There was widespread coverage in the media of Merck and Ridgeback’s interim results of their phase 3 trial of the antiviral molnupiravir. According to a press releas e from Merck on Oct 1, molnupiravir reduced the risk of hospitalisation or death by roughly 50% compared with placebo in non-hospitalised patients with mildto-moderate COVID-19 and at least one risk factor for disease progression. Despite not yet being peer-reviewed, these data incited excitement, in part because of the oral route of administration of molnupiravir, which means the drug could be easily taken at home and used widely in settings with inadequate health-care infrastructure. Of note, Merck has announced that it plans to implement a tiered pricing approach based on World Bank income criteria—although what this means in practice, we do not yet know—and there are reports that the company has agreements with established generic drug manufacturers in more than 100 countries to allow rapid and local production of molnupiravir upon the drug’s approval by licensing authorities.

Owing to the urgent need for treatments for hospitalised, critically ill COVID-19 patients, research on drugs for use in the outpatient setting has understandably lagged behind. Additionally, the existence of SARS-CoV-2 vaccines that are highly effective against hospital admission and death might be impacting the sense of urgency for these drugs. Yet, global inequity in access to vaccines means that there is a serious unmet need for pharmaceutical interventions to limit SARS-CoV-2 infection or progression of COVID-19. There are also cases where individuals do not mount adequate and lasting immune responses to the vaccines.