They will be marching on the streets of Delhi today. Nearly 2,000 people are expected in a protest in which the European Union is cast as the villain, accused of endangering the lives of the poor. It's an unusual scenario and a complex issue, but in a nutshell, the concern is that India's generic drug companies are going to be prevented by a new trade treaty from making medicines at rock-bottom prices for poor countries.

The trade negotiations between the EU and the Indian government have been going on for four long years, but finally a deal seems about to be done. And campaigners, who include Oxfam and Médecins Sans Frontières as well as Unitaid, are deeply unhappy about it.

The hand of Big Pharma is detected behind this treaty. Indian generic companies have been able to undercut them massively, because India does not always recognise their patents. They have lobbied the EU to push for tighter rules in India on intellectual property. The result, say the campaigners, could be the end of some life-saving drugs at prices the developing world can afford. They reject EU assurances that drugs for the poorest will be safeguarded.

If they are right, it matters enormously. Millions of people in sub-Saharan Africa would likely now be dead or dying if it had not been for the cut-price Aids drugs manufactured in India. Competition from Cipla and other generic companies drove the prices down from $10,000 per person per year to around $100 today.

Dr Unni Karunakara, International President of MSF (this is a link to MSF's campaign) said:

We have watched too many people die in places where we work because the medicines they need are too expensive. We cannot allow this trade deal to shut down the pharmacy of the developing world.

And this is from the open letter MSF has sent to India's prime minister, Mr Manmohan Singh:

MSF today relies overwhelmingly on affordable generic HIV/AIDS medicines produced in India to treat nearly 180,000 people in 20 countries, as well as using medicines from India to treat other diseases such as tuberculosis and malaria. India has played a pivotal role in supplying affordable generic versions of drugs used throughout the developing world. It is vital therefore that further barriers are not created that threaten the supply of affordable generic medicines from India.

This is Oxfam policy advisor, Rohit Malpani (their statement here):

At a time of austerity and declining aid budgets, especially for health, efforts to increase medicine prices for the world's poor would be a double blow and have a devastating impact on the achievement of health related Millennium Development Goals.... If the EU succeeds in imposing strict IP rules upon the Indian Government, the massive hike in medicine prices could undermine European leadership to provide international aid for global health. Worryingly it could also debilitate donor programmes that provide access to treatment around the world.

This is Philippe Douste-Blazy, Chair of UNITAID's Board (and here is a link to their document on the issue):

This agreement coincides with a delicate time for access to treatment efforts - the suspension of grants by the Global Fund and diminishing resources for health and development. I call on the European Union - with its long human rights tradition - to safeguard the right of millions of people in developing countries to continue accessing affordable life-saving medicines produced by the Indian generic industry.

And finally, in an open letter to the citizens of Europe, the South African Treatment Action Campaign, which successfully won Aids drugs for Africa at affordable prices, makes this appeal:

We implore you, as citizens of the European Union, to stand with us against policies that are being pursued by your governments through the EU-India Free Trade Agreement (FTA) that will block our access to affordable medicines – putting our health and lives at risk....Ensuring that access to HIV medicines is protected is crucial to save lives and also reduce transmission of the virus. Last year, a landmark clinical trial showed that HIV treatment reduces by 96% the risk that the virus will be passed on. It is imperative that medicines remain available and affordable so that we can begin to turn the epidemic around.

The negotiations have been in secret, so we can't know the exact shape of the deal until it is done. But if the campaigners' fears are justified, the timing is terrible, when the effort to get more and better Aids drugs to people in epidemic countries is under strain because of disappearing funding. And, whether we are talking about drugs for HIV or other diseases, it is hard to believe that the health of the poorest people in the world will not suffer.