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The New York Times. "Zero deaths in some ity as "a moral outrage."6 As is so often the case, the people around the world who suffered the most got the least help. Those in poor countries were far less likely to get tested or treated for COVID than those in rich countries. The difference was most dramatic, though, with vaccines. In January 2021, as COVID vaccines were rolling out, the director of the WHO opened a board meeting with a grim assessment. "More than thirty-nine million doses of vaccine have now been administered in at least forty-nine higher-income countries," said Dr. Tedros Adhanom Ghebreyesus. "Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25."4 By May of that year, the gap that Tedros had warned of had become front-page news. "The Pandemic Has Split in Two," ran a headline in The New York Times. "Zero deaths in some cities. Thousands in others. The pandemic's fault lines continue to widen as vaccines flow toward rich countries."5 One WHO official denounced the inequity as "a moral outrage."6 There were countless examples. In March, 7.6 percent of Americans had been fully vaccinated, while 0.2 percent of Indians and 0.1 percent of South Africans had been. By July, the numbers had shot up to 49 percent in the U.S., but to just 5.8 in India and 2.8 in South Africa. Worst of all, people in wealthy countries who were at low risk of becoming severely sick were being vaccinated before people in poorer countries who were at a much higher risk. To many observers, these facts were both infuriating and shocking. How could the world have billions of doses of a lifesaving vaccine and yet distribute them so unequally? Protesters marched, and politicians gave heartfelt speeches and pledged to donate doses. Inside the world of global health, though, among people who work in the field, the reaction was different. Of course they were angry about the injustices of COVID. But they knew