This purchase is out of reach for poorer hospitals, especially those in rural areas that can barely manage daily expenses. Nearly half of U.S. rural hospitals were operating at a loss in April of this year, said Alan Morgan, chief executive of the National Rural Health Association. And the pandemic has further weakened hospitals’ finances.

Rural populations are precisely those that are vulnerable to Covid-19 and most in need of a vaccine, noted Morgan: “Hundreds of rural, small towns all across the U.S. have a higher percentage of elderly, low-income [residents], a higher percentage of the community with multiple chronic health issues.” Yet, he added, “in this financial environment, you can imagine that there is simply no consideration of rural hospitals purchasing storage equipment for this ultra-cold distribution.”

And so, wealthier, urban hospitals have a huge advantage in gaining access to the vaccine that is expected to be one of the first authorized for widespread distribution.