The literature contains much discussion on the contemporary differences between neorealism and neoliberalism, especially in the context of international relations. However there have, as yet, been limited attempts to investigate how these international relations theories fare in explaining state responses to the COVID-19 outbreak. This study reviews the conceptual frameworks underpinning neorealism and neoliberalism and applies them to key state behaviors during the COVID-19 outbreak. Some examples of neorealism attached to the current pandemic include: criticism of the role of the World Health Organization, the closure of international borders, international competition to collect pharmaceutical products, bans on exports, richer states protecting their national interests, the international misuse of power during emergency orders, restrictions placed on the international media, and the deployment of military forces. By contrast, neoliberalism's focus on international cooperation is noted in U.S., Chinese, and other countries’ attempts to distribute knowledge and aid internationally, as well as in the efforts of key international organizations like the World Health Organization and the global Covax initiative. I offer an evidence-based conceptual framework using neorealism and neoliberalism to show how both have informed international behavior during the COVID-19 outbreak—although continued emphasis on the former shows few signs of abating as the pandemic approaches its third year.