Vaccines across different time periods were developed under distinct innovation organisational systems. These organisational systems are not merely an outcome of scientific and technological efficiency but are significantly shaped by prevailing political-economic conditions. Drawing on the innovation processes underlying three different vaccine candidates, viz. polio, HPV, and COVID vaccines, across three different time periods and their associated innovation-organisation systems, this chapter showcases how the distribution of vaccines is conditioned by their underlying innovation systems, which in turn are co-produced by prevailing political-economic conditions. By highlighting these underlying dynamics, the chapter seeks to demonstrate the limitations of linear understandings of innovation that predominate across innovation and public health policies.