Law professor Brook Baker at Northeastern University in Boston, an adviser to Health Global Access Project, or Health GAP, notes that Gilead allows generic manufacturers to sell its HIV drugs in over 100 countries.

“So why not a similarly large number of countries for the hepatitis C drug?” Baker tells Shots. “An important question to ask is what are their access intentions for countries that have high hepatitis C burdens?”

For instance, 22 percent of people in Egypt are infected with the virus, the World Health Organization reported, while 3.2 percent of Chinese have hepatitis C.

The Solvadi pricing issue is “very important” in the struggle to ensure access to new medicines for those who need them most and can afford them least, Baker says.

“The system is broken now,” he says. “Why can’t we have a system that ensures that research and development is paid for without needing to recoup those costs through high prices — most of which is not plowed back into R&D?”

Brook favors an idea gaining currency among critics called delinkage, in which governments support pharmaceutical research and development as public good. At the same time, drugmakers largely confine themselves to manufacturing, marketing and distribution.

But such a far-reaching reform is not likely to happen overnight. For the foreseeable future, pricing of new drugs such as Solvadi will be hammered out through a complex process of business decisions, activist pressures, legal claims and the politics of affected countries.