Patents have long been seen as the main source of the problem, blocking the poorest communities from getting the drugs they need. It’s not always so, because there are a lot of good off-patent drugs, but the issue blew up over Aids in the late 1990s because the newly discovered drugs against the virus causing it were patented and hugely expensive, at $10,000 per person per year.
The situation was compounded by the World Trade Organization’s agreement on trade-related intellectual property, known as Trips, which enforced patents around the world. On the back of the Aids drug crisis, campaigners fought for exemptions from Trips for countries that wanted to make or buy cheap copies of patented drugs to fight diseases afflicting their people.
They won, in 2001, the Doha declaration, which said countries could override a patent in the interests of public health. Few have done it and there have been allegations of political pressure from countries where the big companies are based. But sometimes the threat alone has led to big pharma dropping its price.