In the battle against COVID-19, there must be global equity in the distribution of antiviral drugs such as molnupiravir and nirmatrelvir. These are potent public-health tools beyond disease mitigation and vaccination (see, for example, Nature 601, 165; 2022). Cheap and easy to use, these pills are well suited to low- and middle-income countries (LMICs).
In under-vaccinated LMICs, widespread access to antiviral drugs is crucial. Antivirals could be a more enduring defence against emerging SARS-CoV-2 variants than are vaccines and monoclonal antibodies. They have the potential to prevent hundreds of thousands of hospitalizations and deaths globally. However, LMICs currently face significant manufacturing and pricing obstacles, and high-income countries have bought much of the existing supply (see go.nature.com/3nfz).
Production of these antivirals must be rapidly scaled up through compulsory licensing, the US Defense Production Act and other strategies (see go.nature.com/3kcxkga). Issues of supply, demand and cost can all be addressed readily, in tandem with vaccine equity, to achieve global pill equity.