Correction: Optimizing Tactics for Use of the U.S. Antiviral Strategic National Stockpile for Pandemic Influenza

Abstract

In 2009, public health agencies across the globe worked to mitigate the impact of the swine-origin influenza A (pH1N1) virus. These efforts included intensified surveillance, social distancing, hygiene measures, and the targeted use of antiviral medications to prevent infection (prophylaxis). In addition, aggressive antiviral treatment was recommended for certain patient subgroups to reduce the severity and duration of symptoms. To assist States and other localities meet these needs, the U.S. Government distributed a quarter of the antiviral medications in the Strategic National Stockpile within weeks of the pandemic's start. However, there are no quantitative models guiding the geo-temporal distribution of the remainder of the Stockpile in relation to pandemic spread or severity. We present a tactical optimization model for distributing this stockpile for treatment of infected cases during the early stages of a pandemic like 2009 pH1N1, prior to the wide availability of a strain-specific vaccine. Our optimization method efficiently searches large sets of intervention strategies applied to a stochastic network model of pandemic influenza transmission within and among U.S. cities. The resulting optimized strategies depend on the transmissability of the virus and postulated rates of antiviral uptake and wastage (through misallocation or loss). Our results suggest that an aggressive community-based antiviral treatment strategy involving early, widespread, pro-rata distribution of antivirals to States can contribute to slowing the transmission of mildly transmissible strains, like pH1N1. For more highly transmissible strains, outcomes of antiviral use are more heavily impacted by choice of distribution intervals, quantities per shipment, and timing of shipments in relation to pandemic spread. This study supports previous modeling results suggesting that appropriate antiviral treatment may be an effective mitigation strategy during the early stages of future influenza pandemics, increasing the need for systematic efforts to optimize distribution strategies and provide tactical guidance for public health policy-makers.

Distributed Manufacturing of Open Source Medical Hardware for Pandemics

“…Similarly, just as individual enterprises are undertaking preventative actions to be more resilient in the face of a disruptive event [243], so can the entire industrial base become more prepared and resilient. Preparedness capacity in this context means being flexible and agile enough to anticipate the consequences of a pandemic such as COVID- 19 and promote the open source paradigm before the next pandemic occurrence. Although disrupted manufacturing (closed commercial or open) would lead to a more resilient system for the supply of needed products during a pandemic or other global disaster, open source distributed manufacturing ensures the widest possible dispersion of fabrication knowledge and ability making for the most resilient society.…”

“…The health care systems have the technology and staff to care for some patients, but not the volume of patients observed during surges brought about by a rapidly spreading virus. Traditionally, these challenges were met with two strategies: first, by pre-planning and stockpiling equipment, supplies, and medication [16][17][18][19][20][21][22], and second, by using policies equivalent to the American Defense Production Act, which allows the President to direct private companies to produce equipment needed for a national emergency [23][24][25]. Unfortunately, as shown during the COVID-19 pandemic, the stockpiles are often insufficient [26][27][28], in part because of the high costs associated with maintaining the stockpiles [29,30].…”

Dynamic Response Systems of Healthcare Mask Production to COVID-19: A Case Study of Korea

“…Once the supply exceeds the demand with approaching the end of the pandemic, the production strategy will be switched to make-to-stock producing. The excess production will be purchased by the government for the strategic national stockpile (SNS) in response to unpredictable public health emergencies [51][52][53]. The emergency supply chain plays a critical role in the public health to assist the control of epidemic outbreaks [54].…”

New York State Emergency Preparedness and Response to Influenza Pandemics 1918–2018

“…The distribution of available vaccines was prioritized by the department's logistics section, leveraging the existing Strategic National Stockpile and Comprehensive Emergency Management Plans. The vaccine deployment activities included working with pharmacies and other private sector partners [20,26,27].…”