Some 18 million people die annually from poverty-related causes. Insofar as present global institutional arrangements foreseeably and avoidably perpetuate this death toll, affluent countries contribute to the great deprivations suffered by the poor. The Obama administration could substantially reduce this burden by supplementing the rules that govern pharmaceutical innovation. These rules, established by the World Trade Organization’s TRIPS Agreement, cause advanced medicines to be priced beyond the reach of the poor and steer medical research away from diseases concentrated among them. We should complement these rules with the Health Impact Fund. Financed by many governments, the HIF would offer any new pharmaceutical product the opportunity to participate, during its first ten years, in the HIF’s annual reward pools, receiving a share equal to its share of the assessed global health impact of all HIF-registered products. Choosing this option, the innovator would have to guarantee to make this product available, wherever it is needed, at the lowest feasible cost of production and distribution. Fully consistent with TRIPS, the HIF achieves three key advances. It directs some pharmaceutical innovation toward the most serious diseases, including those concentrated among the poor. It makes all HIF-registered medicines cheaply available to all. And it incentivizes innovators to promote the optimal use of their HIF-registered medicines. Magnifying one another’s effects, these advances would engender large health gains.