Antiviral Drugs: Economic Incentives and Strategies for Pandemic Preparedness [Reissued with revisions on Sept. 29, 2023]

Create a strategy to focus on developing diverse antiviral drugs to respond to pandemics caused by the most dangerous pathogens (report p. 33).

Policymakers could ensure focus on pathogens and pathogen families, such as flaviviruses and bunyaviruses, that are most likely to cause severe future pandemics, with an emphasis on pathogen families for which no drug candidates are currently in clinical trials.

• Designing hypothetical pandemic scenarios could help identify the relative likelihoods that an outbreak could quickly become severe and widespread, indicating which antiviral drugs may need to be stockpiled and which need to be developed only to the point of phase 1 clinical trials.


• Focusing attention on viral families with no drug candidates in clinical trials could spur research and development.


• Developing drug candidates through phase 1 clinical trials would provide information on the initial safety profile and side effects of different doses in advance of potential pandemics.

• Not every possible pandemic scenario can be considered, and a pathogen that may cause a future pandemic might not appear on current lists of potential pandemic pathogens.


• It is difficult to predict how a novel pathogen may travel across populations. Therefore, assessing the stage to which each drug candidate should be developed and how much manufacturing might be needed may also be difficult.

Assign to a new or existing entity the authority to lead, implement, and be accountable for identifying and developing antiviral drugs for pathogens or pathogen families of greatest risk (report p. 34).

Policymakers could ensure that this entity has authority and accountability for making decisions and allocating resources to implement a strategy for addressing pathogens and pathogen families informed by pandemic scenarios and the risks they present.

• A single, centralized entity could direct strategic investments for pandemics, increase communication across federal agencies and with drug developers, and facilitate greater accountability for more effective allocation of resources and response to the spectrum of pandemic threats.


• A single entity that is explicitly accountable for pandemic preparedness and response could effectively mitigate pandemic risks and enhance government efforts to deal with uncertain but likely pandemic risks. When multiple entities share fragmented responsibilities, no one entity is accountable for the ultimate success of the effort.

• Because authorities among HHS entities vary, designating an entity with responsibility and authority may require new directives or legislation.


• To be effective, any entity with such authority for identifying and developing pandemic antiviral drugs would need to coordinate or align its efforts with related efforts, such as the development of vaccines, diagnostics, and surveillance.

Implement economic incentives to develop antiviral drug candidates and spur new drug-development technologies (report p. 35).

Policymakers could use various push and pull economic incentives to encourage the development of pandemic antiviral drugs, based on the economic costs of scenarios, scientific opportunities, and pathogen priorities. They could also consider other policy priorities, such as drug accessibility.

Policymakers could use economic incentives to stockpile certain drugs in advance as well to ensure sufficient manufacturing capacity.

• Economic incentives could address the identified challenges related to critical market failures that have limited investment in pandemic antiviral drugs. Through such actions, economic and societal costs from viral pandemics could be meaningfully reduced.


• Manufacturing capacity for pandemic antiviral drugs may be useable for similar antiviral drugs with an existing commercial market.


• New drug development technologies spurred by investment in pandemic antiviral drugs may allow for the treatment of nonpandemic infectious diseases, especially diseases caused by pathogens in the same family as those targeted for antiviral development.

• Periodic updates to evaluations of pandemic risks would be needed to guide the deployment of economic incentives for new antivirals and drug development technologies and the extent of investment needed as new pandemic pathogens arise.


• Evidence of the full range of potential pandemic costs may be unavailable or insufficient for precise determinations of the level of investment needed to achieve certain levels of preparedness.