The patent system embodies a general principle of decentralization: by offering a multi-year exclusionary monopoly to inventors and their assignees, the government incentivizes firms to invent and develop new products. Firms consequently choose to innovate in areas in which the expected return outweighs the initial investment. Decentralization has led to major pharmaceutical breakthroughs and has created the widely-held belief that drugs are the success story for the patent system. However, the resultant drugs have not necessarily been what society needs most, such as new antibiotics and vaccines for preventing infectious diseases that pose a threat of a future public health emergency. During the COVID-19 pandemic, governments explored quasi-centralized approaches to drug development, such as funding companies through a mix of incentives. But this level of centralization is still dependent on patent rights and various exclusivities to incentivize drug development. Consequently, governments should consider managing the production of “infrastructure-adjacent drugs”—drugs that are needed to prevent future collapse of the healthcare system and economy, but whose development are not incentivized through traditional means. By licensing promising drug targets from small- to medium-sized pharmaceutical companies, governments could leverage private-sector innovation and foster future private drug development in critical areas, while controlling the intellectual property rights to the final drugs.