The Trade-related Aspects of Intellectual Property Rights (TRIPS) Agreement went into effect for World Trade Organization (WTO) members in 1995. The agreement defines minimum standards of patent protection that must eventually be observed by all signatories. TRIPS includes “compulsory licensing”, a policy that allows for states under certain conditions to permit the use of a patented innovation without the consent of the patent holder. This paper considers instances of compulsory licenses (CLs) aimed to increase access to pharmaceuticals during urgent public health scenarios. The WTO maintains no registry of CLs; therefore, this research is an effort to catalog as many CL case studies as possible since the policy’s institution and analyze them as a whole. Findings include 24 case studies involving 43 CLs in 18 nations. Results show that most CLs are issued by middle income nations such as Brazil and Thailand. Possible structural and institutional explanations are explored. The paper concludes that the policy is commonly practiced for purposes beyond its original design and that suboptimal outcomes are likely to result.