The current pharmaceutical R&D is a broken system with a ‘pay twice’ problem where taxpayers fund research and then face high prices for the resulting medicines. The emergence of the WHO Pandemic Treaty could be a turning point as it introduces provisions on sharing access and equities resulted from pharmaceutical R&D. This article argues that while the Pandemic Treaty represents a landmark in global health governance by addressing R&D equity, it still falls short of fully solving structural R&D problems. The Treaty’s provisions must be complemented by new frameworks that quantify and reward public contributions to pharmaceutical innovation. This article recommends concrete policy tools – from public investment-adjusted royalties to open licensing mandates – that policymakers can implement to ensure equitable access to medicines.