As explained above, the theory suggests that BTAs promote commercial activities between partners, which should lead to a stronger TL between the countries concerned. To empirically assess whether this is indeed the case, we analyze the BTA action indices according to the equation (6) for each BTA. A positive value of B-level implies both an increase in the level and a positive development of ti, reflecting the relative importance of activity between the countries concerned in the first years following the implementation of the BTA. As a result, we believe that a BTA is effective if its BTA impact indices are positive. Walls HL, Smith RD, Drahos P. Improving regulatory capabilities to address the risks associated with trade agreements. Global health. 2015;11(14). doi.org/10.1186/s12992-015-0099-7. Trade agreements also contain provisions beyond the investigative period that may have an impact on pharmaceutical policy and practice.
For example, trade agreements with Australia and Korea contained provisions for national drug coverage programs and pharmaceutical marketing regulation , and similar rules later appeared in the Trans-Pacific Partnership Agreement (TPP)  and the U.S.-Mexico-Canada Agreement (USMCA). The TPP also contained a series of innovative safety and efficacy assessment provisions , which were subsequently introduced into the USMCA . These provisions have been the subject of a less comprehensive analysis. Given the scope and scope of legislation negotiated in recent trade agreements, there are increasingly potential intersections between trade and investment rules and pharmaceutical policy, which go beyond the known field of intellectual property and access to medicines, with a number of implications for the United Nations Sustainable Development Goal (SDG) 3.8 (“Achieving universal health care, including protection of financial risks, access to quality basic health services, and access to safe, effective, quality and affordable essential medicines and vaccines” . Many provisions, which are now often contained in trade agreements, can undermine access to safe, effective, quality and affordable medicines and may jeopardize the achievement of health care and the SDGs. ISDS has become highly controversial due to the increasing number of cases, including several high-level environmental and public health cases . Such a case was a claim by tobacco giant Philip Morris against the Australian government because of its tobacco packaging legislation . Footnote 9 Following this controversy, recently negotiated investment chapters (for example.
(B) Chapter 9 of the TPP) contain clauses to reduce the likelihood that investors will win lawsuits against legitimate and non-discriminatory health measures. Many of these clauses have not yet been tested and some legal experts have expressed doubts about the extent to which such so-called safeguards would help countries defend rights against health and environmental laws and laws . On the other hand, some recently concluded bilateral trade agreements have explicitly excluded any measures in the area of public health and/or specific public health programmes (see z.B the Peru-Australia Free Trade Agreement, Chapter 8, Footnote 17) . Agreement between the United States, Mexico-Canada. Mexico Customs Plan: U.S. Trade Representative; 2018. ustr.gov/sites/default/files/files/agreements/FTA/USMCA/02%20Tariff%20 Calendar%20%20Mexiko%20%20us-MX_0.pdf. Access 8 Nov 2018. While the removal of drug tariffs in multilateral trade relations is generally seen as beneficial for access to medicines, the effects of preferential trade agreements are less obvious due to several complexities. Much depends on the structure of the national pharmaceutical market.