In a policy reversal, the US has announced its support for a proposed temporary waiver of intellectual property rights on COVID-19-related pharmaceuticals, although it is unclear how much of the undisclosed information regarding unpatented elements would be disclosed in order to facilitate technology transfer to developing countries. This column argues that most efficient way to achieve equitable vaccine access would be to concentrate production in a smaller number of countries with sufficient production capacity. It also looks at the implications for Japan, which is caught in a dilemma between the need to vaccinate the population quickly and the need to secure incentives for developing domestic vaccine capacity for future pandemics.