The development and early distribution of the COVID-19 vaccine was both a singular achievement and missed opportunity. In this paper, I argue that the consensus regarding the goals of an effective and morally responsible vaccine distribution program were often eschewed in favor of a reversion to the problematic pre-pandemic healthcare distribution practices. I examine the goals of vaccine planning in terms of the public health, economic and social impacts of a distribution plan against the “first come, first served” strategies that (...) were ultimately employed. I maintain that the failure to implement a coherent top- -down vaccine policy resulted in a proliferation of vaccine distribution programs that undermined efforts to combat the virus while also increasing pre-existing inequities in the healthcare system. The distribution of the vaccine according to a phased rollout strategy for individual groups often limited access to the vaccine for those most likely to suffer the worst outcomes of the disease. Future pandemic planning must learn from these outcomes and employ new technologies to limit the contagion and target at-risk groups most effectively. (shrink)