The moral calculus here is so obvious you have to have your head screwed-on sideways not to see it.

Let's reduce it to the level of individual decisions.

I have a terminal disease.

"Pharma Joe" invented a recipe for substance S that will cure my disease; there's no known cure for my disease at this time other than substance S.

My options are:

(i) try to negotiate with Joe to get his permission to make a batch of substance S, thereby continuing to live

(ii) use publicly-available information to make a batch of substance S, thereby continuing to live

(iii) not acquiring substance S, thereby resigning myself to die soon

Joe would prefer that I choose (i) or (iii); I prefer options (i) or (ii).

When we can arrive at an agreeable (i) there's not much to talk about; things are only interesting when Joe wants me to pick option (iii) and I want option (ii).

What is Joe's argument for why I ought to pick (iii) instead of (i)? It amounts to:

- sure, you could save your own life by making a batch of S

- but if you do that then I won't keep inventing substances like S, and thus in the future some other person will have a disease for which there is no cure, b/c Joe's retargeted his research to penis pills

- so the right thing to do is to go off in a corner and die (and quietly, please), so that someone else in the future might live

It's not surprising that this is spectacularly unconvincing on two levels:

- Joe's asking someone to choose to die so someone else might benefit at some point in the future; aside the usual aversion to Christ-like self-sacrifice on the part of individuals, it's more than a little cheeky of Joe to insist on my making such an extreme sacrifice for the greater good when Joe himself is unwilling to make a lesser sacrifice (reduced profits) for the greater good (we know he's unwilling to do this b/c we were unable to arrive at a mutually-satisfactory arrangement in (i), like selling at prices the about-to-be deceased can afford)

- it's also unconvincing because the real "future proposition" isn't "I die but Joe invents substance T that cures some other disease saving other people's lives"; it's "Joe invents substance T that could cure some other disease but then some other schmuck is going to be in the same position of being unable to afford it and having this same conversation; my death just kicks the can down the road"

...and thus most international agreements that allow Joe color of law to enforce (iii) for "the greater good (of Joe)" have been agreed to as riders on larger treaties and whatnot, making it unsurprising that impoverished countries with disease epidemics try to wiggle around such terms as much as possible.

It's of course absolutely the case that widespread choice of (ii) does disincentivize further research on drugs targeting problems (ii)-choosing populations opt for; it's not like the people making these decisions don't understand the consequences...they've weighed the pros and cons and decided that the best option (unsurprisingly) is to put their lives ahead of someone else's intellectual property and deal with the fallout as it comes.

Even if you really think you'd put someone else's IP ahead of your life -- which I doubt you would, if it ever came to that -- it's not Joe's place to decide that I ought to die for the greater good.