Fourteen million men, women and children die each year of treatable infectious diseases. The drugs that can save these lives exist, yet the world’s poor can’t afford the medicine.

But two-and-a-half years ago, public health appeared to trump the intellectual property rights of the companies behind those treatments. At World Trade Organization (WTO) meetings in Doha, Qatar, trade ministers agreed that countries could issue compulsory licenses to generic drug manufacturers to produce low-cost drugs for fighting diseases like AIDS, malaria and tuberculosis.

While the Doha declaration was seen as a milestone, it was little help to the poorest countries, which do not have generic drug industries. It took until August 2003 — about 25 million lives later — for the WTO to reach a second agreement that allowed countries without manufacturing capacity to import generic versions of patented medicines.

Now, eight months and another nine million lives later, Canada is the first country to enact legislation allowing its generic manufacturers to produced patented drugs for export. Time will tell if Bill C-9 will help slow the counter of lives lost in the developing world.

“This bill has the potential to be a profoundly important humanitarian gesture, one that rises above partisan politics or commercial interests,” Kevin Perkins of the Canada-Africa Partnership on AIDS told the Standing Committee on Industry, Science and Technology in March.

The bill was passed on May 4 — with rare unanimous support in the House of Commons. In a conciliatory gesture to his predecessor, Prime Minister Paul Martin renamed the bill the “Jean Chrétien Pledge to Africa Act.”

Richard Elliott of the HIV/AIDS Legal Network, along with colleagues at Médecins Sans Frontières (also known as Doctors Without Borders), spent years guiding the effort to make Canadian generic drugs available to less developed countries. His work has been as tireless as the big pharmaceutical lobby — one factor he credits for the long delay in acting on the Doha Declaration of 2001.

“Big Pharma” fought “tooth and nail,” Elliott says, along with its ally the United States, against any loosening of patent rights. “The U.S. was the lead bully fighting developing countries and proposals from civil society.” Elliot credits a “perfect storm” of forces that came together to spur the Canadian government to implement the August 2003 WTO decision.

The tireless UN special envoy for HIV/AIDS in Africa, Stephen Lewis, was a gale force wind in that storm. Lewis has reached millions through the media, telling anyone who will listen of the tragedy of AIDS in Africa. He has spoken many times about intellectual property rights and how they have hampered the global fight against AIDS.

“The fact that the UN Special Envoy on AIDS in Africa is a very well-known, articulate, respected Canadian figure, combined with a coalition of Canadian civil society groups that had been working on this issue for some time, combined with the fact that this decision had been made at the WTOâe¦ all of those things made the iron hot,” says Elliott.

And as the first country to implement the WTO decision, there was enormous pressure on Canada to get it right. Bill C-9 will serve as a precedent, as other countries look at amending their patent acts. Canada’s proposed legislation attracted interest from UNICEF, UN Secretary-General Kofi Annan and Irish rock star and activist Bono.

But Canada is not immune to pressure from the pharmaceutical lobby. Bill C-9 originally nodded to that pressure by giving the patent-holders the right of first refusal on contracts between developing countries and Canadian generic manufacturers.

Doctors, community workers and representatives of the generic drug industry convinced the Industry committee studying the proposed legislation that this wouldn’t work. Official testimony was backed up by direct lobbying of MPs, and a flood of letters from concerned citizens.

Brian Masse heard that message as the NDP committee member. “Their message consistently gave us the courage to press for the changes that were so desperately needed,” he says. “It made the government realize that they had to amend their own legislation.” Bill C-9, as passed by the House of Commons on May 4, does not include that right of first refusal, and nor does it include a restrictive list of countries eligible to import generic drugs from Canada.

There is still a major flaw in Canadaâe(TM)s response to the WTO decision, according to Rachel Kiddell-Monroe of Médecins Sans Frontières: a list of medicines exempt from the bill. “Already, most of the front-line drugs that we use in treating malaria, tuberculosis and AIDS, and other more neglected diseasesâe¦ they’re simply not there,” she says.

The Canadian government knows the bill is not perfect, and counters that governing is about compromise. Masse likens Bill C-9 itself to a bitter pill that he had to swallow. He’s waiting to see the effect it will have. “It’s only a victory if people who are suffering from malaria, HIV/AIDS and tuberculosis . . . receive affordable drugs through generic production,” says Masse.

Others liken the bill to a glass of water — half-full or half-empty, but better than nothing. And Canada has been praised as a pioneer. The next three years, before the legislation comes up for review, will show if Canada has helped to slow that global tally of deaths from treatable disease. If not, Canadian civil society will respond again, and do its best to top up the glass.