For example, despite the pandemic the wealthy countries have voted overwhelmingly against waiving patents on the long-needed vaccine

Correct. In modern times, the countries that developed the vaccine are insisting on getting paid for it. In historical times, vaccines didn't exist and everyone died when a pandemic struck.

The reason the countries that developed the vaccines voted against waiving patents is precisely because they believe that IP is required for the modern medical industry to function. The historical alternative to IP law is trade secrets, which is much worse for medicine, which has made its advancements on the back of researchers publishing and sharing their work. And with trade secrets, even assuming that the mRNA research and development necessary had somehow been funded and done entirely in-house since no one would be publishing it, still Pfizer would demand to be paid for its vaccines, and no one could copy them because they wouldn't have told anyone how to make them.

If you don't see an issue with that, then you need to amend the following:

> In historical times, vaccines didn't exist and everyone died when a pandemic struck.

Amendment: now it's the poor countries who die.

> The historical alternative to IP law is trade secrets

Yes, historically it is. But it's shades and shades of possibilities between "you pay, or you die" and "you pay, or you die, but for different reasons"