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Applying the Delphi Method to Develop a NATO Pharmaceutical Stockpile in Support of the Center of Excellence for Military Medicine.

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Title: Applying the Delphi Method to Develop a NATO Pharmaceutical Stockpile in Support of the Center of Excellence for Military Medicine.
Authors: Mani V; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, United States., DuRant-Wise A; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States., Janvrin M; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, United States., Apilado KP; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, United States., Ricks J; Center of Excellence for Military Medicine, NATO, Budapest 1134, Hungary., Lawry LL; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States., Koehlmoos TP; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
Source: Military medicine [Mil Med] 2026 May 01; Vol. 191 (5-6), pp. e1285-e1291.
Publication Type: Journal Article; Research Support, Non-U.S. Gov't
Language: English
Journal Info: Publisher: Oxford University Press Country of Publication: England NLM ID: 2984771R Publication Model: Print Cited Medium: Internet ISSN: 1930-613X (Electronic) Linking ISSN: 00264075 NLM ISO Abbreviation: Mil Med Subsets: MEDLINE
Imprint Name(s): Publication: 2018- : Oxford : Oxford University Press
Original Publication: Washington, D.C. : Association of Military Surgeons, United States, 1955-
MeSH Terms: Military Medicine*/methods , Military Medicine*/trends , Strategic Stockpile*/methods , Strategic Stockpile*/trends , Strategic Stockpile*/standards , Strategic Stockpile*/statistics & numerical data, Delphi Technique ; Humans ; Ukraine
Abstract: Introduction: Recent global events including the Russian invasion of Ukraine have caused major disruptions to medical supply chains, highlighting the fragility of just-in-time logistics models and the risks posed by overreliance on foreign manufacturing capabilities. The transition from peacetime to crisis-and from crisis to full-scale conflict-demands rapid escalations in supply of pharmaceuticals. The objective of this research was to develop a consensus-driven list of high priority critical medicines as a basis for the creation of a North Atlantic Treaty Organization (NATO) pharmaceutical stockpile.
Materials and Methods: This Delphi Panel completed work started by the NATO Center of Excellence for Military Medicine to identify critical medications in July 2024. The panel involved collecting feedback across two rounds of voting from a group of subject-matter experts with background in combat casualty care and pharmaceuticals, with the goal of rating a list of critical medications on three factors on a Likert scale of 1 (low) to 9 (high): overall priority, use above baseline, and availability of alternatives. Median scores and tertiles were calculated to rate the medications in order of priority based on the aggregate statistics. Results were presented and finalized at a NATO-sponsored workshop in Poland as the final round of the Delphi in May 2025.
Results: The first round of the Delphi, conducted in February 2025, was a virtual, asynchronous voting round where 28 respondents participated rating and refining the initial list of 107 medications. Based on these results, 26 medications were determined high priority for stockpiling and 20 were removed from consideration. The second round took place in March 2025, and consisted of synchronous, virtual voting on the 61 medications of "uncertain priority" in the previous round. As a result, two additional medications were added to the high priority category for inclusion in stockpiles, with the final list presented for discussion in person during Round 3 containing a total of 28 critical medicines rated "high priority." Additionally, Rounds 2 and 3 resulted in discussion of alternative medications not included in the list, such as treatments for CBRNE exposures and viable alternatives for listed medications.
Conclusions: Ensuring availability of critical medicines during military operations and humanitarian emergencies supports the health and operational readiness of military personnel and the well-being of civilians affected by crises. By developing a systematic approach for prioritizing pharmaceuticals, this project addresses gaps in medication availability for NATO that could otherwise hinder effective response to emergencies.
(Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2025.)
Grant Information: HU00012520012 Defense Health Agency
Entry Date(s): Date Created: 20251111 Date Completed: 20260505 Latest Revision: 20260724
Update Code: 20260725
DOI: 10.1093/milmed/usaf554
PMID: 41217234
Database: MEDLINE
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  Data: Applying the Delphi Method to Develop a NATO Pharmaceutical Stockpile in Support of the Center of Excellence for Military Medicine.
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  Data: <searchLink fieldCode="AU" term="%22Mani+V%22">Mani V</searchLink>; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, United States.<br /><searchLink fieldCode="AU" term="%22DuRant-Wise+A%22">DuRant-Wise A</searchLink>; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.<br /><searchLink fieldCode="AU" term="%22Janvrin+M%22">Janvrin M</searchLink>; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, United States.<br /><searchLink fieldCode="AU" term="%22Apilado+KP%22">Apilado KP</searchLink>; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, United States.<br /><searchLink fieldCode="AU" term="%22Ricks+J%22">Ricks J</searchLink>; Center of Excellence for Military Medicine, NATO, Budapest 1134, Hungary.<br /><searchLink fieldCode="AU" term="%22Lawry+LL%22">Lawry LL</searchLink>; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.<br /><searchLink fieldCode="AU" term="%22Koehlmoos+TP%22">Koehlmoos TP</searchLink>; Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
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  Data: <searchLink fieldCode="JN" term="%222984771R%22">Military medicine</searchLink> [Mil Med] 2026 May 01; Vol. 191 (5-6), pp. e1285-e1291.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Oxford+University+Press%22">Oxford University Press </searchLink><i>Country of Publication: </i>England <i>NLM ID: </i>2984771R <i>Publication Model: </i>Print <i>Cited Medium: </i>Internet <i>ISSN: </i>1930-613X (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2200264075%22">00264075 </searchLink><i>NLM ISO Abbreviation: </i>Mil Med <i>Subsets: </i>MEDLINE
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  Data: <i>Publication</i>: 2018- : Oxford : Oxford University Press<br /><i>Original Publication</i>: Washington, D.C. : Association of Military Surgeons, United States, 1955-
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  Data: <searchLink fieldCode="MM" term="%22Military+Medicine%22">Military Medicine*</searchLink>/<searchLink fieldCode="MM" term="%22Military+Medicine+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Military+Medicine%22">Military Medicine*</searchLink>/<searchLink fieldCode="MM" term="%22Military+Medicine+trends%22">trends</searchLink> <br /><searchLink fieldCode="MM" term="%22Strategic+Stockpile%22">Strategic Stockpile*</searchLink>/<searchLink fieldCode="MM" term="%22Strategic+Stockpile+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Strategic+Stockpile%22">Strategic Stockpile*</searchLink>/<searchLink fieldCode="MM" term="%22Strategic+Stockpile+trends%22">trends</searchLink> <br /><searchLink fieldCode="MM" term="%22Strategic+Stockpile%22">Strategic Stockpile*</searchLink>/<searchLink fieldCode="MM" term="%22Strategic+Stockpile+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22Strategic+Stockpile%22">Strategic Stockpile*</searchLink>/<searchLink fieldCode="MM" term="%22Strategic+Stockpile+statistics+%26+numerical+data%22">statistics & numerical data</searchLink><br /><searchLink fieldCode="MH" term="%22Delphi+Technique%22">Delphi Technique</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Ukraine%22">Ukraine</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: Recent global events including the Russian invasion of Ukraine have caused major disruptions to medical supply chains, highlighting the fragility of just-in-time logistics models and the risks posed by overreliance on foreign manufacturing capabilities. The transition from peacetime to crisis-and from crisis to full-scale conflict-demands rapid escalations in supply of pharmaceuticals. The objective of this research was to develop a consensus-driven list of high priority critical medicines as a basis for the creation of a North Atlantic Treaty Organization (NATO) pharmaceutical stockpile.<br />Materials and Methods: This Delphi Panel completed work started by the NATO Center of Excellence for Military Medicine to identify critical medications in July 2024. The panel involved collecting feedback across two rounds of voting from a group of subject-matter experts with background in combat casualty care and pharmaceuticals, with the goal of rating a list of critical medications on three factors on a Likert scale of 1 (low) to 9 (high): overall priority, use above baseline, and availability of alternatives. Median scores and tertiles were calculated to rate the medications in order of priority based on the aggregate statistics. Results were presented and finalized at a NATO-sponsored workshop in Poland as the final round of the Delphi in May 2025.<br />Results: The first round of the Delphi, conducted in February 2025, was a virtual, asynchronous voting round where 28 respondents participated rating and refining the initial list of 107 medications. Based on these results, 26 medications were determined high priority for stockpiling and 20 were removed from consideration. The second round took place in March 2025, and consisted of synchronous, virtual voting on the 61 medications of "uncertain priority" in the previous round. As a result, two additional medications were added to the high priority category for inclusion in stockpiles, with the final list presented for discussion in person during Round 3 containing a total of 28 critical medicines rated "high priority." Additionally, Rounds 2 and 3 resulted in discussion of alternative medications not included in the list, such as treatments for CBRNE exposures and viable alternatives for listed medications.<br />Conclusions: Ensuring availability of critical medicines during military operations and humanitarian emergencies supports the health and operational readiness of military personnel and the well-being of civilians affected by crises. By developing a systematic approach for prioritizing pharmaceuticals, this project addresses gaps in medication availability for NATO that could otherwise hinder effective response to emergencies.<br /> (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2025.)
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