/th/news/5cff75921ac9ee073b7bfffe?cate=5cff753c1ac9ee073b7bd1c5 FTA Watch. Civil society points out what Somkid did not say: No pharmaceutical patents, but many other disasters hidden in the CPTPP2020. Available from: http://www.ftawatch.org/node/50424 Caporaso JA, Levine DP. Theories of political economy. New York: Cambridge University Press; 1992. The Secretariat of the Cabinet. Cabinet resolution on preparation for accessing to the Comprehensive and Progressive Trans-Pacific Partnership: CPTPP. 2021. Department of Trade Negotiation MoC. Thailand,. Role and function of Department of Trade Negotiation 2021 [Available from: https://www.dtn.go.th/th/content/page/index/id/35 Matichon. Ministry of Commerce organised public hearings on CPTPP, Thai private sector supported joining the agreement. Matichon. 2018. Ministry of Foreign Affairs. Ministry of Foreign Affairs together with the government agencies and academia organised a consultative meeting on CPTPP with the press 2022. Available from: https://www.mfa.go.th/th/content/cptpp-media-focus-group?page=5d5bd3c915e39c306002a907 FTA Watch. FTA Watch and academics criticize the Ministry of Commerce for misleading the public and rushing CPTPP accession despite numerous sensitive issues2018. Available from: https://ftawatch.org/node/50421 FTA Watch. Six concerns and potential impacts if Thailand joins the CPTPP2019. Available from: https://ftawatch.org/node/50423 Wongsatjachock W, Leesmidt V, Horayangkura S, Phon-amnuai N. Knowledge and Policy Linkage Mechanism between Health and International Trade: A Case Study of the National Committee on International Trade and Health Studies (NCITHS). Health Syst Res J. 2023;17(4):648–59. Tenni B, Lexchin J, Akaleephan C, Kittitrakul C, Gleeson D. The potential impact of the Comprehensive and Progressive Agreement for Prans-Pacific Partnership on Thailand's hepatitis C treatment program. Global Health. 2024;20(1):46. Vongsirisopak S. Studies of the impact on alcohol control in case of joining Comprehensive and Progressive Agreement of Trans-Pacific Partnership (CPTPP). Disease Control J. 2021;41(2). FTA Watch. Why Thailand should not join the CPTPP2020. Available from: https://ftawatch.org/sites/default/files/FTAWatch_BlackPaper_CPTPP.pdf?fbclid=IwAR1puuzL5XnqyK9mc9DhtuVtjvo-6cUoCVIQwwBsAzs9SREAsxmIq3TihMo . Rajpradi W. Legal Measures of the Regulatory Framework for Remanufactured Medical Devices. Wimpat Rajpradi. 2025. Chongkittavorn K. CPTPP procrastination not an option2021. Available from: https://www.eria.org/news-and-views/cptpp-procrastination-not-an-option House of Representatives. Report of the Ad Hoc Committee on the Impacts of Accession to the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP). Legislative Institutional Repository Thailand; 2020. Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review. Int J Health Policy Manag. 2018;7(2):101–11. Gleeson D, Friel S. Emerging threats to public health from regional trade agreements. Lancet. 2013;381(9876):1507–9. McNeill D, Birkbeck CD, Fukuda-Parr S, Grover A, Schrecker T, Stuckler D. Political origins of health inequities: trade and investment agreements. Lancet. 2017;389(10070):760–2. Blouin C. Trade policy and health: from conflicting interests to policy coherence. Bull World Health Organ. 2007;85(3):169–73. Jarman H. Trade policy governance: What health policymakers and advocates need to know. Health Policy. 2017;121(11):1105–12. Townsend B, Tenni BF, Goldman S, Gleeson D. Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy. Globalization Health. 2023;19(1):60. Barlow P, McKee M, Basu S, Stuckler D. The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis. Globalization Health. 2017;13(1):13. Koivusalo M. Policy space for health and trade and investment agreements. Health Promot Int. 2014;29(suppl1):i29–47. Thow AM, Snowdon W, Labonté R, Gleeson D, Stuckler D, Hattersley L, et al. Will the next generation of preferential trade and investment agreements undermine prevention of noncommunicable diseases? A prospective policy analysis of the Trans Pacific Partnership Agreement. Health Policy. 2015;119(1):88–96. Howse R. From Politics to Technocracy—and Back Again: The Fate of the Multilateral Trading Regime. Am J Int Law. 2002;96(1):94–117. Bäckstrand K. Democratizing Global Environmental Governance? Stakeholder Democracy after the World Summit on Sustainable Development. Eur J Int Relat. 2006;12(4):467–98. Labonté R, Mohindra K, Schrecker T. The growing impact of globalization for health and public health practice. Annu Rev Public Health. 2011;32:263–83. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Apr, 2026 Reviews received at journal 09 Apr, 2026 Reviews received at journal 16 Feb, 2026 Reviewers agreed at journal 16 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers invited by journal 10 Feb, 2026 Submission checks completed at journal 09 Feb, 2026 First submitted to journal 31 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8451689","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589250130,"identity":"9b6e36a8-1f20-40ce-99d6-59a05a2e76c6","order_by":0,"name":"Cha-aim 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Health","correspondingAuthor":false,"prefix":"","firstName":"Suriwan","middleName":"","lastName":"Thaiprayoon","suffix":""},{"id":589250132,"identity":"c8f43095-6df5-4f47-a18c-3ffe553f03ed","order_by":2,"name":"Thammarat Marohabutr","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Thammarat","middleName":"","lastName":"Marohabutr","suffix":""},{"id":589250133,"identity":"3b0c12ce-bfb1-4e23-b7b4-d16ed0bee5c5","order_by":3,"name":"Peamanee Chansorklin","email":"","orcid":"","institution":"Ministry of Agriculture and Cooperatives","correspondingAuthor":false,"prefix":"","firstName":"Peamanee","middleName":"","lastName":"Chansorklin","suffix":""},{"id":589250134,"identity":"13d0e318-6556-4c70-b4f3-bb5298e48530","order_by":4,"name":"Siriya Sirithienthong","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Siriya","middleName":"","lastName":"Sirithienthong","suffix":""},{"id":589250135,"identity":"acb32cc3-3095-4fbf-bb54-96d5036c6b4f","order_by":5,"name":"Nantawan Yomchan","email":"","orcid":"","institution":"International Health Policy Program Foundation","correspondingAuthor":false,"prefix":"","firstName":"Nantawan","middleName":"","lastName":"Yomchan","suffix":""}],"badges":[],"createdAt":"2025-12-26 03:08:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8451689/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8451689/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102628881,"identity":"ede2113d-625f-456b-8857-44e74dd55c60","added_by":"auto","created_at":"2026-02-13 18:43:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40698,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual framework of the study\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8451689/v1/43dfce35ebe3aba304feb703.png"},{"id":102747573,"identity":"3cb03fd0-106a-4f9a-80fc-43e51c3f9214","added_by":"auto","created_at":"2026-02-16 09:04:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37257,"visible":true,"origin":"","legend":"\u003cp\u003eThe key informants\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8451689/v1/e20ab0fb935554176736cccd.png"},{"id":102628883,"identity":"919e3c95-1a4f-4fe9-a2f9-23ec3a1d808a","added_by":"auto","created_at":"2026-02-13 18:43:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":55362,"visible":true,"origin":"","legend":"\u003cp\u003eLandscape of stakeholders' engagement in the CPTPP negotiation process\u003c/p\u003e\n\u003cp\u003eMOPH Ministry of Public Health MOC Ministry of Commerce\u003c/p\u003e\n\u003cp\u003eGPO Government Pharmaceutical Organization DTN Department of Trade Negotiations\u003c/p\u003e\n\u003cp\u003eDDC Department of Disease Control DIP Department of Intellectual Property\u003c/p\u003e\n\u003cp\u003eFDA Food and Drug Administration MFA Ministry of Foreign Affairs\u003c/p\u003e\n\u003cp\u003eDHSS Department of Health Services Support MOAC Ministry of Agriculture and Cooperatives\u003c/p\u003e\n\u003cp\u003eDTAM Department of Traditional and Alternative Medicine BOI Board of Investment\u003c/p\u003e\n\u003cp\u003eNCITHS National Commission on International Trade JSCCIB Joint Standing Committee on Commerce,\u003c/p\u003e\n\u003cp\u003eand Health Studies Industry and Banking\u003c/p\u003e\n\u003cp\u003eNHSO National Health Security Office FTI Federations of Thai Industries\u003c/p\u003e","description":"","filename":"drawingimage12.png","url":"https://assets-eu.researchsquare.com/files/rs-8451689/v1/d2dcf1c1279b9d43b26517e0.png"},{"id":102628884,"identity":"ec4c3bac-548c-4180-b387-0317ac044aea","added_by":"auto","created_at":"2026-02-13 18:43:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":281777,"visible":true,"origin":"","legend":"\u003cp\u003eTimeline of key events and key actors who influenced the CPTPP process in Thailand\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePM Prime Minister DPM Deputy Prime Minister\u003c/p\u003e\n\u003cp\u003eM Minister MOC Ministry of Commerce\u003c/p\u003e\n\u003cp\u003eMFA Ministry of Foreign Affairs MOPH Ministry of Public Health\u003c/p\u003e\n\u003cp\u003eIEPC International Economic Policy NCITHS National Commission on International\u003c/p\u003e\n\u003cp\u003eCommittee Trade and Health Studies\u003c/p\u003e\n\u003cp\u003eOther abbreviations are the initials (names) of the key actors who are publicly known.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8451689/v1/14bc2e7548e63ce660eaf4e9.png"},{"id":102750751,"identity":"3c3a0df9-cef5-42ae-9c50-3e5469823f22","added_by":"auto","created_at":"2026-02-16 09:21:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1475809,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8451689/v1/4cf368ff-696d-48bc-8ac6-71a21e3f5f86.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trade, Power, and Public Health: A Political Economy Analysis of Thailand’s CPTPP Negotiation Process","fulltext":[{"header":"Background","content":"\u003cp\u003eBetween 2018 and 2022, the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) received significant attention in Thailand across various sectors. As the agreement has been fully negotiated, countries seeking accession are required to accept the existing text in its entirety, without amendment. Previous studies indicate that the CPTPP may negatively affect public health, particularly access to medicines. (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe CPTPP comprises 30 chapters and covers a wide range of trade-related issues with implications for health, notably intellectual property protection and environmental safeguards. As of 15 December 2024, the agreement had been signed and entered into force for 12 member countries: Australia, Canada, Japan, Mexico, New Zealand, Singapore, Vietnam, Peru, Malaysia, Chile, Brunei, and the United Kingdom.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Four of these members are located in Southeast Asia and have economic structures comparable to Thailand. Given that most CPTPP members are economically advanced economies, the agreement is considered one of the world’s largest free trade agreements, collectively accounting for approximately 15% of global GDP. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe CPTPP accession process for Thailand consists of two main stages. The first involves the in-country preparation, including impact assessments, public consultations, compilation of findings, and submission of a consolidated report to the Cabinet for decision-making prior to the issuance of a formal letter of intent to join the agreement. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) The second stage covers negotiations with existing members, followed by signing and ratification. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) This study focuses on the first stage of the CPTPP negotiation process.\u003c/p\u003e \u003cp\u003eThailand informally expressed interest in joining the CPTPP as early as 2018. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) However, since the initiation of discussions, the agreement has generated intense domestic debate due to its potential economic benefits alongside its contentious implications for public health. Although accession offers increased access to a large regional trading bloc, substantial concerns have been raised regarding access to medicines, expanded intellectual property rights,(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) mandatory adherence to the UPOV 1991 Convention on Plant Variety Protection, and regulatory standards for medical devices. (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eConcerns Regarding Access to Medicines and Pharmaceutical Security\u003c/h3\u003e\n\u003cp\u003eA primary concern involves the impact of CPTPP provisions on intellectual property rights, particularly those affecting compulsory licensing (CL) and patent linkage. Thailand has previously exercised CL under the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which permits state agencies to produce or import essential medicines for public, non-commercial use. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) However, many stakeholders have expressed concern that CPTPP provisions, such as Article 9.8(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and Annex 9-B, could allow private investors to initiate investor–state dispute settlement (ISDS) claims against the government. This potential exposure may discourage the future use of CL, even when such measures are necessary to protect public health. This interpretation is, however, in contrast with Article 18.6 that “\u003cem\u003eaffirm their commitment to the Declaration on TRIPS and Public Health\u003c/em\u003e”. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePatent linkage provisions present further risks to access to medicines. These provisions require drug regulatory authorities to verify patent status prior to approving the registration of generic medicines, which may delay the market entry of more affordable alternatives. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Thailand’s current regulatory framework allows for the registration of generic medicines prior to patent expiration, facilitating timely public access. Without an integrated system linking the patent office and drug regulatory authorities, implementing patent linkage could create legal uncertainty and administrative delays. Furthermore, CPTPP provisions requiring a “reasonable period” for patent holders to seek legal redress may further extend generic approval timelines, with possible negative consequences for public health.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eConcerns Regarding Plant Variety Protection under UPOV 1991\u003c/h2\u003e \u003cp\u003eThe CPTPP requires member countries to accede to the 1991 International Convention for the Protection of New Varieties of Plants (UPOV 1991) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Stakeholders have expressed concern that accession could facilitate seed monopolisation and increase production costs for farmers, particularly smallholders. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) UPOV 1991 restricts farmers’ ability to save, reuse, or exchange seeds of protected varieties, potentially undermining established agricultural practices and agrobiodiversity. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) These provisions may also increase dependence on multinational seed companies, reduce crop diversity, and weaken local food sovereignty.(\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e–\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eConcerns Regarding Remanufactured Medical Devices\u003c/h3\u003e\n\u003cp\u003eStakeholders also expressed concerns regarding the harmonisation of standards for remanufactured medical devices under the CPTPP. There were fears that CPTPP commitments could weaken national regulatory standards, allowing lower-quality or insufficiently verified medical devices to enter the Thai market. Given Thailand’s current limitations in technical infrastructure and regulatory capacity, these developments could pose significant risks to patient safety. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) Furthermore, strengthened intellectual property protections may restrict the ability to reverse-engineer or locally reproduce medical devices, particularly those with patented components, potentially limiting domestic innovation and access.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eImplications for Regulatory Autonomy and Decision-Making\u003c/h3\u003e\n\u003cp\u003eCollectively, these concerns reflect broader apprehension that CPTPP membership could limit Thailand’s regulatory autonomy in safeguarding public health, food security, and local innovation. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) Despite extensive consultations, including deliberations in the House of Representatives to facilitate stakeholder engagement and consensus-building, no common position was reached after nearly five years of discussion. Consequently, the Thai government has not made a final decision regarding participation in the CPTPP.\u003c/p\u003e\n\u003ch3\u003eStudy Objectives\u003c/h3\u003e\n\u003cp\u003eThailand’s CPTPP negotiation process has been shaped by the interaction of political interests, economic priorities, and diverse stakeholder perspectives. This study examines the evolution of CPTPP-related discourse in Thailand, the roles and influence of different actors in the negotiation process, and the implications for coherence between trade and public health policies. Employing a political economy framework, the analysis highlights structural power asymmetries and challenges to effective participation within Thailand’s international trade policy landscape.\u003c/p\u003e \u003cp\u003eThe specific objectives of the study were to:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentify the key concerns raised by stakeholders regarding CPTPP accession.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExamine the landscape and modalities of stakeholder engagement in Thailand’s CPTPP negotiation process.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAnalyse power relations shaping stakeholder participation and influence; and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePropose policy recommendations to strengthen inclusive, coherent, and health-sensitive trade policymaking.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eConceptual framework\u003c/h3\u003e\n\u003cp\u003eThis analysis was guided by a hybrid political economy framework combining power-centred and state-centred approaches (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The power-centred perspective emphasises how non-state actors exercise influence through agenda-setting, coalition-building, and strategic framing to shape negotiation processes. In contrast, the state-centred approach conceptualises the state as a semi-autonomous actor, operating according to its own institutional logics, policy mandates, and strategic priorities. By integrating these lenses, this framework uniquely addresses both horizontal and vertical power dynamics, offering fresh insights into Thailand's trade negotiations beyond conventional singular approaches. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eTogether, this integrated framework enables examination of both the horizontal dimensions of power—among state and non-state actors—and the vertical dimensions of influence within the state apparatus itself. This approach provides a nuanced understanding of how interests, institutions, and power relations interact to shape Thailand’s CPTPP negotiation process.\u003c/p\u003e "},{"header":"Methods","content":"\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis study employed a qualitative research design grounded in political economy theory, integrating both power-centred and state-centred analytical frameworks. This approach enabled the study to capture the complexities of power dynamics, stakeholder participation, and public health considerations within the context of Thailand’s CPTPP negotiation process.\u003c/p\u003e\u003ch3\u003eData Collection\u003c/h3\u003e\u003cp\u003eTwo primary data sources were used to enhance analytical depth and ensure triangulation of findings: document review and in-depth interviews.\u003c/p\u003e\u003ch2\u003eDocument Review\u003c/h2\u003e\u003cp\u003eA systematic review of 37 relevant documents published between 2018 and 2023 was conducted. These documents included reports of the Cabinet meeting on the appointment of the CPTPP Commission, minutes of the CPTPP Commission and health-related sub-commission meetings, reports of the CPTPP Commission, reports of the Commission appointed by the International Economic Policy Committee, and research and academic papers focusing on Thailand’s involvement in the CPTPP negotiation process. The 37 documents can be categorised as 17 technical articles, one research report, five peer-reviewed articles, one commissioned report, and 13 media and social media archives.\u003c/p\u003e\u003cp\u003eThese documents were retrieved from the website of government agencies affiliated by the Ministry of Public Health, the Ministry of Commerce, the Ministry of Industry, the Bank of Thailand, the Parliament, non-governmental organizations, including FTA Watch and iLaw as well as online press and media. In addition, the website of the private consultant Bolliger \u0026amp; Company (Thailand) was also a source for related documents, whereas the Thai Journals Online website was the source for research and academic papers.\u003c/p\u003e\u003cp\u003eThe document search was conducted in July-September 2022. The search keywords of ‘CPTPP Thailand’, ‘CPTPP negotiation process’, ‘Thailand joining CPTPP’, ‘impacts of Thailand joining CPTPP’, and ‘CPTPP trade and health’ were used. Documents with these keywords were all included.\u003c/p\u003e\u003cp\u003eThe documents and information retrieved from these data sources were printed out for reading and understanding by the research team.\u003c/p\u003e\u003cp\u003eThe documents were analysed to identify key stakeholders, map the evolution of the CPTPP negotiation process, and triangulate findings from the interview data.\u003c/p\u003e\u003cp\u003eThe detailed list of the included documents and their citations are in Annex 1.\u003c/p\u003e\u003ch2\u003eIn-depth Interviews\u003c/h2\u003e\u003cp\u003eThirty-one key informants were purposively selected to represent a diverse range of stakeholders involved in or affected by the CPTPP negotiations. Interviewees were categorised into two groups: representatives from the health sector and representatives from the trade sector (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Eight health sector key informants were from government agencies (state) (e.g., Ministry of Public Health, FDA, Government Pharmaceutical Organisation), seven from Civil Society Organisations or academia. For the trade sector, four informants were from government (state), 11 from non-state entities (e.g., private sector, business associations), and 1 international observer\u003c/p\u003e\u003cp\u003eInterviews followed a semi-structured guide that explored participants’ views on CPTPP provisions, mechanisms for stakeholder engagement, perceived power asymmetries, and the anticipated risks and benefits associated with CPTPP accession. Interviews were conducted both face-to-face and online, audio-recorded with participants’ consent, and transcribed verbatim for analysis. For informants who declined audio recording, two researchers independently took detailed contemporaneous notes to ensure accuracy and reliability.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were analysed using thematic analysis guided by the Framework Analysis approach. The process involved five steps: (i) familiarisation with interview transcripts and documents; (ii) development of an analytical framework grounded in political economy concepts and recurrent themes; (iii) indexing and coding texts into thematic categories, such as stakeholder roles, institutional power dynamics, and concerns related to TRIPS-plus provisions; (iv) charting data into thematic matrices to facilitate comparison across stakeholder groups; and (v) mapping and interpreting actor relationships, negotiation processes, and policy outcomes.\u003c/p\u003e\u003cp\u003eMicrosoft Excel was used as the primary tool for data management, coding, and matrix construction. Key issues from the included documents and interview transcripts were systematically organised within Excel spreadsheets. Coding was conducted by indexing text segments into thematic categories. Charting involved constructing thematic matrices to enable comparison across stakeholder groups and data sources. Excel also facilitated iterative refinement of themes and transparent tracking of analytical decisions throughout the analysis process\u003c/p\u003e\u003cp\u003eTo enhance analytical rigour, findings were validated through internal triangulation across data sources and peer debriefing within the research team.\u003c/p\u003e\u003cp\u003eEthical approval for the study was obtained from Thailand’s Institute for the Development of Human Research Protections (IHRP) (Protocol No. IHPR2023056).\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eThe study reveals a complex landscape of stakeholder involvement and power dynamics in Thailand’s CPTPP negotiation process (Fig.\u0026nbsp;3). Using the political economy framework, five key thematic findings emerged: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the dominance of state trade actors, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) a fragmented yet formally inclusive consultation landscape, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) asymmetric power relations among stakeholders, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) substantive public health–related concerns, and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) politicisation and institutional fragility in decision-making processes.\u003c/p\u003e\u003ch2\u003eDominance of State Trade Actors and Limited Health Sector Influence\u003c/h2\u003e\u003cp\u003eThe process of considering Thailand's accession to the CPTPP was predominantly led by state trade agencies, most notably the Department of Trade Negotiations (DTN) under the Ministry of Commerce, and later the Department of International Economic Affairs under the Ministry of Foreign Affairs. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) These agencies played a central role in policy formulation, coordination of impact studies, organisation of stakeholder consultations, and consolidation of findings for submission to the Cabinet (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) While trade agencies primarily focused on economic and trade priorities, some trade officials recognised the importance of public health considerations and voiced concerns regarding potential impacts on access to medicines and other health-related issues.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“In terms of the Department itself, the issues we have discussed most extensively are the impacts of Thailand’s continued use of compulsory licensing (CL), the establishment of a patent linkage system…These are the issues that have been debated quite intensively (TS3)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“On the issues that everyone in the public health sector is concerned about, we share the same concerns. We are users as well, we care about our health, and of course we want affordable products.”(TS3)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“As negotiators, we, of course, safeguard the national interests. We will never concede on critical issues—especially those related to health and public health.”\u003c/em\u003e (TS3)\u003c/p\u003e\u003cp\u003eThis acknowledgment highlighted a more nuanced perspective within trade circles, suggesting a willingness to consider public health alongside economic objectives.\u003c/p\u003e\u003cp\u003eAlthough public health institutions—including the Ministry of Public Health (MoPH), the National Health Security Office (NHSO), and the Government Pharmaceutical Organization (GPO)—were actovely involved in consultation processes, they did not possess formal decision-making authority as the authority is with the Ministry of Commerce or the Ministry of Foreign Affairs, as well as the International Economic Policy Committee. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eMOPH Ministry of Public Health MOC Ministry of Commerce\u003c/p\u003e\u003cp\u003eGPO Government Pharmaceutical Organization DTN Department of Trade Negotiations\u003c/p\u003e\u003cp\u003eDDC Department of Disease Control DIP Department of Intellectual Property\u003c/p\u003e\u003cp\u003eFDA Food and Drug Administration MFA Ministry of Foreign Affairs\u003c/p\u003e\u003cp\u003eDHSS Department of Health Services Support MOAC Ministry of Agriculture and Cooperatives\u003c/p\u003e\u003cp\u003eDTAM Department of Traditional and Alternative Medicine BOI Board of Investment\u003c/p\u003e\u003cp\u003eNCITHS National Commission on International Trade JSCCIB Joint Standing Committee on Commerce,\u003c/p\u003e\u003cp\u003eand Health Studies Industry and Banking\u003c/p\u003e\u003cp\u003eNHSO National Health Security Office FTI Federations of Thai Industries\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eFigure 3\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eLandscape of stakeholders' engagement in the CPTPP negotiation process\u003c/p\u003e\u003cp\u003eKey informants also noted that trade officials tended to frame public health concerns as technical or implementation issues that could be managed or mitigated, rather than as central considerations influencing core policy decisions. This framing effectively marginalised health-sector perspectives and reinforced existing power asymmetries, with trade imperatives prioritised over public health objectives in shaping Thailand’s CPTPP negotiation stance.\u003c/p\u003e\u003ch2\u003eFragmented but Formally Inclusive Stakeholder Engagement\u003c/h2\u003e\u003cp\u003eThe CPTPP negotiation process incorporated a range of formal and informal mechanisms for stakeholder engagement. Government-led consultations included public hearings, expert focus groups, commissioned impact studies, and inter-ministerial working groups (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Civil society organisations (CSOs)—such as FTA Watch, AIDS Access, and BioThai—were actively involved in articulating concerns and advocating for public interest perspectives. Academic institutions and international organisations also contributed technical evidence and policy analysis.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite the breadth of participation, many stakeholders perceived the consultation process as largely symbolic or “procedural,” rather than substantively deliberative.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“It feels more like a ritual—something done just to tick the boxes so it can be claimed that it was done. This is the problem with the public consultation process.”\u003c/em\u003e (TN11)\u003c/p\u003e\u003cp\u003ePublic hearings were frequently described as poorly facilitated, offering limited opportunities for meaningful dialogue or engagement with competing viewpoints.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“We began to express our views that it would have an impact on the public, and we called on the government to listen to these opinions. But at that time, there was no law requiring state agencies or the government to listen to such views at all. We hardly had any participation, apart from organizing forums together with local residents in different areas—that was all.” (HN5)\u003c/em\u003e \u003c/p\u003e\u003cp\u003eHealth-sector actors, in particular, reported that their inputs were not systematically incorporated into policy deliberations, with trade agencies retaining control over agenda-setting and the interpretation of evidence.\u003c/p\u003e\u003cp\u003eWhile political leadership within advisory bodies such as the National Commission on International Trade and Health Studies (NCITHS) was perceived as relatively inclusive and balanced between health and trade sectors, the commission lacked formal decision-making authority.(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) As a result, its recommendations carried limited weight in shaping final policy outcomes, reinforcing existing power asymmetries within the negotiation process.\u003c/p\u003e\u003ch2\u003ePower Relations Among Stakeholders in Thailand’s CPTPP Negotiation\u003c/h2\u003e\u003cp\u003eThe debate surrounding Thailand’s potential accession to the CPTPP reveals a complex configuration of power relations among both governmental and non-governmental actors, particularly across the trade and health sectors. These dynamics can be analytically understood along two interrelated dimensions: structural power and collaborative power (Fig.\u0026nbsp;4).\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003c/p\u003e\u003cp\u003ePM Prime Minister DPM Deputy Prime Minister\u003c/p\u003e\u003cp\u003eM Minister MOC Ministry of Commerce\u003c/p\u003e\u003cp\u003eMFA Ministry of Foreign Affairs MOPH Ministry of Public Health\u003c/p\u003e\u003cp\u003eIEPC International Economic Policy NCITHS National Commission on International\u003c/p\u003e\u003cp\u003eCommittee Trade and Health Studies\u003c/p\u003e\u003cp\u003eOther abbreviations are the initials (names) of the key actors who are publicly known.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eFigure 4\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eTimeline of key events and key actors who influenced the CPTPP process in Thailand\u003c/p\u003e\u003ch2\u003eStructural Power: “Power Over” Decision-Making\u003c/h2\u003e\u003cp\u003eState trade agencies, together with affiliated private-sector actors, generally supported CPTPP accession, framing it as a strategic opportunity for economic growth and regional integration. In contrast, health-sector actors—spanning public institutions and civil society organisations—largely opposed accession due to concerns regarding potential adverse public health consequences.(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) Despite sustained efforts to build consensus through commissioned studies, public consultations, and multi-sectoral committees, no shared position ultimately emerged. Trade interests benefited from higher levels of coordination and institutional backing, with state agencies exercising control over agenda-setting, commissioning impact assessments, and determining how evidence was presented and interpreted during consultation. However, informants highlighted that limited transparency, particularly restricted public access to consultation outcomes and analytical reports, undermined trust in the negotiation process.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“…it was wondering whether the information we have provided—our concerns, documents, and evidence—would actually be used in decision making, or is this merely a consultation arranged to ease concerns and reduce social friction?...”\u003c/em\u003e (HN6)\u003c/p\u003e\u003cp\u003e \u003cem\u003e“The issue is that this results in a lack of openness and transparency, and there is no longer a role for Parliament or the legislative branch to ensure that sensitive issues are properly protected or genuinely negotiated.”\u003c/em\u003e (HN1)\u003c/p\u003e\u003cp\u003e \u003cem\u003e“As a result, we do not trust the process. Even if there are public consultations, we still do not trust it. The research they conducted was based on exaggerated assumptions, and even the parliamentary committee’s report pointed out that those assumptions were invalid. So you could say we did participate, but it was participation filled with mistrust—there was no trust between the parties.”\u003c/em\u003e (HN1)\u003c/p\u003e\u003cp\u003eWhile health-sector actors conducted parallel studies to articulate public health risks (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), no single body possessed the authority to reconcile competing evidence or definitively establish a shared understanding of the national interest, further entrenching structural imbalances in influence.\u003c/p\u003e\u003ch2\u003eCollaborative Power: “Power With Others”\u003c/h2\u003e\u003cp\u003eCivil society actors, most notably FTA Watch, mobilised collaborative power by leveraging public legitimacy to highlight the CPTPP’s potential risks to access to medicines and sustainable development. These actors used a range of strategies, including public forums, media engagement, academic publications, and social media advocacy, most visibly through campaigns such as #NoCPTPP. Collectively, these efforts elevated public awareness and sustained political pressure on decision-makers. Such mobilisation contributed to tangible political responses, including the establishment of a parliamentary committee to review the potential impacts of CPTPP accession. In addition, FTA Watch also submitted a petition opposing the agreement to the Prime Minister, reportedly supported by more than 400,000 signatures. These actions illustrate how collaborative networks among civil society, academics, and advocacy groups were able to shape the policy agenda, even without formal decision-making authority.\u003c/p\u003e\u003cp\u003eOverall, the CPTPP debate in Thailand involved multiple actors with varying degrees of influence. No single actor held overriding power; rather, stakeholders leveraged alliances and public legitimacy to advance their positions. This collective engagement influenced decision-making and reflected the contested nature of Thailand’s trade-health policy space.\u003c/p\u003e\u003ch2\u003eCritical Public Health Concerns Consistently Raised by Stakeholders\u003c/h2\u003e\u003cp\u003eAcross interviews and documentary analysis, three recurring public health concerns were consistently articulated by stakeholders.\u003c/p\u003e\u003ch2\u003eAccess to Medicines and Pharmaceutical Security\u003c/h2\u003e\u003cp\u003eProvisions related to intellectual property protection, particularly patent linkage and potential constraints on compulsory licensing, were widely viewed as risks to Thailand’s capacity to issue government-use licenses for essential medicines. Stakeholders expressed concern that these measures could delay the market entry of generic medicines, increase pharmaceutical prices, and constrain public procurement mechanisms, undermining access to affordable treatments.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“…civil society may be very worried about the impact [of the CPTPP], but we [the Joint Standing Committee on Commerce, Industry and Banking] are actually concerned about everything, including medical equipment, waste, and things to be imported in terms of capital that will compete with the procurement service sector, compulsory licenses, and medicine. The local pharmaceutical company was also concerned, especially the Thai Pharmaceutical Manufacturers Association ... If they can't compete (with international manufacturers), people would not afford costly medicines …” (HN3)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“It means that the generic drug industry would not have the right to use the data that has been developed as supporting information for drug registration…This is another major issue—an extremely big one—because it will affect our ability to produce new generic drugs to replace expensive medicines. And at this point, this issue is still in a vacuum; no one is talking about it.” (HN4)\u003c/em\u003e \u003c/p\u003e\u003ch2\u003ePlant Variety Protection under UPOV 1991\u003c/h2\u003e\u003cp\u003e Stakeholders from the health and agricultural sectors raised concerns that CPTPP accession would require Thailand to comply with the 1991 Act of the International Union for the Protection of New Varieties of Plants (UPOV 1991). Civil society organisations feared this would facilitate seed monopolisation, restrict traditional seed-saving and exchange practices, reduce agricultural biodiversity, and increase farmers’ dependence on commercial seed companies.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“…if we were to join the CPTPP, I think that the provisions on seed protection would have a fairly significant impact on our farmers.” (HS6)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e“This is something we are very concerned about: that access to the original varieties of medicinal plants will be restricted for farmers, and if farmers are required to purchase them, the cost of producing medicines will increase.” (HS6)\u003c/em\u003e \u003c/p\u003e\u003cp\u003eSuch changes were seen as risks to food and nutritional security, particularly for small-scale farmers.\u003c/p\u003e\u003ch2\u003eRegulation of Remanufactured Medical Devices\u003c/h2\u003e\u003cp\u003eConcerns were also raised regarding the harmonisation of regulatory standards for remanufactured medical devices under the CPTPP. Stakeholders warned that weakened or insufficiently adapted regulatory requirements could compromise quality control (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Given Thailand’s limited capacity to monitor and verify such devices, health professionals highlighted potential risks to patient safety .\u003c/p\u003e\u003cp\u003e \u003cem\u003e“If they [remanufactured devices] don’t come with that technology, they can end up being like discarded waste—and waste that directly affects people’s lives, which can be dangerous.”\u003c/em\u003e (HN2)\u003c/p\u003e\u003cp\u003eIn addition, strengthened intellectual property protections were perceived as possible barriers to reverse engineering, repair, and local adaptation of medical devices. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e \u003cem\u003e“Regarding medical devices, there is concern that reused devices might be refurbished and then put back into use. At present, Thai law does not allow this. The worry is that if we were to participate and become part of such agreements, they might open the door to this practice. Therefore, there is considerable concern among medical device manufacturers. We should also be promoting our domestic industry.” (HN3)\u003c/em\u003e \u003c/p\u003e\u003ch2\u003ePoliticisation and Institutional Weakness Impeded Decision-Making\u003c/h2\u003e\u003cp\u003eDespite broad-based stakeholder participation and sustained public interest, the Thai government was unable to reach a decision on CPTPP accession over the five-year study period. Two interrelated factors were identified as central to this policy stalemate.\u003c/p\u003e\u003ch2\u003eInstitutional Ambiguity\u003c/h2\u003e\u003cp\u003eLegal authority over trade policy formulation and decision-making was fragmented across multiple bodies. While the Department of Trade Negotiations (DTN) was responsible for leading technical preparations and stakeholder consultations, ultimate decision-making authority rested with the Cabinet. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) In practice, Cabinet deliberations were repeatedly deferred, reflecting institutional ambiguity and sensitivity surrounding the political implications of CPTPP accession. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e\u003ch2\u003ePolitical Timing and Risk Aversion\u003c/h2\u003e\u003cp\u003eDuring 2022–2023, the government approached the end of its term, contributing to reluctance among political leaders to pursue highly contested policy decisions. Informants noted that CPTPP accession was closely tied to broader foreign policy and investment objectives, yet simultaneously associated with politically sensitive domestic issues—particularly access to medicines and agricultural autonomy.\u003c/p\u003e\u003cp\u003e \u003cem\u003e“Working on the CPTPP provisions is beneficial in terms of the investment chapter. You’ll notice that the investment provisions provide extensive protection…When we look at the conditions for protection, they’re quite good, excellent even.”\u003c/em\u003e (TN4)\u003c/p\u003e\u003cp\u003eThis convergence of external economic pressures and internal political risks reinforced a cautious, non-decisive stance.\u003c/p\u003e\u003cp\u003eAs a result, the CPTPP accession process became a contested policy arena where competing interests among economic actors, public health advocates, and political leaders intersected without resolution. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cem\u003e‘’… The Thai government had the ‘available options’ to convince stakeholders, but may find ‘different support from stakeholders’…”\u003c/em\u003e (TI1)\u003c/p\u003e\u003cp\u003eThis impasse underscores the limitations of existing institutional arrangements in managing complex trade and health policy trade-offs.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a critical examination of Thailand\u0026rsquo;s CPTPP negotiation process through a political economy and policy coherence lens. It identifies three interrelated challenges: the institutional dominance of trade actors, the limited integration of public health perspectives into trade policymaking, and fragmented mechanisms of stakeholder engagement. Together, these dynamics help explain the prolonged indecision surrounding Thailand\u0026rsquo;s potential accession to the CPTPP.\u003c/p\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eTrade Dominance and Power Asymmetry\u003c/h2\u003e \u003cp\u003eConsistent with a power-centred political economy framework, trade agencies exercised disproportionate influence over agenda-setting, evidence interpretation, and the formulation of policy recommendations. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) Although health-sector actors were formally consulted, trade and investment priorities ultimately shaped the negotiation discourse. Public health concerns were frequently reframed as technical or implementation issues, rather than treated as core determinants of national welfare and policy choice.\u003c/p\u003e \u003cp\u003eThese findings align with global evidence indicating that health ministries often face structural disadvantages in intersectoral trade negotiations (\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Such disadvantages include weaker political capital, limited technical capacity in trade-related matters, and marginal positioning within national economic policymaking institutions.(\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) As a result, health interests are frequently subordinated to economic objectives in trade policy processes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eSymbolic Inclusion Versus Substantive Participation\u003c/h2\u003e \u003cp\u003eThailand\u0026rsquo;s CPTPP experience illustrates a broader challenge in global trade governance - the gap between formal inclusivity and substantive participation. While the consultation process was procedurally inclusive, engaging civil society organisations, academics, and health professionals through public hearings and working groups, these actors exerted limited influence over decision-making outcomes. (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) Trade officials often characterised health-related critiques as \u0026ldquo;misunderstandings\u0026rdquo; or \u0026ldquo;over-interpretations\u0026rdquo; of the CPTPP provisions, reflecting a technocratic orientation that tended to marginalise social and public health perspectives.(\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis pattern aligns with broader academic critiques of the democratic deficit in global trade, where public engagement is often treated as a procedural requirement rather than a meaningful opportunity to influence policy. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePolicy Coherence Between Trade and Health Remains Elusive\u003c/h3\u003e\n\u003cp\u003eThailand\u0026rsquo;s efforts to promote policy coherence through intersectoral mechanisms such as the National Commission on International Trade and Health Studies (NCITHS) represent an important institutional innovation(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). NCITHS provided a rare multisectoral forum for dialogue between trade and health actors. However, its limited mandate and lack of binding authority constrained its capacity to influence national negotiation positions. The absence of a decision on CPTPP accession after five years reflects the absence of institutional reforms. Consequently, trade policymaking is likely to continue privileging economic integration over public health objectives, hence prolonging structural incoherence.\u003c/p\u003e \u003cp\u003eAs highlighted in previous research, achieving policy coherence between trade and health requires more than cross-sectoral dialogue. It requires institutionalised mechanisms for health impact assessment, ex ante review of trade commitments, transparency in evidence use, and strengthened authority for health ministries within trade policymaking processes. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e) Without such reforms, tensions between economic integration and public health protection are likely to persist.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Future Negotiations\u003c/h2\u003e \u003cp\u003eThailand\u0026rsquo;s experience with the CPTPP offers important lessons for countries engaging in trade negotiations with significant public health implications. First, the presence of an active civil society and a well-informed health sector served as a critical counterbalance to rapid policy shifts driven by economic considerations. Such actors played a key role in scrutinising trade commitments and elevating public health concerns within national debates.\u003c/p\u003e \u003cp\u003eSecond, the prolonged indecision surrounding CPTPP accession underscores the absence of a centralised and authoritative mechanism to reconcile tensions between trade and health objectives. This highlights the need for clearer legal and institutional mandates for systematic consideration of health impacts in trade policymaking.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eThis study has offered several recommendations for policymakers, the trade negotiation process, the public, and future research to enhance policy coherence between trade and health in Thailand.\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eFor Policymakers\u003c/h2\u003e \u003cp\u003eAs the CPTPP accession negotiations will be more complex, the traditional mechanism of health engagement in trade negotiations would no longer suffice to advocate health interests in the new context of trade negotiations. Government authorities are recommended to enhance policy communication and transparency in trade decision-making with clear, timely, and accessible communication about the objectives, risks, and potential health implications of trade agreements to build public trust and reduce misinformation.\u003c/p\u003e \u003cp\u003ePolicymakers are also recommended to ensure transparency in decision-making, including publishing impact assessments, negotiation rationales, and relevant dissenting views.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eFor the Trade Negotiation Process\u003c/h2\u003e \u003cp\u003eEngagement strategies should be tailored to specific stakeholder groups, acknowledging differences in technical capacity, institutional influence, and access to policymaking forums.\u003c/p\u003e \u003cp\u003eIt is strongly recommended that sufficient and realistic timeframes should be allocated for commissioned studies, public hearings, and intersectoral review.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eFor Public Engagement\u003c/h3\u003e\n\u003cp\u003eImproving public understanding of complex trade provisions, such as intellectual property rights or regulatory standards, can reduce reliance on polarised narratives and enhance public debate. Public engagement should be facilitated through systematic education and access to reliable information on trade and health issues..\u003c/p\u003e \u003cp\u003eIndividuals or groups are also recommended to participate in all public consultations and hearings to express their concerns and their continuous engagement with strong articulation could influence policy deliberation.\u003c/p\u003e\n\u003ch3\u003eFor Further Research\u003c/h3\u003e\n\u003cp\u003eThis study is limited to a formal process to assess the impact of the CPTPP on health. The further research should conduct in-depth, issue-specific analyses of the most significant health concerns related to CPTPP accession, including access to medicines, pharmaceutical policy space, and plant variety protection. Quantitative and mixed-methods studies are also suggested to quantify positive and negative health impacts, complementing the qualitative insights of this study.\u003c/p\u003e \u003cp\u003eInvestment in interdisciplinary research teams and institutional platforms can support the independent generation of policy-relevant evidence to inform trade negotiations and public discourse. Strengthening national research capacity on trade and health is therefore strongly recommended.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSince 2018, Thailand has expressed interest in acceding to the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP). However, this initiative has encountered sustained opposition from multiple sectors, including the Ministry of Public Health, driven by concerns over potential adverse impacts on food security, biodiversity, and the public health system. Despite extensive and formally inclusive consultation processes conducted through various multiple platforms, including parliamentary mechanisms, the government was unable to reach a consensus on CPTPP accession after nearly five years of deliberation between 2018 and 2022.\u003c/p\u003e \u003cp\u003eThroughout the negotiation process, a diverse array of stakeholders from both trade and health sectors, encompassing governmental and non-governmental actors, actively engaged in the policy debate. These actors exercised varying degrees of influence depending on their perceived interests and potential gains or losses from the agreement. While no single government agency exerted absolute control over the process, actors sought to legitimise their positions through coalition-building with like-minded partners. This collective mobilisation contributed to heightened political scrutiny, including the establishment of a Senate subcommittee to further examine the CPTPP and its implications.\u003c/p\u003e \u003cp\u003eOverall, the CPTPP debate in Thailand illustrates a dynamic interplay of institutional power in which legitimacy was constructed less through formal authority than through alliances, sustained engagement, and strategic framing. Rather than converging around a shared conception of the national interest, the process remained shaped by competing sectoral priorities and contested interpretations of policy evidence.\u003c/p\u003e \u003cp\u003eLooking ahead, Thailand\u0026rsquo;s experience highlights the need for stronger institutional arrangements to support evidence-informed and transparent trade policymaking. For future trade negotiations, Thailand should consider establishing an independent research institute to generate academically rigorous, policy-relevant evidence; ensuring sufficient timelines to allow for high-quality research and inclusive public consultations; and developing clear, actionable mechanisms to support, mitigate, and compensate sectors and populations adversely affected by trade agreements. Such reforms would strengthen policy coherence, enhance public trust, and better align trade objectives with public health and social protection goals.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cp\u003eBOI Board of Investment\u003c/p\u003e \u003cp\u003eCL Compulsory licensing\u003c/p\u003e \u003cp\u003eCPTPP Comprehensive and Progressive Agreement for Trans-Pacific Partnership\u003c/p\u003e \u003cp\u003eCSO Civil society organisations\u003c/p\u003e \u003cp\u003eDDC Department of Disease Control\u003c/p\u003e \u003cp\u003eDHSS Department of Health Services Support\u003c/p\u003e \u003cp\u003eDIP Department of Intellectual Property\u003c/p\u003e \u003cp\u003eDPM Deputy Prime Minister\u003c/p\u003e \u003cp\u003eDTAM Department of Traditional and Alternative Medicine\u003c/p\u003e \u003cp\u003eDTN Department of Trade Negotiations\u003c/p\u003e \u003cp\u003eFDA Food and Drug Administration\u003c/p\u003e \u003cp\u003eFTI Federation of the Thai Industries\u003c/p\u003e \u003cp\u003eGDP Gross Domestic Product\u003c/p\u003e \u003cp\u003eGPO Government Pharmaceutical Organization\u003c/p\u003e \u003cp\u003eIEPC International Economic Policy Committee\u003c/p\u003e \u003cp\u003eJSCCIB Joint Standing Committee on Commerce, Industry and Banking\u003c/p\u003e \u003cp\u003eMFA Ministry of Foreign Affairs\u003c/p\u003e \u003cp\u003eMOAC Ministry of Agriculture and Cooperatives\u003c/p\u003e \u003cp\u003eMOC Ministry of Commerce\u003c/p\u003e \u003cp\u003eMOPH Ministry of Public Health\u003c/p\u003e \u003cp\u003eNCITHS National Commission on International Trade and Health Studies\u003c/p\u003e \u003cp\u003eNHSO National Health Security Office\u003c/p\u003e \u003cp\u003ePM Prime Minister\u003c/p\u003e \u003cp\u003eTRIPS Agreement on Trade-Related Aspects of Intellectual Property Rights\u003c/p\u003e \u003cp\u003eUPOV International Convention for the Protection of New Varieties of Plants\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative interview data in this study are not publicly available. However, data from document review can be available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the Enhancing Leadership in Global Health Thailand (EnLIGHT), under the International Health Policy Program Foundation, for funding support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCP, ST, TM contributed to conceptualisation, methodology, data collection and analysis, writing, review and editing. PC, SS, NY contributed to project administration, data collection, and analysis. CP drafted the manuscript with reviews and edits provided by ST, TM, PC, SS, NY.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institute for the Development of Human Research Protection (IHRP), Thailand (Protocol No. IHPR2023056).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants provided written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (IHRP) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by the Enhancing Leadership in Global Health Thailand (EnLIGHT) Program, under the International Health Policy Program Foundation, Thailand.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGleeson D, Lopert R, Reid P. How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand. Health Policy. 2013;112(3):227\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriel S, Gleeson D, Thow A-M, Labonte R, Stuckler D, Kay A, et al. A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement. Globalization Health. 2013;9(1):46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuckert A, Schram A, Labont\u0026eacute; R, Friel S, Gleeson D, Thow A-M. Policy coherence, health and the sustainable development goals: a health impact assessment of the Trans-Pacific Partnership. Crit Public Health. 2017;27(1):86\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Foreign Affairs and Trade. A. Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) 2025. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dfat.gov.au/trade/agreements/in-force/cptpp/comprehensive-and-progressive-agreement-for-trans-pacific-partnership\u003c/span\u003e\u003cspan address=\"https://www.dfat.gov.au/trade/agreements/in-force/cptpp/comprehensive-and-progressive-agreement-for-trans-pacific-partnership\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Economic Forum. The United Kingdom is set to join the trans-Pacific free trade pact. Here's what you need to know 2023. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.weforum.org/stories/2023/04/cptpp-trade-tariff-brexit-uk/#:~:text=Three%20years%20after%20leaving%20the,the%20UK%20keen%20to%20join\u003c/span\u003e\u003cspan address=\"https://www.weforum.org/stories/2023/04/cptpp-trade-tariff-brexit-uk/#:~:text=Three%20years%20after%20leaving%20the,the%20UK%20keen%20to%20join\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e?.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInfoQuest. The 12 steps of accessing the CPTPP. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNew Zealand Foreign Affairs and Trade, Comprehensive, and Progressive Agreement for Trans-Pacific Partnership (CPTPP). : Accession Process 2019. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mfat.govt.nz/assets/Trade-agreements/CPTPP/Accession-Process.pdf\u003c/span\u003e\u003cspan address=\"https://www.mfat.govt.nz/assets/Trade-agreements/CPTPP/Accession-Process.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchott JJ. Joining the CPTPP is a long process and needs consensus among existing members. 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.piie.com/research/piie-charts/joining-cptpp-long-process-and-needs-consensus-among-existing-members\u003c/span\u003e\u003cspan address=\"https://www.piie.com/research/piie-charts/joining-cptpp-long-process-and-needs-consensus-among-existing-members\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBangkok Post. Somkid: Thailand eyes becoming CPTPP member 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bangkokpost.com/business/general/1437386/somkid-thailand-eyes-becoming-cptpp-member\u003c/span\u003e\u003cspan address=\"https://www.bangkokpost.com/business/general/1437386/somkid-thailand-eyes-becoming-cptpp-member\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBangkok Post. DPM Somkid backs Thailand to join ex-US TPP. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeelaprathuang N. The Impact of CPTTP on Accessing Medicine in Thailand. J Humanit Social Sci Suratthani Rajabhat Univ. 2021;13(1):172\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThailand Consumers Council, No. CPTPP2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.tcc.or.th/policies/consumer-cptpp/?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://www.tcc.or.th/policies/consumer-cptpp/?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsra News Agency. Dean of the Faculty of Pharmacy, Chulalongkorn University, indicates CPTPP accession could raise medicine costs and reduce domestic industry share2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.isranews.org/article/isranews-short-news/90440-cptpp-2.html?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://www.isranews.org/article/isranews-short-news/90440-cptpp-2.html?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth Focus. CPTPP\u0026rsquo;s potential risks to health system and medicine access in the Thai context2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hfocus.org/content/2020/05/19203?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://www.hfocus.org/content/2020/05/19203?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Trade Organization. Agreement on Trade-Related Aspects of Intellectual Property Rights. 1995.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCPTPP Portal APFoC. Chapter 18 \u0026ndash; Intellectual Property2025. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apfccptppportal.ca/agreement/20\u003c/span\u003e\u003cspan address=\"https://apfccptppportal.ca/agreement/20\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth Focus. Chulalongkorn University pharmacy researchers reveal CPTPP will increase pharmaceutical expenditure2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hfocus.org/content/2020/07/19788\u003c/span\u003e\u003cspan address=\"https://www.hfocus.org/content/2020/07/19788\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChanwichi P. The effect of CPTPP on the farmers' rights in Thailand. Interdisciplinary Sripatum Chonburi J. 2020;6(2):14\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFTA Watch. FTA Watch warns the Cabinet not to trust Somkid\u0026rsquo;s push to submit a letter of intent to join the CPTPP2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ftawatch.org/node/50425\u003c/span\u003e\u003cspan address=\"http://www.ftawatch.org/node/50425\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlobal Agriculture. Seeds and Patents on Life2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.globalagriculture.org/topics/seeds-patents-life/\u003c/span\u003e\u003cspan address=\"https://www.globalagriculture.org/topics/seeds-patents-life/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTCIJ. Academics worry that joining the CPTPP and the Plant Variety Protection Convention will disadvantage farmers. 2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.tcijthai.com/news/2020/10/current/11021\u003c/span\u003e\u003cspan address=\"https://www.tcijthai.com/news/2020/10/current/11021\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Momentum. As CPTPP progresses, a call to revisit intellectual property and patent issues2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://themomentum.co/what-are-the-concerns-regarding-comprehensive-and-progressive-agreement-for-trans-pacific-partnership/\u003c/span\u003e\u003cspan address=\"https://themomentum.co/what-are-the-concerns-regarding-comprehensive-and-progressive-agreement-for-trans-pacific-partnership/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThai Publica. CPTPP (Final Part): Untangling three major concerns \u0026mdash; seed-saving rights, pharmaceutical CLs, and government procurement2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://thaipublica.org/2021/07/cptpp-and-thailand-stance-01/\u003c/span\u003e\u003cspan address=\"https://thaipublica.org/2021/07/cptpp-and-thailand-stance-01/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThird World Network. Stringent plant variety protection may impinge on right to food. TWN Info Service on Biodiversity and Traditional Knowledge [Internet]. 2014. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://twn.my/title2/biotk/2014/btk141008.htm?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://twn.my/title2/biotk/2014/btk141008.htm?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSDG Move, Insights SDG. Viewing the CPTPP through the SDGs lens \u0026mdash; Uneven development2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sdgmove.com/2020/04/28/cptpp-through-sdgs-lens-unbalanced-development/\u003c/span\u003e\u003cspan address=\"https://www.sdgmove.com/2020/04/28/cptpp-through-sdgs-lens-unbalanced-development/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFTA Watch. FTA Watch examines 13 key CPTPP issues proposed by the Ministry of Commerce to the Deputy Prime Minister. 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Trade Negotiation MoC, Thailand. \u0026lsquo;Commerce Ministry\u0026rsquo; holds public hearing on the CPTPP; \u0026lsquo;private sector\u0026rsquo; supports accession, while \u0026lsquo;civil society\u0026rsquo; urges further studies and inclusive participation2019. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dtn.go.th/th/news/5cff75921ac9ee073b7bfffe?cate=5cff753c1ac9ee073b7bd1c5\u003c/span\u003e\u003cspan address=\"https://www.dtn.go.th/th/news/5cff75921ac9ee073b7bfffe?cate=5cff753c1ac9ee073b7bd1c5\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFTA Watch. Civil society points out what Somkid did not say: No pharmaceutical patents, but many other disasters hidden in the CPTPP2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ftawatch.org/node/50424\u003c/span\u003e\u003cspan address=\"http://www.ftawatch.org/node/50424\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaporaso JA, Levine DP. Theories of political economy. New York: Cambridge University Press; 1992.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Secretariat of the Cabinet. Cabinet resolution on preparation for accessing to the Comprehensive and Progressive Trans-Pacific Partnership: CPTPP. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment of Trade Negotiation MoC. Thailand,. Role and function of Department of Trade Negotiation 2021 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dtn.go.th/th/content/page/index/id/35\u003c/span\u003e\u003cspan address=\"https://www.dtn.go.th/th/content/page/index/id/35\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatichon. Ministry of Commerce organised public hearings on CPTPP, Thai private sector supported joining the agreement. Matichon. 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Foreign Affairs. Ministry of Foreign Affairs together with the government agencies and academia organised a consultative meeting on CPTPP with the press 2022. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mfa.go.th/th/content/cptpp-media-focus-group?page=5d5bd3c915e39c306002a907\u003c/span\u003e\u003cspan address=\"https://www.mfa.go.th/th/content/cptpp-media-focus-group?page=5d5bd3c915e39c306002a907\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFTA Watch. FTA Watch and academics criticize the Ministry of Commerce for misleading the public and rushing CPTPP accession despite numerous sensitive issues2018. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ftawatch.org/node/50421\u003c/span\u003e\u003cspan address=\"https://ftawatch.org/node/50421\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFTA Watch. Six concerns and potential impacts if Thailand joins the CPTPP2019. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ftawatch.org/node/50423\u003c/span\u003e\u003cspan address=\"https://ftawatch.org/node/50423\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWongsatjachock W, Leesmidt V, Horayangkura S, Phon-amnuai N. Knowledge and Policy Linkage Mechanism between Health and International Trade: A Case Study of the National Committee on International Trade and Health Studies (NCITHS). Health Syst Res J. 2023;17(4):648\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTenni B, Lexchin J, Akaleephan C, Kittitrakul C, Gleeson D. The potential impact of the Comprehensive and Progressive Agreement for Prans-Pacific Partnership on Thailand's hepatitis C treatment program. Global Health. 2024;20(1):46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVongsirisopak S. Studies of the impact on alcohol control in case of joining Comprehensive and Progressive Agreement of Trans-Pacific Partnership (CPTPP). Disease Control J. 2021;41(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFTA Watch. Why Thailand should not join the CPTPP2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ftawatch.org/sites/default/files/FTAWatch_BlackPaper_CPTPP.pdf?fbclid=IwAR1puuzL5XnqyK9mc9DhtuVtjvo-6cUoCVIQwwBsAzs9SREAsxmIq3TihMo\u003c/span\u003e\u003cspan address=\"https://ftawatch.org/sites/default/files/FTAWatch_BlackPaper_CPTPP.pdf?fbclid=IwAR1puuzL5XnqyK9mc9DhtuVtjvo-6cUoCVIQwwBsAzs9SREAsxmIq3TihMo\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajpradi W. Legal Measures of the Regulatory Framework for Remanufactured Medical Devices. Wimpat Rajpradi. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChongkittavorn K. CPTPP procrastination not an option2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.eria.org/news-and-views/cptpp-procrastination-not-an-option\u003c/span\u003e\u003cspan address=\"https://www.eria.org/news-and-views/cptpp-procrastination-not-an-option\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHouse of Representatives. Report of the Ad Hoc Committee on the Impacts of Accession to the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP). Legislative Institutional Repository Thailand; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review. Int J Health Policy Manag. 2018;7(2):101\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGleeson D, Friel S. Emerging threats to public health from regional trade agreements. Lancet. 2013;381(9876):1507\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcNeill D, Birkbeck CD, Fukuda-Parr S, Grover A, Schrecker T, Stuckler D. Political origins of health inequities: trade and investment agreements. Lancet. 2017;389(10070):760\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlouin C. Trade policy and health: from conflicting interests to policy coherence. Bull World Health Organ. 2007;85(3):169\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJarman H. Trade policy governance: What health policymakers and advocates need to know. Health Policy. 2017;121(11):1105\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTownsend B, Tenni BF, Goldman S, Gleeson D. Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy. Globalization Health. 2023;19(1):60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarlow P, McKee M, Basu S, Stuckler D. The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis. Globalization Health. 2017;13(1):13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoivusalo M. Policy space for health and trade and investment agreements. Health Promot Int. 2014;29(suppl1):i29\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThow AM, Snowdon W, Labont\u0026eacute; R, Gleeson D, Stuckler D, Hattersley L, et al. Will the next generation of preferential trade and investment agreements undermine prevention of noncommunicable diseases? A prospective policy analysis of the Trans Pacific Partnership Agreement. Health Policy. 2015;119(1):88\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowse R. From Politics to Technocracy\u0026mdash;and Back Again: The Fate of the Multilateral Trading Regime. Am J Int Law. 2002;96(1):94\u0026ndash;117.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026auml;ckstrand K. Democratizing Global Environmental Governance? Stakeholder Democracy after the World Summit on Sustainable Development. Eur J Int Relat. 2006;12(4):467\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabont\u0026eacute; R, Mohindra K, Schrecker T. The growing impact of globalization for health and public health practice. Annu Rev Public Health. 2011;32:263\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"globalization-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"glah","sideBox":"Learn more about [Globalization and Health](https://globalizationandhealth.biomedcentral.com/)","snPcode":"12992","submissionUrl":"https://submission.nature.com/new-submission/12992/3","title":"Globalization and Health","twitterHandle":"@GHJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CPTPP, trade negotiation, political economy, stakeholder engagement, access to medicines, Thailand, public health, policy coherence","lastPublishedDoi":"10.21203/rs.3.rs-8451689/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8451689/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) has generated intense debate in Thailand, particularly concerning its implications for public health, intellectual property rights, and access to medicines. Thailand undertook an extended in-country process to provide evidence on its economic opportunity and public health challenges for the cabinet decision during 2018\u0026ndash;2022. However, there is no evidence indicating whether Thailand has decided to join the CPTPP. This study examines Thailand\u0026rsquo;s CPTPP negotiation process using a political economy framework, focusing on the institutional and actor landscape that shaped the negotiations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings demonstrate that both state and non-state actors played influential roles in shaping public discourse and decision-making. The Ministry of Commerce emerged as the lead negotiating authority, while the health sector\u0026rsquo;s influence remained limited despite its active engagement. Key stakeholder concerns centred on pharmaceutical access, plant variety protection, and medical device regulatory standards.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Trade, Power, and Public Health: A Political Economy Analysis of Thailand’s CPTPP Negotiation Process","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 18:43:08","doi":"10.21203/rs.3.rs-8451689/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T11:38:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-09T04:05:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T01:42:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273871289899475080352908558032203831895","date":"2026-02-16T09:19:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88795968398288305330243646394868092391","date":"2026-02-10T23:08:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-10T10:56:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-09T08:22:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"Globalization and Health","date":"2026-01-31T22:15:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"globalization-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"glah","sideBox":"Learn more about [Globalization and Health](https://globalizationandhealth.biomedcentral.com/)","snPcode":"12992","submissionUrl":"https://submission.nature.com/new-submission/12992/3","title":"Globalization and Health","twitterHandle":"@GHJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"920a49fc-c94f-4d52-b0bb-bb30562278a0","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T14:38:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 18:43:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8451689","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8451689","identity":"rs-8451689","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}