The COVID-19 pandemic has illuminated the stark inequities between the Global North and Global South in vaccine production and access. Such inequities are a continuation of asymmetrical power relations rooted in historical racialized processes such as slavery and colonialism and its post-colonial legacies, which led to the subordination of many countries in the Global South. This paper builds on racial capitalism scholarship within studies of the COVID-19 crisis, which critiqued the disproportionate mortality within populations and unequal labor relationships, presenting a novel contribution by thinking through the systemic impacts of racial capitalism on the production of essential medicines, and particularly COVID-19 vaccines, in global health. A deeper understanding of the systemic injustice in the international patent system enables us to center the experiences of the Global South through a re-examination of how international law sustains and encourages the geographic and racial stratification of vaccine manufacturing, which is now largely centralized in the Global North. The paper also calls for changing law and funding structures as mechanisms of reparative justice. While, on the one hand, law plays a role in sustaining racial-capitalist harms, it can also be used as a tool for facilitating reparative justice.