Should we waive intellectual property rights to fight COVID-19? And what might be the consequences for medical innovation if we do so? In my recently published Feature in Drug Discovery Today, I reflect on the consequences for innovative entrepreneurial companies, the incentives to innovate, and the consequences for international knowledge flows to low- and middle-income countries. I conclude that waiving intellectual property rights – such as patents – reduces opportunities for young, entrepreneurial companies to attract sufficient funding for developing medical innovations. Moreover, low- and middle-income countries might suffer reduced knowledge inflows in the absence of intellectual property rights which undermines ability the of these countries to develop medical innovations.