"The patent system is such that it gives pharmaceutical companies a monopoly," said Sultan Ahmed Sheikh, a TRIPS lawyer on the Pakistani delegation. "The patent is valid throughout the world, which creates a monopolistic system, hurting the economy of developing countries."

The TRIPS agreement sets minimum standards of patent laws for WTO member states. In the area of pharmaceuticals, new drug patents are protected for 20 years restricting cheap access to drugs. In the last 25 years only 11 drugs have been developed for tropical, or non-Western diseases, according to the organization Medecins Sans Frontiers. Simultaneously developing countries do not have the resources or the expertise necessary to undertake research and development to produce drugs themselves, and rely on drugs developed in the West to combat major diseases such as tuberculosis and HIV/AIDS. The new draft TRIPS text introduces some changes in relations to patents and health, but the negotiations between developed and developing countries will be an uphill struggle.

In September of this year 47 developing countries put forth a proposal on TRIPS, patents and access to medicines at a meeting of the TRIPS council. The text, a draft Ministerial Declaration on TRIPS and Public Health, sought to clarify some points of the agreement, especially relating to compulsory licenses. This is one of the safeguards in the TRIPS agreement, which allows countries to produce generic versions of drugs by paying royalties to the patent holder. Pharmaceutical companies are required to issue licenses in cases of "national emergency," which is not clearly defined in the current agreement.

The developing countries' proposal also called on WTO members to "refrain from imposing or threatening to impose sanctions or granting incentives or other benefits, which could curtail the ability of developing and least-developed countries Members to avail themselves of every possible policy option to protect and promote public health." Thus if countries invoke the "national emergency" clause to take a compulsory license they should not be penalized.

In response to this draft the United States, Switzerland, Canada, Japan and Australia backed a counter-proposal, which, according to Mary Moran of Medecins Sans Frontiers, is just as unclear as the original agreement.

The current draft Ministerial Declaration on intellectual property and access to medicines and public health has a provision for a separate declaration on TRIPS and health. Developing countries will no doubt lobby very hard in the next few days to health and medicines on the high agenda.