The debate over lack of access to COVID-19 vaccines for countries in the Global South joins a long history of struggle for effective and affordable treatments for those diseases for which the World Health Organization uses the telling adjective "neglected." Empirical evidence shows that the pharmaceutical innovation system has failed broadly in this area. The same applies to the category of new infectious diseases, which also includes coronaviruses. The COVID-19 pandemic should therefore be used for fundamental reform with the aim of aligning pharmaceutical innovation more closely with public health goals. The BP provides some specific suggestions to these topics.