Twenty-first century capitalism features financialization and monopoly power. A structural perspective of contemporary political economy illuminates how these aspects shape the COVID-19 response. COVID-19 has exposed failures across health care systems, working conditions, supply chains, the depth of inequality, systemic racism, and features of globalization that exacerbate negative outcomes for the many. Examining access to medicines, personal protective equipment and vaccines, inequality and working conditions highlights just some of what is broken and what needs to be fixed. The unsparing challenge and immiseration of COVID-19 offer an opportunity to re-think basic structures of contemporary capitalism and re-imagine a more compassionate future.