Public concern has been increasing about the high prices of novel medicines, limits on availability and access, and the strain on health-care budgets across all countries. Addressing these challenges requires scrutinizing the underlying system of research and development (R&D) that produces these outcomes. Increasing policy attention has turned towards how to make the outputs of the innovation process accessible to all, and what changes to the current innovation model are needed. This report analyses the implications and challenges of transforming medicines – which have to date largely been treated as national private goods – into "global public goods" (GPGs). It describes the current model for pharmaceutical R&D and assesses how well it performs in producing GPGs along three dimensions: generation of pharmaceutical knowledge, its global availability and its global affordability. It then investigates alternative business models, including those implemented for COVID-19, and analyses how well they may be able to produce GPGs, concluding with proposals for consideration by public and private actors in the WHO European Region that could reorient the R&D system towards delivering GPGs.