 Public investment has been essential in developing new health technologies such as Rimdesivir, which is being used to treat the coronavirus pandemic. The public has played a key role in risk-taking and reward, but the rewards have largely gone to a small number of actors, leaving the public with limited returns. To ensure equitable access and affordability, the state must take a market shaping approach instead of a market fixing one, and ensure that patent laws don't impede global access or affordability. This article was authored by Sabrina Wimmer and Sarah M. Kiestra.