It took just two hours yesterday for representatives from 145 countries to abandon their latest attempt to decide how and even whether the poorest people in the world should get access to affordable medicines. (Getty Images)...

The 2002 deadline for the organisation's agreement on trade and related property rights (Trips) is long past and no one would want to take a heavy bet now on a deal before trade ministers meet in Cancun, Mexico, in September. Yet if the issue of medicines for the poor is not settled by then, there is talk that Cancun could be another Seattle, where anger at the rich world's refusal to make concessions to the poor spills out on to the streets.

But at the discussions in Geneva there was stalemate. The US showed no sign of loosening its veto on the lucrative patent rights enjoyed by its powerful pharmaceutical industry. Yesterday, there was evidence of growing anger among other countries over the behaviour of the WTO's most powerful member, whose opposition has deadlocked discussions for more than a year on clarifying the rules that allow poor countries to break patents and import cheap copies of medicines.

But other countries say the drugs industry has a stranglehold over the White House and is dictating the negotiating position of the US.

The pharmaceutical lobby provided nearly $60m (£39m) in funding in the recent mid-term US elections, helping the Republicans win key seats in their successful bid to retake control of the senate. Now, as one official puts it, "it's pay-back time; the industry is calling in its favours".

In Geneva, people believe Karl Rove, George Bush's political adviser, has more influence over the drug talks than Robert Zoellick, the US chief trade representative.

Observers detect a hardening of attitude in the two years since the drug firms were drowning in opprobrium after being forced to drop their court case against the South African government.

About 39 companies had sued to prevent the government importing cheap drugs; but after hugely hostile publicity, the prospect of scrutiny of the real cost of drug manufacture and pricing, and the possibility that Nelson Mandela would take the witness stand, the industry backed off.

By November 2001, when the trade ministers arrived in Doha, Qatar, to kick off a new round of global trade talks, the pharmaceutical giants were still reeling.

The developing countries asked for a declaration confirming their right - which is written into the Trips agreement but not set out as a fundamental principle - to set aside patents in the interests of public health and buy or make cheap generic versions of expensive drugs.

These nations won their demands and Mr Zoellick was instrumental in securing the agreement. The Doha declaration helped to win the developing world's agreement to the start of a new trade round. But as the Doha talks overran the original deadline, ministers left the detail to be decided by negotiators in Geneva.

At issue was how the rules should be interpreted to allow manufacturers to export copycat drugs to countries too poor to make their own, such as most within sub-Saharan Africa, which is in the grip of the Aids pandemic.

It is this point that has bedevilled the WTO for nearly 14 months as the drugs firms have fought tooth and nail for the most narrow interpretation of the Doha agreement. "They feel Doha was paid for at their expense," said one trade official.

As far as the developing world is concerned, the Doha declaration was all-encompassing, enshrining their right to affordable medicines for any condition which undermines public health, from asthma to diabetes, cancer and HIV/Aids.

But the drug companies are appalled at that broad definition and have lobbied the US government hard to get the list of diseases limited to malaria, tuberculosis and HIV/Aids, and the countries entitled to bypass patents limited to the poorest.

One compromise attempted last year was to include tropical diseases for which there are no commercially sensitive drugs - since parasitical diseases, such as leishmaniasis, do not exist in rich countries. That was promptly thrown out. So was the idea that countries would have to declare a national emergency or get the approval of the World Health Organisation before they could buy or import cheap drugs for particular conditions.

The companies say they fear that lax patent rules could allow firms making copycat generics to seize lucrative markets in lifestyle drugs in middle-income developing countries with increasingly affluent populations. They and the US delegates accuse Brazil and India of defending the interests of their own generics companies. "There is no trust around the table and the drugs industry thinks the Brazilians and the Indians pinch patents," said one.

Yesterday, KM Chandrasekhar, the Indian ambassador to the WTO, reiterated his opposition to any attempt to narrow the agreement reached by ministers 14 months ago. "We are not willing to accept a limitation on anything decided in Doha," he said.

The Brazilians, however, appeared in recent days to be backing a new compromise, which has raised hopes that the deadlock can be broken. Under the plan, the WHO would determine whether a country lacked manufacturing capacity and should be allowed to override patents to access cheap medicines.

Paranoia may rule in the boardrooms of the big drug firms, but most trade officials think that the new rules would be only invoked to allow poor countries to import the drugs their populations so desperately need.

In the meantime, the deadlock continues in Geneva and is threatening to poison negotiations in other areas. Impatience is growing over the Bush administration's position, while business leaders in other industries are warning that the drug companies' obstinacy could cause a repeat of the WTO's disastrous Seattle meeting.

And Africa's needs appear in danger of being overlooked. As Kenya's trade minister, Mukhisa Kituyi, said last weekend: "While you people are having this complicated debate, my people are dying."

Unholy alliance Bush's men and the drug lobby

Observers believe three top Bush aides are determining the US line at the talks:

Karl Rove (below) is President Bush's chief political strategist and a trusted lieutenant. He joined the Bush campaign in 2000 but has had a long career in Republican politics

Josh Bolten is chief of staff for policy and worked for the office of the US trade representative during George Bush Senior's administration. The Washington Post says he "has a quiet hand in all domestic policy and international policy"

Gary Edson is a senior aide to the president on international economic issues. He has also worked in the office of the US trade representative

· The pharmaceutical industry raised $60m for the Republican war chest for last year's mid-term elections. Its lobbying group, PhRMA (Pharmaceutical Research and Manufacturers of America) is pressing for a tough line on the Doha talks. Individually, Pfizer, Merck, Roche and Bristol Myers Squibb are also thought to be demanding that the government defends their interests

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