---
title: "Global demand and public health impact of oral antiviral stockpiles for influenza pandemics"
id: "pubmed-42520120"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42520120"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42520120/"
doi: "10.1073/pnas.2524161123"
published_at: "2026-08-04T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Global demand and public health impact of oral antiviral stockpiles for influenza pandemics
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42520120
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42520120/)
- **DOI:** [10.1073/pnas.2524161123](https://doi.org/10.1073%2Fpnas.2524161123)
- **Published At:** 2026-08-04T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The authors used a **multiscale transmission model** that incorporated heterogeneous healthcare-seeking behavior and clinical estimates of antiviral transmission risk reduction to estimate country-specific demand and mortality impact for four pandemic scenarios across **186 countries**. - Baloxavir marboxil (**BXM**) was projected to avert **37–68%** of mean pandemic deaths in the first epidemic wave, roughly **double** the impact of **oseltamivir**, due to BXM's transmission-reducing potential. - Mean stockpile requirements for BXM were estimated at **7–34%** of the population, which is **5–10% smaller** on average than the stockpile required for oseltamivir (estimated **28–36%** of the population for oseltamivir). - There is uncertainty in BXM's impact because of variability in viral load dynamics and transmission reduction observed in clinical trials; sensitivity analyses nonetheless consistently favored BXM over oseltamivir. - Under constrained drug availability, the model suggests prioritizing **treatment** of symptomatic cases rather than **postexposure prophylaxis** to maximize mortality reduction. - Rationing drugs to high-mortality groups (for example, the elderly) can substantially reduce the overall demand for BXM but leads to higher total pandemic deaths. - Rapid deployment is critical: each **week of delay** in initiating antiviral distribution reduces impact by up to **3% of averted deaths**, indicating that stockpiles need accompanying infrastructure for swift distribution. - The study frames antiviral stockpiling as a key pandemic preparedness measure, noting that previous stockpiling estimates relied on outdated assumptions that the COVID-19 pandemic and recent trials have made untenable. - Key study limitations and sources of uncertainty reported include viral load dynamics and transmission-reduction effect sizes from clinical trials; no competing interests were declared by the authors.
## Clinical Analysis & Structured Key Points
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Epub 2026 Jul 28. # The global demand and potential public health impact of oral antiviral treatment stockpile for influenza pandemics [Alvin X Han](https://pubmed.ncbi.nlm.nih.gov/?term=Han+AX&cauthor_id=42520120)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42520120/#full-view-affiliation-1 "Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands."), [Katina D Hulme](https://pubmed.ncbi.nlm.nih.gov/?term=Hulme+KD&cauthor_id=42520120)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42520120/#full-view-affiliation-1 "Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands."), [Colin A Russell](https://pubmed.ncbi.nlm.nih.gov/?term=Russell+CA&cauthor_id=42520120)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42520120/#full-view-affiliation-1 "Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.") Affiliations Expand ### Affiliation * 1 Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands. * PMID: **42520120** * DOI: [ 10.1073/pnas.2524161123 ](https://doi.org/10.1073/pnas.2524161123) Item in Clipboard # The global demand and potential public health impact of oral antiviral treatment stockpile for influenza pandemics Alvin X Han et al. Proc Natl Acad Sci U S A. 2026. Show details Display options Display options Format Abstract PubMed PMID Proc Natl Acad Sci U S A Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Proc+Natl+Acad+Sci+U+S+A%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Proc+Natl+Acad+Sci+U+S+A%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42520120/) . 2026 Aug 4;123(31):e2524161123. doi: 10.1073/pnas.2524161123. Epub 2026 Jul 28. ### Authors [Alvin X Han](https://pubmed.ncbi.nlm.nih.gov/?term=Han+AX&cauthor_id=42520120)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42520120/#short-view-affiliation-1 "Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands."), [Katina D Hulme](https://pubmed.ncbi.nlm.nih.gov/?term=Hulme+KD&cauthor_id=42520120)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42520120/#short-view-affiliation-1 "Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands."), [Colin A Russell](https://pubmed.ncbi.nlm.nih.gov/?term=Russell+CA&cauthor_id=42520120)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42520120/#short-view-affiliation-1 "Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.") ### Affiliation * 1 Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands. * PMID: **42520120** * DOI: [ 10.1073/pnas.2524161123 ](https://doi.org/10.1073/pnas.2524161123) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract Antiviral drugs are among the few countermeasures available during the critical interval between the emergence of a novel influenza pandemic and vaccine availability. Antiviral stockpiling is a key pandemic preparedness measure, yet existing stockpiling estimates vary widely and rest on outdated assumptions about healthcare-seeking behavior and drug-specific effectiveness-limitations that the COVID-19 pandemic and recent clinical trial evidence have made untenable. We developed a multiscale transmission model incorporating heterogeneous healthcare-seeking behavior and direct clinical estimates of antiviral transmission risk reduction to estimate country-specific demand and mortality impact across four pandemic scenarios in 186 countries. We find that baloxavir marboxil (BXM), due to its transmission-reducing potential, could avert 37 to 68% of mean pandemic deaths in the first epidemic wave, approximately double the impact of oseltamivir, while requiring a mean stockpile approximately 5 to 10% smaller (7 to 34% of the population, compared to 28 to 36% for oseltamivir). Uncertainty in viral load dynamics and transmission reduction benefits from clinical trials means that BXM's impact could vary, but sensitivity analyses consistently suggest that BXM is likely to be more effective than oseltamivir. Under limited drug availability, priority should be given to treatment over postexposure prophylaxis. Although drug rationing for high-mortality populations (e.g., elderly) can substantially reduce BXM demand, doing so leads to greater total pandemic deaths. Critically, each week of delay in initiating antiviral distribution erodes impact by up to 3% of averted deaths, meaning that antiviral stockpiles must be accompanied by rapid deployment infrastructure to deliver their potential impact. **Keywords:** antiviral stockpiling; influenza pandemic; oral antivirals; pandemic preparedness; public health. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Competing interests statement:The authors declare no competing interest. ## MeSH terms * Administration, Oral Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Administration%2C+Oral%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Administration%2C+Oral) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42520120/) * Antiviral Agents* / supply & distribution Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antiviral+Agents%2Fsupply+and+distribution%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Antiviral+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42520120/) * Antiviral Agents* / therapeutic use Actions * [ Search in PubMed 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