The COVID-19 pandemic exposed deep vulnerabilities in Nigeria’s access to essential medicines, laying bare the country’s heavy reliance on pharmaceutical imports and the rigidity of its patent system. Adopting a doctrinal, analytical and comparative legal research design, this study critically examines how Nigeria’s patent regime (rooted in the Patents and Designs Act and shaped by the Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement)), affects the availability and affordability of life-saving drugs. Situated within the field of intellectual property and public health law, the study interrogates the chronic underuse of compulsory licensing, the structural barriers confronting local pharmaceutical production, and the persistent disconnect between intellectual property protection and public health policy. Drawing on statutes, policy documents, secondary literature, comparative reference to India, Brazil, Thailand and South Africa and the empirical record of Nigeria’s COVID-19 Vaccines roll-out, the study finds that Nigeria’s formally TRIPS-compliant patent framework, including its compulsory licensing and government-use provisions, remains chronically underused because of an outdated statute, weak coordination between health, trade and intellectual property institutions, and a limited political will — a gap illustrated by the destruction of over one million expired COVID-19 vaccine doses in 2021 and the stalled Biovaccines Nigeria Limited manufacturing venture. It concludes that Nigerian patent law currently functions more as a barrier than a bridge to public health equity, not for want of legal tools, but of institutional will to deploy them. The study offers targeted recommendations such as: legislative reform of the Patents and Designs Act, systematic use of TRIPS flexibilities, systematic investment in local manufacturing capacity, and closer alignment between patent policy and the right to health in order to reposition Nigeria’s intellectual property framework as an instrument of health equity rather than an obstacle to it.