The USMCA (NAFTA 2.0), although signed over a year ago, went through several months of renegotiation of certain of its new rules that the Democrat-controlled US Congress wanted altered or strengthened. In December a 'Protocol of Amendment' was agreed upon and signed by the three Parties (the USA, Mexico, and Canada). A number of tough, new measures governing pharmaceuticals were revised or deleted, making it potentially easier for generic competition and lower drug costs in all three countries. Rules on protection of labour rights were also strengthened, lowering the threshold at which a complaint of unfair labour practices could be initiated. Procedures for investigating such a complaint or resolving a formal dispute were also improved. Similar procedural improvements were made on measures affecting environmental protection. These Protocol agreements are more health-positive than health-negative, and in the case of pharmaceuticals are of significant impact. Overall, however, these amendments are simply a political fine-tuning of the agreement. Concerns raised in our earlier health impact assessment of the USMCA, notably how the agreement's regulatory reforms reduce public health policy flexibilities, remain. The agreement continues to subordinate known or potential health costs of many of its measures to dubious claims of aggregate economic gains. Moreover, these gains, if materialized, are likely to accrue to those atop the income/wealth hierarchies in all three nations.

中文翻译：

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USMCA 2.0：进行了一些改进，但与“健康”贸易条约相去甚远。

USMCA（NAFTA 2.0）虽然是一年多以前签署的，但经过了几个月的重新谈判，重新谈判了民主党控制的美国国会希望改变或加强的某些新规则。12月，三个缔约方（美国，墨西哥和加拿大）就“修订协议”达成了一致并签署。修改或删除了许多针对药品的强硬，新措施，这使得这三个国家的仿制药竞争变得更加容易，药品成本更低。保护劳工权利的规则也得到了加强，降低了可以对不公正的劳工做法提出申诉的门槛。调查此类投诉或解决正式争议的程序也得到了改进。在影响环境保护的措施上也进行了类似的程序改进。这些议定书协议对健康的影响要大于对健康的负面影响，并且在药品方面具有重大影响。总体而言，这些修正案只是对该协议的政治微调。在我们之前对USMCA的健康影响评估中，尤其是该协议的监管改革如何降低公共卫生政策的灵活性，仍然存在担忧。该协议继续使许多措施的已知或潜在健康成本服从于总经济收益的可疑索赔。而且，这些收益，如果实现的话，很可能会归因于所有三个国家的收入/财富等级最高的收益。这些修订只是对该协议的政治微调。在我们之前对USMCA的健康影响评估中，尤其是该协议的监管改革如何降低公共卫生政策的灵活性，仍然存在担忧。该协议继续使许多措施的已知或潜在健康成本服从于总经济收益的可疑索赔。而且，这些收益，如果实现的话，很可能会归因于所有三个国家的收入/财富等级最高的收益。这些修正案只是对该协议的政治微调。我们在先前对USMCA的健康影响评估中提出的担忧，尤其是该协议的监管改革如何降低公共卫生政策灵活性。该协议继续使许多措施的已知或潜在健康成本服从于总经济收益的可疑索赔。而且，这些收益，如果实现的话，很可能会归因于所有三个国家的收入/财富等级最高的收益。