Effective Antivirals in Pandemic Preparedness: Past Mistakes, Future Needs.

The next pandemic may demand faster, more flexible responses with better risk-benefit and cost-benefit ratios than current systems can deliver. During COVID-19, R&D funding allocation strongly favored vaccines over antivirals and regulatory approvals of vaccines far exceeded approvals for antivirals. Moreover, early evidence on antiviral effectiveness was often limited or even misleading. Antivirals may have advantages in early outbreak control, high-risk populations, and settings with delayed vaccine uptake. For future pandemics, we propose a dedicated antiviral agenda to coordinate R&D for broad-spectrum agents, fund phase 2/3 trials for high-severity pathogens, enable rapid manufacturing scale-up for demonstrably effective interventions, and secure equitable global access through tiered pricing, stockpiling, and technology transfer. This platform would fill the critical therapeutic blind spot in existing pandemic vaccine-centric strategies. The proposed approach should ensure transparency, strengthen equity, and provide rigorous evidence for both vaccines and antivirals, dissecting their relative benefits, limitations, complementarity, and cost-benefit.