text: Not the great equalizers Covid 19 1918 20 influenza and the need for a paradigm shift in pandemic preparedness Despite common perceptions to the contrary pandemic diseases do not affect populations indiscriminately In this paper we review literature produced by demographers historians epidemiologists and other researchers on disparities during the 1918 20 influenza pandemic and the Covid 19 pandemic Evidence from these studies demonstrates that lower socio economic status and minority stigmatized race or ethnicity are associated with higher morbidity and mortality However such research often lacks theoretical frameworks or appropriate data to explain the mechanisms underlying these disparities fully We suggest using a framework that considers proximal and distal factors contributing to differential exposure susceptibility and consequences as one way to move this research forward Further current pandemic preparedness plans emphasize medically defined risk groups and epidemiological approaches Therefore we conclude by arguing in favour of a transdisciplinary paradigm that recognizes socially defined risk groups includes input from the social sciences and humanities and other diverse perspectives and contributes to the reduction of health disparities before a pandemic hits 