Optimizing Antiviral Stockpiles for Pandemic Response: A Strategic Framework

Influenza antiviral stockpiling represents a critical component of pandemic preparedness, yet evolving challenges demand new approaches to this strategic imperative. The Strategic National Stockpile's target of maintaining antiviral courses for 25% of the United States population reflects both economic modeling and practical experience from recent pandemics, including the 2009 influenza A(H1N1) and coronavirus disease-19 pandemics. This perspective examines the evolution of antiviral stockpiling strategies, highlighting key lessons from these events as well as challenges in supply chain resilience, resistance management, and rapid deployment. The increasing diversity of available antivirals, from traditional neuraminidase inhibitors to a newer cap-dependent endonuclease inhibitor and emerging host-targeted therapeutics, offers opportunities for more robust stockpiling strategies. However, this diversity also introduces complexities in decision-making, storage, and deployment. Recent advances in artificial intelligence and manufacturing technologies present promising solutions for enhancing stockpile management, potentially enabling more responsive just-in-time production capabilities. The integration of rapid diagnostics, streamlined distribution systems, and novel therapeutic approaches could transform traditional stockpiling paradigms. This analysis provides a framework for optimizing antiviral stockpiles that balances immediate pandemic response capabilities with long-term strategic considerations, while addressing critical challenges in resistance management, pediatric formulations, and supply chain resilience.