Reform, repeal, replace: a case study of policy whiplash in New Zealand's health sector

AIMS: For over a decade, New Zealand pursued a comprehensive reform of its outdated medicines legislation, culminating in the passage of the Therapeutic Products Act 2023 (TPA) in 2023. In a policy reversal, the Act was repealed by a new government in 2024. This study provides an analysis of this policy cycle to understand the drivers of the reform, its subsequent repeal and the implications for future health policy. We take a political economy perspective, foregrounding health policy instability and its consequences for patients, clinicians and Māori health interests. 

METHODS: We conducted a qualitative documentary policy analysis of 25 key government and stakeholder documents, including legislation, regulations, cabinet papers and select committee reports with their submissions. We employed a framework method for a systematic thematic analysis of the corpus to map and interpret the policy narratives. 

RESULTS: The impetus for the TPA was a consensus that the Medicines Act 1981 and its associated regulations from 1984 and 1985 were "no longer fit for purpose". The repeal was driven by an ideological shift, reframing the TPA as an unacceptable "regulatory burden". This has tangible consequences, including the loss of a pre-market approval framework for medical devices and the erasure of legislative provisions designed to protect and recognise Rongoā Māori (traditional Māori healing). 

CONCLUSION: The TPA policy cycle is a case study in the fragility of evidence-based health reform. It demonstrates that without a durable, cross-party political consensus, long-term policy projects are highly vulnerable to being dismantled by short-term shifts in political ideology, with downstream harms from regulatory instability. It also illustrates how a targeted "micro‑reform" can generate outsized system‑level consequences.