How biotech firms are racing to develop oral antiviral pills and what that means for healthcare access

I remember the first headlines about Pfizer's Paxlovid and Merck's molnupiravir — an immediate sense of relief that effective antiviral pills could finally offer a simple, early treatment for viral infections like COVID-19. Since then, the race among biotech firms to create oral antiviral medications has accelerated into a sprint. As a reporter who follows the intersection of medicine, business and public policy, I’ve watched this market evolve from emergency response into a major commercial and public-health battleground. Here’s what I’ve learned about why companies are racing, what these pills change for patients and the practical challenges that determine who actually gets them.

Why biotech companies are investing heavily in oral antivirals

There are several reasons firms are pouring resources into oral antivirals:

All of this has triggered a wave of R&D, acquisitions and licensing deals. Big pharma moved fast, and smaller biotech firms pivoted or partnered up to access trial networks and manufacturing capacity.

How the pills work — and why timing matters

Most oral antivirals target viral replication. Paxlovid, for example, combines a protease inhibitor with ritonavir to block SARS-CoV-2 replication, while molnupiravir induces errors in viral RNA. The common thread is that they work best when given early — typically within five days of symptom onset.

I often explain to readers that the window for these drugs is narrow. That’s not just a clinical detail: it has real implications for testing, prescribing and access. If you have to wait several days for a test result or a clinic appointment, the antiviral might become ineffective. That’s why combining rapid testing, telemedicine and readily available antivirals is a practical necessity.

Access: the good, the bad and the complicated

From where I sit, one of the most consequential questions is not whether these drugs work — it’s who can get them. The race has produced both promising access strategies and worrying disparities.

On the positive side:

But there are major caveats:

Manufacturing and supply-chain hurdles

I’ve covered several factory visits and sat down with industry sourcing leads — the story is always the same: the pill itself might be simple, but the supply chain is not. Active pharmaceutical ingredients (APIs), specialized excipients, sterile packaging and quality-control testing can create bottlenecks. When demand surges, capacity to manufacture at scale is often the weak link.

Two industry trends stand out:

Pricing, patents and the politics of access

Intellectual property debates are central to any discussion about equitable access. I’ve interviewed policymakers and public-health advocates who argue that compulsory licensing or patent pooling are necessary during pandemics. I’ve also spoken with industry executives who say patents are crucial for recouping R&D and incentivizing future innovation.

Real-world solutions so far have been mixed. The Medicines Patent Pool secured voluntary licenses for molnupiravir early on, enabling manufacturers in several countries to produce cheaper versions. For Paxlovid, licensing coverage has been broader but not universal. The crux is timing: voluntary licenses help, but often arrive after the initial commercial rollout — which is when demand and pricing pressure are highest.

Clinical practice and antiviral stewardship

From a clinician’s perspective, oral antivirals introduce new decisions: who should get the drug, when to start, and how to monitor for resistance. In primary care, that translates to rapid triage protocols and clearer patient communication about benefits and side effects.

There’s also the specter of resistance. Widespread, inappropriate use of antivirals — for example, starting them late or using them for mild disease unnecessarily — could select for resistant strains. I’ve heard calls for antiviral stewardship programs modeled on antibiotic stewardship: targeted use, surveillance for resistance, and coordinated prescribing guidelines.

What this means for healthcare delivery

Oral antivirals can decentralize care. That’s exciting: they enable treatment in community settings, reduce reliance on hospital beds and give primary care clinicians a powerful tool. But to realize these benefits, systems need to adapt:

I’ve seen systems that did this well — for instance, integrating testing kiosks outside clinics, allowing same-day prescribing and pharmacy pickup — and the result was measurable reductions in hospital admissions. When rollout is disjointed, however, pills sit unused and the clinical impact is lost.

Looking ahead: competition, newer targets and broader implications

Even as Paxlovid and molnupiravir became household names, dozens of candidates are in development targeting different viral proteins and offering different resistance and safety profiles. Companies like Shionogi and Roche, and newer entrants focused on pan-viral platforms, could reshape treatment options in the next few years.

For me, the most compelling takeaway is that oral antivirals change the architecture of infectious disease care. They make early outpatient intervention feasible. But their promise depends on aligning manufacturing, policy, diagnostics and clinical practice. Without that alignment, the pills risk becoming another innovation that benefits those with easy access while leaving vulnerable populations behind.

I’ll continue tracking how companies, regulators and health systems handle these trade-offs. For readers, the practical things to watch are simple: can you access rapid testing where you live, are local clinics or pharmacies offering antiviral prescriptions quickly, and are public-health authorities negotiating licenses or procurement deals that expand supply? Those factors will determine whether these pills become a global game-changer or remain an unevenly distributed innovation.