The protection of intellectual property (IP) is a question of life and death. COVID-19 vaccines, partially incentivized by IP, are estimated to have saved nearly 20 million lives worldwide during the first year of their availability in 2021. The vast majority of the benefit of this lifesaving technology, however, went to high- and upper-middle-income countries. Despite 10 billion vaccines having been produced by the end of 2021, only 4 percent of people in low-income countries were fully vaccinated. Paradoxically, IP may also be partly responsible for hundreds of thousands of lives lost in 2021, due to insufficient supply of vaccines and inequitable access during the critical first year of vaccine rollout, most notably in low-income countries that lacked the ability to buy or manufacture vaccines to save their populations. The contributors to this book diagnose a number of causes for the inequitable distribution of life-saving COVID-19 vaccines, from misguided reliance on intellectual property rights and voluntary mechanisms to share knowledge and vaccines, to the rise of vaccine nationalism and vaccine diplomacy, to unequal global intellectual property institutions that disenfranchise low-income countries and continue to reproduce colonial era dependency by poor countries on high income nations for life-saving technologies. Global experts herein suggest several reforms to prevent such inequity in the next pandemic, including delinking vaccine development from monopoly rights in technology, enhanced legal requirements to share publicly-funded technologies in pandemic times, and investment in technology transfer hubs and local vaccine manufacturing capacity in low and middle-income countries.