Non-targeted use of AVs for prophylaxis reduces transmission minimally, and is therefore wasteful. However, there is a compelling case for using AVs liberally (but targeted) at the very beginning. The initial response should include treating every case reached within 48 hours of onset of symptoms with AVs and using AVs liberally for timely prophylaxis of any individual who was potentially exposed to an infectious individual, or is likely to be so exposed. This is justified by the fact that the liberal use of AVs for treatment and targeted prophylaxis at the start
i. provides treatment to all early cases and allows us to assess AV effectiveness for treatment,
ii. improves the chance of achieving early elimination, because targeted prophylactic use of AV drugs can reduce transmission substantially, if the targeted dispensing of drugs is timely,
iii. helps to delay the peak of the local epidemic, should early elimination fail,
iv. will not make a large dent in the AV stockpile, if reviewed after a nominated number of cases or affected households, and
v. provides the opportunity to estimate the effectiveness of AVs to reduce transmission and severity of illness for the newly emerged pandemic influenza.
The last of these is crucial for making objective decisions about the strategic use of the remaining stockpile.