Abstract
BACKGROUND: Oral antiviral medication is available free of charge to Australians with SARS-CoV-2 infection who meet specific eligibility criteria. Health services and systems are targeted to support vulnerable populations, but not all eligible people received antivirals prior to hospitalisation. To expand the evidence base of social and behavioural insights in infectious disease emergencies and inform future pandemic responses, we sought to understand why people at high risk of hospitalisation with COVID-19 did not access antivirals. METHODS: We conducted 29 semi-structured interviews with people who were eligible for antivirals but did not receive them, and who were subsequently hospitalised with COVID-19. Interview questions explored all levels of influence on antiviral uptake from intrapersonal to policy, via the patients’ perspective. Analysis blended deductive and inductive approaches and resulting themes were categorised into the factors of the Capability-Opportunity-Motivation-Behaviour (COM-B) model. FINDINGS/RESULTS: Most participants lacked the capability to access antivirals through primary care. The key impediment was a lack of awareness about their existence or availability. In addition, many did not have sufficient opportunity, usually due to an inability to access primary care services in a timely manner. Almost all participants were highly conscious of their health and risks posed by their pre-existing conditions. Of those who were motivated to seek antivirals, reasons included preventing severe symptoms and limiting their time off work. Participants described situational mistrust in the provision of primary healthcare as structural changes made it harder or more expensive to access. CONCLUSION: To improve antiviral uptake during an infectious disease emergency, policy makers need to ensure medication access to those eligible but also provide good motivations to take them by promoting them as a preventative measure. This can be done by targeted government communication and measures that address healthcare system inequities through better access to and quality of primary care for vulnerable populations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14392-7.