This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics— drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socioeconomic, ethnic and geographical inequalities in COVID- 19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemic pandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generationsIn 1931, Edgar Sydenstricker outlined inequalities by socio-economic class in the 1918 Spanish influenza epidemic in America, reporting a significantly higher incidence among the working classes.1 This challenged the widely held popular and scientific consensus of the time which held that ‘the flu hit the rich and the poor alike’.2 In the COVID-19 pandemic, there have been similar claims made by politicians and the media - that we are ‘all in it together’ and that the COVID-19 virus ‘does not discriminate’.3 This essay aims to dispel this myth of COVID-19 as a socially neutral disease, by discussing how, just as 100 years ago, there are inequalities in COVID-19 morbidity and mortality rates— reflecting existing unequal experiences of chronic diseases and the social determinants of health. The essay is structured in three main parts. Part 1 examines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. Part 2 examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemic pandemic. In Part 3, we explore the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on