Evolution of WHO Influenza Antiviral Stockpile: Rapid Access and Use in Low- and Middle-Income Countries for Pandemic Preparedness and Response

The SARS outbreak and influenza A(H5N1) infections (2003-2004) prompted WHO to establish a global influenza antiviral stockpile, enabling rapid distribution to 72 countries during the 2009 A(H1N1) pandemic. To improve access in low- and middle-income countries, WHO added antivirals to the WHO Model List of Essential Medicines and included them in the Prequalification Programme. The 2011 Pandemic Influenza Preparedness Framework refined strategies for equitable access and rapid response. Lessons from COVID-19 led to a new WHO-led mechanism-the Interim Medical Countermeasures Network (i-MCM-net)-which supports integrated supply chains, real-time data sharing, research and development, and equitable access. WHO continues to emphasise equity and global solidarity, highlighting the need for accessible, effective, and affordable antivirals alongside vaccines to protect vulnerable populations and mitigate the impact of future pandemics.