Strategic Cost Implications of Medical Countermeasure Stockpiling

By Danélia Botes

April 9, 2024


In this day and age, when public health emergencies can occur with little to no prior warning, the strategic stockpiling of medical countermeasures (MCM) is an essential component of national preparation all over the world. This article examines the cost implications of such stockpiles, drawing on insights from recent international approaches. The Health Information and Quality Authority (HIQA) recently released a report. Five countries namely, France, Latvia, Lithuania, the Netherlands and Norway, were interviewed on this critical issue.

The Evolution of Medical Countermeasure Stockpiles

Countries have progressed from stockpiling for mass casualty incidents to encompassing a broader spectrum of threats which includes antimicrobial resistance, biological and nuclear threats, as well as pandemics. The COVID-19 pandemic, in particular, has catalysed an expansion of stockpiles to include general medicines and personal protective equipment, alongside a reassessment of supply chain resilience. They reported on national and cross-border stockpiles in this report.

Balancing Cost and Preparedness in Stockpiling Strategies

While none of the surveyed countries utilise a formal cost-benefit analysis for their stockpiling strategies, budgetary constraints significantly influence decisions on stockpile contents. The challenge is to balance fiscal prudence with the imperative to be prepared for a range of health crises. Two countries reported the use of international documentation as guidelines to inform their decisions on stockpiling.

Minimising Waste in Medical Countermeasure Stockpiles

Waste management emerges as a critical concern, with countries adopting strategies such as stock rotation and donation to mitigate the issue. These practices reflect a commitment to cost-efficiency while maintaining readiness for emergency deployment of MCMs.

The Prospects of Stockpiling: Efficiency and Coordination

Looking ahead, countries are considering more decentralised stockpiles and enhanced coordination at both national and EU levels. Currently government ministries are mostly responsible for the governance of national stockpiles in these countries. These future approaches aim to optimise the efficiency and responsiveness of MCM stockpiles, ensuring that resources are used judiciously and effectively.


The strategic stockpiling of MCMs is a complex interplay of preparedness and cost considerations. By learning from international experiences, nations can refine their approaches. In this way they can ensure they are both economically sustainable and robust against future health emergencies.

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