Reading the American and foreign press, you'd think two separate agreements were being reached this month to allow poor countries to buy generic versions of life-saving pharmaceutical drugs.

In the first agreement, as reported by the New York Times, the pact, intended to "improve the access of millions of people in [poor] countries to expensive patented medicines for AIDS and other diseases," stood to "enhance the Bush administration's international standing." The Bush Administration, which had blocked a similar agreement last December, had reversed itself, we learn; this represented a tremendous victory for the world's poor, a victory won over the outraged protests of Big Pharma and in stark contrast to the White House's previous intransigence.

Well, set aside for a moment how much money has been made in the last nine months by US pharmaceutical companies like Pfizer--which led the global lobbying against the use of generics--or how many people who might otherwise have survived died because of the delay in the agreement. No, let's turn instead to that other agreement--the one which Ellen t'Hoen of the volunteer doctors' organization Medecins sans Frontires called "disastrous." The one that Oxfam's Michael Bailey says "isn't really anything to cheer about."

Both quotes appeared in the British press, which is considerably more skeptical about the Bush Administration's "concession." So which is it?

To be sure, the Bushies needed an agreement. The rift between Washington and poor countries over this issue was threatening to derail next month's meeting of the World Trade Organization in Cancun, Mexico. In the preliminary negotiations for that meeting, Washington has been pushing hard to lock in trade advantages for itself on a host of issues, from intellectual property to privatization of public services to the dumping of agricultural goods. But especially in the wake of the AIDS pandemic, no issue is more contentious, or more a matter of life and death, than poor countries' access to cheap generics. Washington's stubbornness on the issue threatened to provoke a repeat of the revolt by poor and especially African nations at the 1999 Seattle WTO ministerial, a trauma which nearly killed the organization.

That was the rock on one side of the White House. The hard place opposite it was the pharmaceutical industry, among the Bush Administration's biggest campaign donors heading into an election for which the White House has begun to raise $200 million.

Big Pharma won. The world's poor lost.

Under the Geneva deal, manufacturers of generics would be allowed for the first time to export their products to countries which don't have an internal drug industry. This has been at the heart of the matter, particularly since countries like India and Brazil have begun manufacturing generic equivalents of US-patented anti-AIDS drugs.

But the agreement's fatal flaw, according to the NGOs on the front lines of health care in the South, is the export process itself. It involves having the manufacturing country issue a license overriding foreign patents--a process that might be too cumbersome for the manufacturers, and that leaves exporting countries susceptible to pressure to not grant the licenses.

Countries wealthy enough to make their own generic drugs are currently allowed, under WTO rules, to override foreign patents within their own borders during a health emergency. The US itself came close to taking this step during the 2001 anthrax murders. It's only the poorest countries, the ones without the capacity to make such drugs, that are left helpless by the exorbitant prices of patented drugs. The same countries are the ones with the worst public health infrastructure for dealing with nightmare scenarios like AIDS--and the least political or economic leverage for being able to expedite a licensing process that is under the control of the exporting government.

"It poses so many hurdles and hoops to jump through that we are really worried it may not work at all," t'Hoen was quoted as saying in the Guardian. "We need more industrial activity and greater competition in the market. That is the mechanism which is being killed."

But here in America--one of the countries whose export licensing process might just conceivably be influenced by lobbying from the likes of Pfizer--everything's pretty much rosy, and the world appreciates Bush anew. Here's the New York Times again: "After weeks of intensive negotiations, the United States won assurances that countries would not take advantage of the arrangement to increase exports of generic drugs to nations that are not poor and do not have a medical emergency."

Heaven forbid cheap drugs be made available more widely. But we did learn, from the Times, that US pharmaceutical companies are satisfied with the agreement--which in itself suggests that there's a catch, since such companies have a long history of basing their pricing on what the market will bear. Thus, economies of scale notwithstanding, their prices tend to go up, not down, in a medical emergency. If they're happy, something's wrong.

The catch, of course, is in the very process of trade negotiation--a point which was made emphatically both inside and outside those now-notorious meetings in Seattle. Here we have an issue upon which the global public health of hundreds of millions, even billions of people may rest--and it is being decided not by the World Health Organization or some similar international public health agency, but by an institution, the WTO, devoted to protecting commercial interests, in this case the sanctity of intellectual property.

It's like having the IRS decide tax law. Commercial interests will win, because by definition they have greater priority to the WTO. Peoples' health and survival don't.

The very process itself is designed, in the case of generic drugs, to consign millions of poor people to unnecessary death. There isn't a lucrative enough market for keeping them alive. That's the principle that for the last nine months, the Bush Administration has gone to the mat to fight for.

Chances are pretty good they've won. This month's agreement will surely help in some instances, but it's far too little and quite a bit too late. Until global health decisions are made on the basis of keeping the afflicted alive, not on the basis of keeping Pfizer's stockholders happy, people will keep right on dying needlessly.