outbreak scenarios. The more robust is the strategy to pandemic influenza infectiousness, the lower is strain on government capacity, and the greater the possibility of containment at source. At the margin, the probability of containment in resource‐poor countries grows if there is a global redistribution – especially of pharmaceutical stockpiles – that matches resources to the risk of preliminary outbreaks. Currently, resources are concentrated in countries at risk of secondary outbreaks, deriving from the focus in such countries on mitigation – rather than containment of initial outbreaks – of pandemic influenza in their society during an ‘inevitable’ global pandemic.

The modeling studies reviewed in this study indicate a variety of effective control policies and strategies, as well as their variants suited to particular feasibility, cost and ethical standards. These results (summarized below) are a first cut at winnowing the field of potential interventions for containment and mitigation. They are cross‐referenced to the known science on theoretical or laboratory efficacy of particular policies. These results indicate the likelihood of containment success in ‘frontline risk’ countries, given specific resource availability and level of infectiousness; as well as mitigation success in ‘secondary’ risk countries, given the assumption of inevitable international transmission through air travel networks. However, from the analysis of the modeling results on interventions in the U.S. and U.K. after a global pandemic starts, as well as the results from modeled containment strategies in S.E. Asia, there is a basis for arguing that the emphasis in the secondary risk countries could shift from mitigation towards containment. This follows since a mitigation‐ focused strategy in developed countries presupposes that initial outbreak containment in these countries will necessarily fail. This is paradoxical if containment success at similar infectiousness of the virus is likely in developing countries with lower public health resources, based on results using similar modeling methodologies.

Such a shift in emphasis could have major implications for global risk management for diseases of international concern such as pandemic influenza or a SARS‐like disease. For example, if international air travel reduction (as a function of globally coordinated policy as well as due to self‐restraint of travelers) combined with airport/border control has a strong chance of reducing the entry of infectives into the U.S., then the minimum required size of the U.S. stockpile of antivirals and pre‐pandemic vaccines would reduce. This is a reflection of the shift in emphasis from community‐level _mitigation_ across urban areas towards specific, risk‐based _containment_ at the level of airport/border areas as well as the traced contacts of international travelers. Given the reduction in the minimum stockpile size in the U.S., the balance could be efficiently and quickly redistributed. This could contain the spread in frontline countries (e.g., in S.E. Asia) for a greater range of infectiousness, reducing the overall global risk of the current wave of the pandemic as well as reducing the possibility of large subsequent outbreaks. This shift in emphasis could reduce the overall global burden of deaths and illness compared to a scenario where the resource‐rich countries retain the preponderance of resources in a strategy of ‘hope for the best, prepare for the worst’.

# **Summary of modeling results for containment of outbreaks in frontline countries**

Nonpharmaceutical interventions (NPIs) such as quarantine of infected individuals, social distancing measures including the closure of schools and offices, etc., are effective in containing the overall size of an outbreak within a country such as Thailand for viral strains of moderate infectiousness ( _R0_ less than 1.4)<sup>3</sup> . When NPIs are combined with a policy of 41