Evolution of the global emergency vaccine stockpile system

INTRODUCTION: The emergence of epidemic-prone diseases continues to pose a threat to global health. Vaccine stockpiles allow effective and timely response to outbreaks. Global stockpiles have been established for multiple vaccines, but stockpile management has evolved in recent years, both in the number of globally managed stockpiles and in stockpile strategy, from a reactive to a more integrated approach bridging with preventive strategies. AREAS COVERED: We conducted a review of published and gray literature to provide an update on the evolution of stockpile management in recent years (2014-2025), specifically for cholera, yellow fever, polio, meningococcus, COVID-19, Ebola, and mpox. EXPERT OPINION: The benefit of accelerated development of new vaccines and medical countermeasures to fight epidemic-prone diseases cannot be achieved without efficient and transparent stockpile management and distribution mechanisms, to ensure equitable and needs-based allocation.