Public health management of antiviral drugs during the 2009 H1N1 influenza pandemic: a survey of local health departments in California

This study examines how local health departments managed antiviral drugs during the 2009 H1N1 pandemic. Even with low demand, agencies had to plan, allocate, distribute, track, and communicate about antivirals across many partners. Common operational tasks included selecting dispensing sites, prioritizing high-risk or uninsured groups, and monitoring use. Major challenges were inconsistent guidance from multiple authorities, unclear eligibility rules, staffing shortages, and pediatric drug shortages. Guidance confusion and staffing were top issues. For preparedness, standardize guidance, predefine allocation rules, strengthen staffing plans, and build simple tracking and communication systems to reduce confusion during future responses. Bottom line: Clear rules, enough staff, and simple tracking systems are critical to manage medical countermeasures effectively during a pandemic.