Healthcare providers in America are reportedly facing “a barrage of requests from the rich and powerful, desperate for access to the first round of vaccines”, says Gillian Tett. The issue is not unique to the US, but the ethics are “particularly tortured and emotive” in a country without a single-payer healthcare system like the NHS: 29 million Americans under 65 lack health insurance. Moreover, the fragmented roll-out by individual states has created “numerous loopholes” which, in the language of Wall Street, are “prone to arbitrage”: in New York and Illinois, for example, financiers, bankers and journalists were defined as “essential workers” during the pandemic. “The most ethical medical groups are trying to hold the line”, but the feeling is that “lots of people will try to get it early”. Could the incoming Biden team fix the issue? Don’t hold your breath. They’re inheriting a system whose “profound health inequalities have become not only entrenched but culturally normalised”. Even so, the looming vaccine row “could reveal these iniquities with surprising clarity”.