While new COVID-19 lockdown measures swept the world late last year, 2021 has begun with announcements of new contracts to pave a rocky road to vaccine access. This access will neither be the sole responsibility, nor within the exclusive control of individual governments. Who sets the terms for vaccine access is a complex picture of pharmaceutical companies, national governments, multilateral agencies, development banks and philanthropic foundations. Philanthropy – drawing on its core tenet to promote the welfare of others – must be a voice for dismantling the barriers to accessing the vaccine.