Therapeutic options for COVID-19 primarily fall into two categories: monoclonal antibodies (administered by infusion) and oral antivirals (administered as tablets). Throughout 2021, monoclonal antibodies were the only option with regulatory approval in most countries but are expensive (around $1,500 to $2,100 USD per dose) and resource-intensive to administer, as they require a hospital or health clinic setting.
These factors mean that monoclonal antibodies, though used in wealthy countries, have been non-starters for much of the world. In addition, some of the monoclonal antibody options now appear to be less effective against the omicron variant.
Oral therapeutic options, which can be self-administered as tablets taken in multiple doses over the course of about 5 days, promise a more cost-effective option but they are not created equal. So far, there are two options that have come to market: Pfizer's Paxlovid (nirmatrelvir/ ritonavir) and Merck's Lagevrio (molnupiravir). Paxlovid appears to be significantly more effective in preventing hospitalization and severe disease (89%) than molnupiravir (30%).
Despite their recent entry, purchases of oral therapeutics already dominate the COVID-19 treatment options (see Tabs 1.1 and 1.2).
However, purchases are dominated by high-income countries (see Tab 2). Given supply constraints that will persist throughout 2022, this likely means that the vast majority of available supply will go to high-income countries this year. Manufacturing of generic versions of both Pfizer's and Merck's oral therapeutics is underway globally but significant production is not expected until the end of the year.
We will continue to track purchases of COVID-19 therapeutics and regularly update the data here. As always, please be in touch if you spot any gaps or errors by emailing us at firstname.lastname@example.org.