Many treatment and vaccine candidates for COVID-19 will receive some form of exclusivity rights that protect against domestic and international competition. The COVID-19 pandemic has magnified the need to expediently develop vaccines and therapeutics, and exclusivities exist to incentivize research and development. However, we have seen in the past that exclusivities have unintended consequences – increased costs to patients and payers, shortages due to limited manufacturing capabilities, and efforts to forestall competition, particularly for lucrative products. Three forms of exclusivities are relevant in the context of COVID-19, which are cumulative but can also exist separately: data, patent, and regulatory exclusivity. This article compares each of these exclusivities in Europe and in the United States, focusing on implications for pricing, production and global access of therapeutics and vaccines for COVID-19. Given the need to develop, rigorously test, mass produce, and widely disseminate treatments and vaccines once available, exclusivity rights may be used as nationalistic shields, favoring provision to certain nations over others and posing an impediment to global treatment for and eradication of COVID-19. We suggest system improvements for COVID-19 and future emerging infectious disease outbreaks that balance the need to incentivize research and development without sacrificing cost, availability, or access. In public health emergencies such as pandemics, policies should be in place to optimize provision of essential products across the globe. We also explore potential reforms of the patent, regulatory, and antitrust systems that will help broaden access to essential treatments and vaccines in response to extraordinary situations such as COVID-19.