The COVID-19 pandemic has exposed the fragility of local, regional and global health systems and their inability to meet their populations’ health needs. South Africa also experienced severe shortages of health technologies, attributable to a lack of institutional capacity, corruption in supply chain management and procurement, inadequacy of local manufacturing capacity, and intellectual property barriers. This chapter analyses the extent to which intellectual property barriers have impeded the availability, affordability and accessibility of health products, especially vaccines, needed to avert COVID-19 infection. Global initiatives to improve access, such as the COVID-19 Vaccines Global Access facility, the COVID-19 Technology Access Pool, and the waiver of intellectual property rights proposed at the World Trade Organization by South Africa and India, are appraised. A situational analysis of the relevant health product landscape, is also provided. The two-year delay in tabling a Bill to amend the Patents Act, and the limited use of legal flexibilities to circumvent patent and other barriers, are examined. South Africa experienced significant shortages of diagnostics, personal protective equipment and other products; the country’s vaccine acquisition programme lacked urgency; intellectual property rights holders were unable to meet demand for vaccines and their failure to implement technology transfer prevented any prospect of scale-up or local production; and government has stalled on its commitment to patent law reform. It is recommended that the government urgently give attention to, among others: accelerating its vaccine acquisition and administration; addressing the severely strained health infrastructure; eliminating corruption in procurement contracts and the distribution of supplies; and tabling of a Bill to reform patent legislation.