Clinical considerations include assessing product duplicity. Products that can be used to address multiple active ingredients or events can reduce the number of medications purchased. For example, doxycycline is approved by the FDA to treat several biologics such as anthrax, tularemia, and plague. Decisions about which product formulations to stockpile should take into account specific populations, such as children or people who cannot swallow pills. Appropriate sizes of children`s medical devices should be considered.8,27 When considering these options, remember that you do not want to store drugs unnecessarily. Medications have expiration dates. It is also possible that the dose of your medication will change in the future, eliminating the need for stored medication. It may be worth considering a one-month supply as a backup. More than that could potentially be waste. On a personal level, it can be helpful to store medication. You can be sure you have what you need when you need it. At the societal level, the opposite is true.

If everyone hoarded medicines or medical supplies, it could lead to unnecessary shortages. The U.S. decision to stockpile remdesivir sets a bad precedent for issues of access to upcoming vaccines and other COVID-19 shipments at a time when global cooperation is needed. This will create black markets for treatments, an increase in the supply of substandard and counterfeit medicines, and excessive profits. But the most damaging thing is that it will lead to misery for the families of sick people, especially in the poorest countries that do not have universal health coverage, who have to pay for these treatments themselves. Many health decision-makers have been caught off guard by the pandemic and, in the absence of robust national pandemic preparedness strategies, have resorted to drastic and costly non-pharmaceutical measures known to control the spread of pandemic respiratory viruses. However, the high baseline reproduction number (R0) and case fatality rate (CFR) of this novel coronavirus in older adults with underlying health conditions overwhelmed the responses, even in high-income settings. This has led to very long periods of national lockdown, school closures, travel restrictions and the closure of many important economic activities. As protective vaccines are developed, researchers around the world have been working to find effective treatments, with drug reuse being the fastest, most convenient and cost-effective option.

In a context where global collaboration is perhaps more necessary than ever, how concerned should we be about efforts to «stockpile» potential treatments and how can we encourage further collaboration? We consider the case of dexamethasone and remdesivir. In this context, we should refuse to suspend the application of the fundamental principles underlying good evidence-based judgment. The U.S. decision to stockpile the drug at a higher-than-deserved price does not take into account the potentially high opportunity costs to the health of its own population. The rest of the world should not feel compelled to do the same and should choose wisely. During the COVID-19 pandemic, states have criticized the lack of availability of medical care from the Federal Reserve. At a White House press conference on April 2, 2020, senior adviser Jared Kushner commented, «The idea of the federal stockpile was that it should be our stock. It should not be the stocks of the States that then use them.

[27] [28] [29] The idea that the stockpile was not a backup for states short of supplies was challenged, among others, by Kansas Governor Laura Kelly,[30] During the Trump administration, Trump falsely claimed that his administration inherited an «empty» supply from the previous administration. [22] The stock was reused during the 2022 monkeypox outbreak. As a result, Clinton held a meeting with academics and cabinet members to discuss the threat of bioterrorism. He was so impressed that he asked the experts to meet with senior officials from the Ministry of Defense and the Ministry of Health. [13] At that time, the government had supplies of medicines for military personnel, but not for civilians. Shortly thereafter, the Washington Post wrote that Clinton surprised many in Washington at how quickly he and his National Security Council acted to change that. In October, Clinton signed a new $51 million budget for stockpiling pharmaceuticals and vaccines to be managed by the CDC. [15] Emergency managers may choose to have the necessary supplies expected from major drug and medical care houses delivered «just in time» after a particular disaster. The study of needs in the event of similar disasters can guide these arrangements. These providers can also ensure that drugs that are about to expire are sent to hospitals for quick application in real time, rather than being thrown away months later from a stockpile. Coordination with commercial pharmacy chains can also improve recovery efforts, as these large chains are able to provide intervention kits tailored to the needs of the local population for chronic disease medications or provide prescription information to evacuees using their services.

In this scenario, stored antivirals are administered as short-term prophylaxis to exposed close contacts in addition to treating index patients, a strategy referred to as «circular prophylaxis» (35) or «targeted prophylaxis» (29) (strategy 3A). Only 1 previously published study (29) used dynamic mathematical models to investigate the expected effectiveness of this population-level pandemic control measure during a pandemic. This stochastic simulation model by Longini et al. suggests that during an influenza pandemic, post-exposure prophylaxis targeting close contacts (i.e., household contacts, daycares, play groups, and schools) could prevent 36% of all infections while providing prophylactic antiviral therapy to 54.8% of the population. We adopted these results as point estimates, while allowing a wide range of values for our sensitivity analysis (Table A3). When considering a ring prophylaxis strategy, consideration should be given to the risk of «strategy failure» due to early depletion of antiviral residue heaps. If post-exposure prophylaxis does not provide sufficient immunity to exposed contacts who have undergone prophylaxis, and if additional vaccines or antivirals become unavailable, rapid consumption of available supplies may leave the population vulnerable to further outbreaks that may be caused by the influx of new cases.