The UN is preparing to challenge the multinational drug companies' control over HIV and Aids treatments in developing countries by encouraging a far wider use of cheaper, generic alternatives.
The organisation, frustrated by slow progress in brokering discounts between pharma ceutical giants and countries threatened by social and economic chaos because of Aids, is ready to back states such as Brazil, Thailand and India where national laws allow them to override drug patents in cases of dire emergency.
The new gloves-off approach, outlined by the UN's secretary general, Kofi Annan, is likely to be widely welcomed by aid agencies. It comes as 42 drug companies begin a court case to stop South Africa importing generic versions of the life-enhancing drugs it so desperately needs. The United States is meanwhile preparing to challenge Brazil's attitude towards drug patents in the World Trade Organisation.
Mr Annan, in his report to the general assembly's special session on HIV and Aids in New York in June, says that the "equitable and affordable" provision of life saving treatments is a cornerstone of the worldwide battle against Aids.
Although some progress has been made in price reductions by big companies, the UN chief says more needs to be done through other measures such as "tiered" pricing between rich and poor countries, subsidies by the public and private sector, and "the effec tive use of health safeguards in trade agreements".
Governments must bring their "power and authority" to bear in fighting the "most formidable development challenge of our time", he says.
Mr Annan praises Brazil, where reported Aids deaths have been reduced by a quarter. "With a rights-based approach to care, together with local production of generic anti-retrovirals in some countries, coverage of patients is increasing in Brazil, Argentina, Chile and Uruguay, where HIV-positive people are living longer, positive lives."
His report makes a stark case for affordable treatment and care. In many African states, more than half today's 15-year-olds will die from HIV/Aids if present rates of infection continue. Only adults who escape HIV infection can expect to survive to middle and old age.
UNAids, the agency set up to combat the disease, says it supports Oxfam and Médecins sans Frontières, which have been highly critical of drug companies' pricing policies.
A UNAids initiative to improve access to drugs and care attracted 29 applications involving generic products but the emphasis until recently appeared to concentrate on brokering discounts with five major pharmaceutical companies. The discounts have only been taken up in Rwanda, Senegal and Uganda.
UNAids insists it is sticking by a multiple approach to tackling epidemics, but its call for the "reinforcement and use" of health safeguards indicates a big change of gear.