evidence: Strategic stockpiles are a stopgap in a health emergency, offering critical medical countermeasures when market supplies may be short. The US Biomedical Advanced Research and Development Authority’s (BARDA) Pandemic Influenza Vaccine Stockpile Program stockpiles antivirals and pre-pandemic flu vaccines using egg- and cell-based technologies, as well as adjuvants45. BARDA has for example accumulated hundreds of millions of prepandemic H5N1 bulk vaccine doses, with multiple other countries having stockpiled H5N1 vaccines45. Stockpiles also extend beyond influenza; Gavi in partnership with UNICEF has routinely stockpiled Ebola vaccines46. Another example includes the stockpiling of smallpox vaccines, which were quickly distributed amid a 2022 outbreak of monkeypox47. If a pathogen with an outbreak or pandemic potential emerges that closely aligns with a stockpile, it can be quickly distributed to protect the population or provide some level of protection before more tailored interventions are developed if they are necessary. For that reason, stockpiles are one of a set of tools used for pandemic preparedness. One of the limitations of stockpiling is the short shelf life of some products leading to significant financial and material wastage. An additional consideration is that maintaining stockpiles requires stringent inventory management and replenishment.