On the eve of the coronavirus-vaccine rollout, an ethically compromised subset of 1-percenters are already scheming about ways to cut the line.

If you are a certain type of person, there are ways to justify almost anything, including stepping ahead of the heroic health-care workers, to get the vaccine. As one well-connected woman put it, “It’s hardly like a middle-aged man jumping on a Titanic raft before a woman and her children. This isn’t life or death.” Well, maybe not for everybody.

“The Entitled Are More Entitled”

Donald Trump set the tone by giving his coronavirus-infected allies—most recently, Rudy Giuliani—first crack at the same rare experimental treatments that expedited his recovery at the Walter Reed medical center.

To give the vaccine rollout an extra, unwelcome layer of complexity and confusion, the federal government has punted delivery plans to the best judgment of the leaders of the 50 states. Without strict and clear national guidelines beyond the first line of priority, local officials can poke huge and convenient holes in the equity process.

Case in point: in New York, the Empire State Development executive order includes “banks and lending institutions,” or people who perform “services related to the financial markets,” as essential workers. And, Wall Street brokering being what it is, those “services” don’t mean only bank tellers in close proximity to customers needing a roll of quarters for the washing machine. Obnoxious, buff, and newly inoculated hedge-funders will only become more obnoxious as they high-five each other over Wagyu filets at expensive steak houses, all pumped up that social distancing, for them, is over. Let’s hope that Governor Andrew Cuomo’s mandate that health-care workers receive it before other essential workers actually holds.

“The entitled are more entitled. Jerks are bigger jerks, and the assholes are bigger assholes,” one East Coast doctor, who asked to remain unnamed, told me. “People who are brave in the face of adversity make me feel good about life. But this is disgusting. The rich families keep calling, coming up with reasons, like I had a bad stress test once, or I’ve gained some weight. It’s like we are going into war, and you see who the courageous people are.”

In fairness, there will be line cutters across the income spectrum. Health-care personnel may do their best to help their families and close friends with whom they have interpersonal responsibilities by pulling in a favor to inoculate a spouse. It’s not as if the whole lot of financially successful Americans will insist on first dibs; many represent the best of the entrepreneurial spirit and are wildly generous with causes.

Equity Issues

I interviewed many wealthy Americans who are outright disgusted by the suggestion of using money to cut this unprecedented and tragic national line. Nonetheless, remember how the testing process revealed the ingrained American racial and class inequities in Technicolor? In the early days of the pandemic, some Americans stood in interminable lines and waited a nonsensical 14 days for results. Black and brown communities had little or no access to tests or any therapeutic interventions.

Meanwhile, behind the Hamptons hedges, residents hired bespoke emergency-room firms with doctors and nurses on call with $5,000 to $15,000 annual fees—charging extra for house calls—to administer rapid P.C.R. tests for the whole family while they binged on Tiger King. I know a few people who even bought up dozens of the $109 rapid tests and traveled to the Caribbean with a “testing nurse” so they could instantly test friends who came over for lunch or met up with their children on the beach.

Many vaccine providers have spent their careers observing how privilege is built into the American health-care edifice. And, to some extent, how they and their institutions benefit from it. Though most will try hard, many know they cannot break the tight network of clubhouse codes to stem a portion of early vaccines leaking to the entitled and undeserving. Selfish shenanigans of the rich will abound soon, much of the groundwork already put in place.

An early vaccine for a principle-compromised wealthy individual will not be as simple as buying a line-cutting Disney World VIP Tour pass, available to anyone able to slap down $625 per hour. However, wealthy insiders operate a favor mill in constant motion, harvested year after year, often over generations. This arrangement may come in quite handy during a global pandemic. It will simply be a matter of finding an unscrupulous health-care professional willing to cross an ugly line by faking or exaggerating a high-risk diagnosis.

Doctors I interviewed disagreed over whether and when major health-care institutions or reputable health practitioners might compromise their integrity for their patients. Would a loaded donor come before a healthy childhood best friend? No one agreed on when, who, or how.

However it happens, this insider, no-rules-apply clubhouse game is oiled over the years in such a way that the tagline from the Orson Welles commercial of yesteryear—“No wine before its time”—applies perfectly. No cash is ever traded for instant delivery of goods and services. The Varsity Blues scandal, in which a crass fee was exchanged for a college entry, was considered amateur child’s play to this set. The seriously rich get their kids into college or access to superior health care through connections as well tended over the years as a prize-winning rose garden.

The Varsity Blues scandal, in which a crass fee was exchanged for a college entry, was considered amateur child’s play.

This is not to contend that money alone won’t get morally dubious donors to the front of the vaccine line. Some people who have donated gargantuan amounts to health-care causes will just need to call the right doctor, one willing to break the rules. And they will get a vaccine the next day at a convenient time between a Zoom call and a scotch with an old St. Paul’s chum. They will vaccinate their spouses, but most know better than to push it by asking for doses for all five kids and the housekeeper.

The coterie of high-end doctors who socialize with well-heeled patients will be put in particularly awkward situations. In pre-coronavirus times, as thanks for detecting that tumor early, a grateful patient might invite the doctor to compete in the member-guest tennis tournament at the Meadow Club on those divine grass courts. These days, a legacy letter to grease the doctor’s nephew’s college-admission process might be construed as legal tender for an early vaccine. In the past, these “gifts” may have been a genuine act of gratitude for good care. However, both recipient and donor know a coveted invite for unlimited sushi in the Chase box at the U.S. Open ensures goodwill and good care for the future.

There is goodwill, and then there is an egregious assumption of quid pro quo in a global pandemic.

“It’s the same thing that’s wrong with cutting the cafeteria at middle school. There are other people in line, and it’s not fair or just to disregard that they are there,” says Glenn Ellis, visiting scholar at the National Center for Bioethics in Research and Health Care at Tuskegee University. “It’s unethical but, sadly, part of the American inequity story.”

“All Kinds of Leakage”

The officials know what’s coming. This past week, California governor Gavin Newsom told a flock of reporters he would be “very aggressive” in making sure that those with means and influence don’t crowd out those who are the most deserving of the vaccines.

Newsom, savvy politician that he is, neglected to mention his exact method for keeping the rich at bay. He grew up alongside the Getty family and has a wife from a prominent Marin County clan. Newsom knows that anyone claiming they can clean up the plutocrat playground won’t get very far.

Sadly, some donors have occasionally failed to read the mission statements of institutions they support. Dr. Steven Phillips, a medical epidemiologist who is now vice president for science and strategy at the nonprofit Covid Collaborative, said that as long as supplies of the vaccine are scarce, the initial “street” value will be astronomical. “The health-care community is very worried about wholesale diversion and theft,” he says. “No doubt, there will be all kinds of leakage from all sectors in the chain of custody.”

They will vaccinate their spouses, but most know better than to push it by asking for doses for all five kids and the housekeeper.

Besides the leakage through the favor mill, the wealthy have other options to cut the vaccine line. Women from Lake Shore Avenue to Highland Park’s Beverly Drive speak of jetting to resorts in the Alps, which may benefit from earlier delivery of the vaccine. Wealthy Italians are rumored to be shipping in the Chinese vaccine. Wall Street power mongers are begging their internists for a high-risk diagnosis.

That East Coast doctor ranted about this. “Twenty times a day, every day, I get these calls from schmucks with a ton of dough. ‘Who should I put the pressure on? My cardiologist or my pulmonologist? Which one has the greatest pull?’” he says. “It’s going to be a feeding frenzy out there. This is happening before it comes. Wait until the vaccine is actually here. It’s a total disgrace.”

For those who do partake in questionable vaccine behavior, hiding the fact that they did so may be even trickier than getting an early vaccine in the first place. “The vaccine should be a public good, and getting vaccinated shouldn’t be a privilege,” argues Mary Travis Bassett, director of the François-Xavier Bagnoud Center for Health and Human Rights at Harvard. “It should be seen in the interest of the protection of everyone in the correct priority order.”

As the unfairly vaccinated sun themselves in Mustique this season, one wonders if they might feel a tinge of guilt over the injustice they inflicted on the deserving dialysis patients still waiting in line. Or, maybe, frolicking in their Missoni bikinis and Orlebar Brown trunks, the wealthy and connected won’t give a hoot. They may even feel satisfied they once again manipulated the system in their favor.

Buying a table at the melanoma benefit honoring the dermatologist who injects early vaccines along with cheek-plumping Juvéderm may be, in their twisted reasoning, money well spent.

Holly Peterson is a journalist and the author of several novels, most recently It’s Hot in the Hamptons