They required stockpiling products and shipping them to customers.
Deeper advances would have required stockpiles to be moved forward, potentially forcing delays.
Any strategy involving NI use would require stockpiles of these drugs.
However, in the presence of resistance with HTF, the required stockpile will substantially increase for higher treatment levels, since drug-resistance spreads widely in the population, resulting in a large number of resistant clinical cases that may receive treatment.
Assuming R0 = 2, the adaptive strategy with an initial 0% treatment level (increased to 80% at time t* = 35) requires a stockpile of size 18.5% (relative to S0), and results in 24% reduction in the total number of clinical infections compared with the constant antiviral treatment at the optimal level 41%, which requires a stockpile of size 17.5%.
The addition of at least four weeks of school closure was found to further reduce cumulative and peak attack rates and the size of the required antiviral stockpile.
Our evaluation of antiviral drug interventions using a detailed simulation model shows that their effectiveness, and the required antiviral stockpile size, is strongly dependent on (i) the delay occurring between symptom onset and diagnosis, and (ii) the percentage of the infected population being diagnosed, and consequentially benefiting from antiviral administration.
In our simulations, AVP is confirmed to be the most effective single intervention [11]; however this would require to stockpile a high number of antivirals, to be capable to rapidly identify index cases, to treat a high number of contacts, and to maintain their compliance to a treatment lasting 10 days.
However, such a strategy would require a stockpile of 1.9 billion doses of antiviral agents, which exceeds the current production capacity for these drugs for at least the next 5 years.
This epidemiologically directed short-term prophylaxis of close contacts may require antiviral stockpiles considerably larger than necessary for therapeutically treating patients, but our model suggests that this investment may still prove cost-saving, providing that the outbreak dissemination patterns and population attributes correlate with those assumed by Longini et al. (Appendix).
