The arguments over access to drugs are simple. The world agreed in November 2001 that health should take priority over patents. But with millions dying, drug companies and Western governments seem to have muddied the waters.
Today 200,000 Ugandans need anti-retroviral drugs to fight the Aids virus. But only 'between 12,000 and 17,000 are getting them', said Stephen Lewis, the United Nations special envoy on Aids, speaking in Uganda last week. 'The intellectual property debate is rendering human rights subsidiary to human greed.'

Rows over access to life-saving medicine were supposed to have been laid to rest in the wake of 11 September, when the US was desperate to build an international coalition against terrorism. It appeared to have one, partly thanks to a short statement by world trade ministers in November 2001 - the Doha declaration - which confirmed that public health superseded intellectual property rights.

What has blocked the deal is the reluctance of drug firms to allow countries unable to manufacture cheap copies of brand name medicines to import them from countries which can make them.

Not a single poverty-stricken country has been able to do this. Agreement between drug firms, Western governments and developing nations on allowing them to do so was scheduled to have been reached last December.

Last week, Robert Mallett, a senior executive with Pfizer, the world's biggest drug firm, told The Observer that Indian generic drug manufacturers were using the row for their own commercial ends.

It also emerged that as a condition of ratifying a new intellectual property treaty, known as Trips - which would allow the issuing of compulsory licences - major drugs firms want to force China, Brazil and India to stop producing cheap copies of brand name drugs.

'This is a nightmare catch-22,' said Mohga Kamal Smith, Oxfam's health policy adviser. 'Without the capacity to manufacture drugs, developing countries won't be able to find a country prepared to export them. There's a scandalous double standard at work here. Poor countries are punished for not having the capacity to produce drugs.'

For decades, 'big pharma' has fought to limit the scope of countries to import cheap copies of its patented drugs. In the post-industrial age, patents are the most valuable commodity a company has and are jealously guarded.

Drug firms argue that generic producers compromise the research and development of drugs, that there is a risk that cheap drugs could leak back into Western healthcare systems and that poor countries' health systems need to be robust, with more money devoted to health provision.

Critics say that huge amounts of public money go into researching cures for diseases, that developing countries account for a minuscule proportion of drug firms' turnover and that drug 'leakage' is easily controllable.

Campaigners point to the influence of leading drug firms - during the last Presidential election, they contributed $14 million to George Bush's campaign and there are 625 lobbyists on Capitol Hill hired by pharmaceutical companies, more than the number of Congressman.

Although the US seems to have been the biggest stumbling block to agreement post-Doha, the UK Government has lobbied for years against legitimising access to cheap generic copies.

Negotiations have recently centred on the offer to allow the provision of generic drugs to treat a limited number of diseases. This was rejected by poor countries since most of the diseases did not have any patented drugs to counter them. Negotiations have subsequently shifted to poverty-stricken countries, citing national emergency as the trigger to win the right to import generics.

'You only have to look at the economic implications of citing national emergency in the wake of the Sars outbreak to know that this could cause even more problems,' said Nathan Ford of Médecins sans Frontières. A declaration of national emergency is assumed to have wider negative economic implications, such as a boycott by tourists and a disappearance of investment.

Negotiations in Canada between the world's trade ministers last week got nowhere. The talks are aimed at finding a solution before the world trade talks in Cancun, Mexico, next month.

Cancun is meant to secure access to restricted Western markets for developing countries' products. It could also see developing countries forced to privatise their utilities. But for the talks to have a chance of success, the drugs issue - as well as some agricultural disputes - has to be resolved.

Developing countries are still under huge pressure to relent on their demand for generic drugs and trade sanctions have been deployed against nations producing cheap copies. But many now point to George Bush's promise of $15bn to fight Aids in Africa as a major breakthrough.

However, the programme still has to be passed by Congress - and the majority of funds will not be forwarded to the UN's global fund on Aids. There are fears that it might be used to secure bilateral trade agreements between the US and poor countries.

The UN's Lewis said: 'There's a desperate need to keep people alive. There's no justification for not doing so. One of the keys is anti-retrovirals. Therefore I understand the need to give people sweeping access to generic drugs for a long period of time. I don't think one can settle on short-term arrangements.'

Short-term arrangements amount to the world's most powerful pharmaceutical firms - whose collective profits run into hundreds of billions of pounds - offering time-sensitive discount schemes or partnering on vital but small-scale charitable projects.

The arguments over access to drugs are simple. The world agreed in November 2001 that health should take priority over patents. But with millions dying, drug companies and Western governments seem to have muddied the waters.