Drivers and consequences of influenza antiviral resistant-strain emergence in a capacity-constrained pandemic response

► Optimal use of antivirals in a pandemic to avoid drug resistance remains uncertain. ► We considered this question in a model that incorporated drug delivery constraints. ► In consequence, achievable drug coverage and intervention impact were reduced. ► Selective pressure for resistance was also lower - only highly fit mutants dominated. ► Our work shows the importance of real world constraints in scenario analysis modeling.