Andrew, you have focussed attention on a policy area where Australian government activism is urgently needed.

Big pharma ought to be more innovative in developing win-win strategies in poor countries. Why not compete in poor countries with cheap generic manufacturers who have copied the big pharma patents? Better still, why not pre-empt the copy-cats.

For example, India has a bad reputation for quality assurance and regulatory efforts against fake medicines, so there is an opportunity for Big Pharma to challenge competitors on quality assurance, and if production is established in poor countries, then price can match or beat competitors as well.

Re-branding big pharma anti-virals for poor countries can generate good sales revenue based on a low-profit margin if high sales volume is guarranteed under contracts with aid donors from rich countries like Australia.

Big Pharma could also establish well organised, international standard, clinical anti-viral trials first in poor countries for promising new drugs that could lower the huge costs of approval in rich countries. Above all Big Pharma needs to win hearts and minds to build shareholder profits - ugly bully tactics have a bad habit of undoing company reputations for social responsibility and their excellent work in bringing new life saving medications to world markets.