The deadly public policy of letting Big Pharma companies like Gilead control access to COVID-19 therapies is clearer now than ever before. While promising “global access” out of one side of its mouth, Gilead has shown its true intentions with new, confidential bilateral licenses negotiated with five generic companies in India and Pakistan. These licenses only cover approximately 52% of the global population leaving the other 48% of the whim of Gilead’s monopoly-based predations. These licenses exclude people living in at least 73 countries and territories, including, outrageously, 30 low- and middle-income countries. Gilead wants to exercise total monopoly control over manufacture and sale in those 73 countries, giving it unfettered freedom to charge prices far in excess of the estimated $5-$10 per treatment that it costs to manufacture remdesivir.