The challenges of prioritising access to molnupiravir and nirmatrelvir–ritonavir for COVID-19

Simon Collins, HIV i-Base

An opinion article in Lancet Infectious Diseases stresses the importance of clear guidelines for prioritising access to new antiviral drugs to treat COVID-19 in different countries.

This includes situations when medical need might be highest in those who have not been vaccinated while still remaining very high in other people who have actively engaged in vaccinations.

Molnupiravir and nirmatrelvir–ritonavir both need to be prescribed within five days of symptoms of confirmed COVID-19. Demand currently exceeds supply in every country.

Prioritisation needs to account for transparency, relevance, appeals, enforcement, and fairness – and on defining clinical need by using evidence-based scoring.

It also needs to overcome the data limitations of the phase 3 registrational studies being carried out in those who were unvaccinated.


Dal-Ré R et al. Availability of oral antivirals against SARS-CoV-2 infection and the requirement for an ethical prescribing approach. Opinion. Lancet Infectious Diseases. DOI: 10.1016/S1473-3099(22)00119-0. (29 March 2022).

This report was first published on 5 April 2022.

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