The Trump administration , fresh off its battle against breastfeeding at the United Nations, is once again pressuring countries to revise a U.N. public health resolution, this time focused on tuberculosis.

The U.S. is seeking to remove language asserting the legal right for developing countries to override drug industry patents and license low-cost versions of otherwise expensive TB medicines, arguing over the wording of a draft declaration for a high-level meeting on tuberculosis scheduled to take place in September.

But in this effort, the administration has an unlikely ally: a former Obama administration senior adviser who has criticized Trump.

Josh Black was the White House director for U.N. and Multilateral Affairs under Barack Obama in 2016. A career diplomat and sanctions negotiator, he served in the State Department under three presidents, but quit this January amid “growing disillusionment” with the Trump administration.

Black now works as the point person at the U.N. for the Pharmaceutical Research and Manufacturers of America, or PhRMA, the nation’s main drug industry lobbyist. And the U.S. meddling on the tuberculosis declaration aligns with PhRMA’s stated desire to protect corporate patents.

It’s not exactly surprising to see continuity among Democratic and Republican presidents on drug patents. The Obama administration repeatedly fought nongovernmental organizations over access to affordable drugs in the developing world, advocating for higher prices and pressuring poorer countries to stop creating generics. “This isn’t something unique to the Trump administration,” said Leonardo Palumbo, an advocacy manager with Médecins Sans Frontières, which first raised concerns about the TB resolution.

The famously loyal Trump operating hand in hand with someone who worked for his heated rival Obama and condemned his leadership is an anomaly. In the rarefied world of global pharmaceutical profits, however, it’s just par for the course.

The Trump administration courted controversy last month when the New York Times reported that it opposed a resolution supporting breastfeeding at the World Health Assembly. The U.S. reportedly threatened countries with trade sanctions and withdrawal of military aid if they introduced the resolution, and later sought to soften the resolution’s text. The aggressive action aligned with the interests of the $70 billion infant formula industry, which has thrived on providing misinformation about breastfeeding to the developing world.

At that same World Health Assembly, countries gathered to prepare for the first U.N. General Assembly high-level meeting on tuberculosis, which was announced in December 2016. Tuberculosis is the world’s leading infectious disease killer and the ninth leading cause of death worldwide, killing 1.674 million people in 2016, per the World Health Organization’s most recent report. Over half of the 10.4 million new cases that year came from just five countries: India, Pakistan, Indonesia, China, and the Philippines. And new strains of drug-resistant TB reached 600,000 people last year, suggesting a continuing struggle.

Most TB deaths are preventable with early detection and treatment. But the drugs necessary to treat TB are costly, particularly the multidrug-resistant strain. “The average regimen can cost up to $2,000,” said Palumbo.

In 2013, Johnson & Johnson developed bedaquiline, the first new TB treatment in 40 years, but other than that and Japanese manufacturer Otsuka’s delamanid, breakthroughs have been scarce because it’s hard to get a drugmaker to see the profit in creating medicines to eradicate a disease that primarily affects poor countries. And these drugs have suffered from slow scale-up; MSF estimated in February that less than 5 percent of those afflicted with TB had access to the new medicines.

A donation program runs out next year, which could lead to even higher prices. The high-level meeting is intended to guide the global response to TB, with the goal of wiping it out. And civil society groups had one major priority: reaffirm the right for all countries to legally ensure access to affordable TB treatments.

Under the 2001 Trade-Related Aspects of Intellectual Property Rights, or TRIPS, agreement worked out at a World Trade Organization meeting in Doha, Qatar, all countries can use “compulsory licensing” to rip patents away from drug companies and produce low-cost versions that increase competition. As Palumbo explains, this flexibility was used to reduce the cost of HIV medications by 99 percent over a 20-year period. “Ensuring intellectual property rights should not be a barrier for wider access to medicines,” Palumbo said.

Again, this is allowable under international trade law. Global society has agreed that countries’ lack of wealth shouldn’t force them to suffer with epidemics that kill citizens on a mass scale, for the sake of a profit margin on a drug company spreadsheet.

But when negotiations ramped up in June, the U.S. rejected this reaffirmation. According to an early draft reviewed by The Intercept, the U.S. objected to paragraphs that specifically cited the TRIPS agreement and the rights of countries to put access to medicines for all above intellectual property concerns. Instead, the U.S. wanted to soften the references to TRIPS, and demanded inclusion of this passage: “Intellectual property rights are an important incentive in the development of new health products.”

The World Health Organization’s Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property includes the same line, but adds, “This incentive alone does not meet the need for the development of new products to fight diseases where the potential paying market is small or uncertain.” The U.S. didn’t want that part in.

According to Médecins Sans Frontières, the U.S. refused to sign the draft declaration without its changes. The European Union, Norway, South Africa, Russia, and the Group of 77 coalition of developing nations all supported the original language; only the U.S. lodged an objection on paper. But in the end, the final draft released on July 20 included the U.S. version.

“How is it possible that global leaders will gather for the first time to decide how to tackle the world’s most deadly infectious disease killer, and yet some countries backed by their big pharma lobbies are pushing to remove any mention of the need for vital medicines to be affordable?” asked Sharonann Lynch with MSF’s Access Campaign in a damning statement.

After a four-day “silence procedure,” South Africa formally objected to the document, reopening negotiations. This sets new negotiations and a somewhat unclear way forward leading up to the high-level meeting in September. South Africa’s ambassador to the U.N., Jerry Matjila, did not answer questions from The Intercept.

If the resolution doesn’t reaffirm compulsory licensing, it sends a political message that countries opting for this legal procedure would face blowback from the world’s global superpower. While the TRIPS option would remain, poor countries wouldn’t have the backing of a global declaration to support their actions.

Health and Human Services spokesperson Ryan Murphy told The Intercept that the U.S. has been the global leader in funding the fight against TB, through research and subsidies for treatments to poorer countries. In a statement, Murphy said, “Experts and stakeholders know that what impedes TB patients from receiving treatments and care is not U.S. insistence on basic protections of intellectual property. Rather, it is the fundamental failure of healthcare systems to connect sick people with lifesaving treatments that are readily available and inexpensive.”

Médecins Sans Frontières didn’t think much of this argument. “There’s nothing stopping government from both taking actions to strengthen health systems and implement measures to promote access to medicines,” Palumbo said. “And when countries spend less on medicines, they have more resources for paid staff.”

But the White House’s line matches the pharmaceutical industry’s position on the issue. In a response to The Intercept, PhRMA spokesperson Megan Van Etten said, “The issues involved in the U.N. negotiations on tuberculosis are much more complex than any one press release has portrayed. Instead of tackling the real barriers to improved TB treatment – particularly the urgent need to strengthen and better fund health care systems – the negotiations risk getting stuck in an ideological trap focused on anti-IP arguments that aren’t relevant to the unique challenges of tuberculosis care.”

Not only does this mirror the White House’s position on TB, it’s nearly identical — as in word for word — to a private communication obtained by The Intercept from PhRMA’s lead representative at the U.N., Josh Black.

