This document provides a comprehensive, risk-informed framework to support countries in assessing, designing, and managing medical countermeasure (MCM) stockpiles for pandemic influenza and related respiratory threats. It positions stockpiling as a complementary preparedness mechanism, distinct from routine procurement and supply chain operations, and emphasizes the need for context-specific, resource-conscious decision-making. The framework guides countries through multidimensional risk assessments—covering hazard likelihood and severity, systemic vulnerabilities, and national capacity—to determine whether and how stockpiling should be pursued. It further outlines strategic objectives, governance and policy requirements, supply chain resilience, workforce capacity, and performance monitoring necessary for effective stockpile stewardship. Overall, the document offers practical guidance to help countries strengthen preparedness and resilience by optimizing equitable access to critical MCM during public health emergencies.