ABSTRACT
Against the background of stalled negotiations in the World Trade Organization (WTO), there has been a proliferation of bilateral and regional trade agreements. Most of these contain provisions which go beyond existing WTO agreements in the protection of intellectual property (IP), and raise concerns about the ability of low and middle-income countries to provide affordable drugs for their populations. An extreme case is the Trans-Pacific Partnership Agreement (TPPA), now under negotiation among eleven countries. Competing interests within and among countries, evolving alliances and economic ties, and external factors present a challenge for health diplomacy at the intersection of health and trade. With the emergence of new economic power centres, low and middle-income countries have wider choice for trade partnerships and do not have to accept agreements that are incompatible with their policy objectives. The situation calls for a more sophisticated and inclusive style of health diplomacy than we have seen up to now.