WASHINGTON — The U.S. government has a secretive, $7 billion stash of emergency medical equipment — one that it drew on to respond to the terror attacks of 9/11, to prepare for a subsequent threat of anthrax attacks in 2001, and to help thousands of homes guard against Zika with insecticide.
The outbreak of the novel coronavirus, however, marks the first potential pandemic to reach U.S. soil since the H1N1 flu of 2009, teeing up one of the biggest challenges yet for the 21-year-old store, known as the Strategic National Stockpile.
Already, the outbreak has placed significant strain on the stores of masks, medicine, and medical equipment. The stockpile has been called on to help with efforts to repatriate and quarantine Americans flown back from China and Japan, but has come under fire for a perceived shortage of masks — and for allowing millions of masks already in its stock to pass their expiration dates.
In an interview, the stockpile’s acting director Steven Adams reiterated that the SNS stocks roughly 13 million N95 masks — though health secretary Alex Azar has told lawmakers that as many as 5 million may be expired.
Adams said the federal government updated guidelines on March 1 clarifying that many older masks were still usable. All supplies in the current SNS store, a spokeswoman said, are in good working order. Adams also emphasized that the federal government had recently pledged to purchase 500 million more masks, though the order won’t be fulfilled for 18 months.
Still, public health officials have criticized the stockpile for, in some cases, failing to act with sufficient urgency. After officials in Washington state requested 233,000 respirator masks, the stockpile initially offered to supply less than half amount, the Washington Post reported. An SNS spokeswoman said the state eventually received the full requested shipment.
And the store has already proven valuable in other areas, Adams said. Beyond sending masks to hard-hit states, the stockpile helped with efforts to bring Americans in China and Japan back to the U.S., supplying protective equipment for medical workers who monitored the Americans’ health during their stays on military bases. That effort largely relied on materials stored in SNS warehouses but maintained by the National Disaster Medical System, a separate emergency medical-supply distribution network.
“We were quite involved with moving matériel to support the repatriation of State Department [employees] and other Americans from China, and then a follow-on mission of doing so from Japan,” Adams said.
Adams added that the stockpile has since “transitioned into providing support to what some would call ‘hot spot areas,’ states where they’re actively managing large numbers of patients with COVID-19,” the respiratory disease caused by the coronavirus, namely by shipping respirator masks to hard-hit regions like the Seattle metropolitan area.
The coronavirus outbreak comes at a time of significant change for the stockpile. Its longtime director, Greg Burel, retired at the end of January, according to an agency spokeswoman. Adams, the deputy director, was left at the helm in an acting capacity.
And in 2018, the Trump administration shifted control of the stockpile from the Centers for Disease Control and Prevention to an office within the Department of Health and Human Services dedicated to emergency preparedness and response.
While public health advocates have criticized the Trump administration for proposing cuts to the CDC budget and for firing a National Security Council staffer overseeing global pandemic response, few opposed shifting control of the stockpile from CDC to its parent agency, HHS.
Irwin Redlener, a Columbia University public health professor, said it makes more sense to house the stockpile under the Office of the Assistant Secretary for Planning and Response, which oversees emergency preparedness efforts.
“I actually think it’s been good to have it over at ASPR,” he said.
The stockpile was established in 1999 with the goal of guarding against both pandemics and threats of bioterrorism, including substances like anthrax and botulism. With roughly 200 employees, the SNS maintains 12 sites across the country, but keeps their location classified, citing security concerns.
While the locations are secret, much of the warehouse’s inventory is public: Recent SNS contracts include a $1.5 billion deal to restock its shelves with smallpox vaccine, and a number of other nine-figure contracts for expensive pharmaceuticals that health officials hope they’ll never need.
Pandemic-preparedness experts and former public health officials sing the stockpile’s praises. Tommy Thompson, the former Wisconsin governor and health secretary during the George W. Bush administration, recalled relying on the SNS in the hours following the Sept. 11 terrorist attacks.
“When 9/11 happened, we were able to get a plane in the air from CDC to deliver 50 tons of medical supplies up to the city of New York by 5 o’clock the day of 9/11,” he said. “And then we were able to get 100,000 masks delivered out of our stockpile to the city of New York that same evening, and gloves the next day — 200,000 pairs.”
During Thompson’s tenure, he recalled, he pushed to increase the number of stockpile warehouse locations from eight to the current 12 — an effort, he said, to ensure the network was up to the task of quickly supplying locations across the 50 states and U.S. territories with emergency medical supplies on hours’ notice.
“They have gloves, they have masks, they have medicines, they have scales to weigh ingredients,” Thompson said. “They have a full supply of things to fight infectious diseases and viruses like we’re experiencing now.”
Adams, the acting director, also emphasized the SNS’ readiness. Should the current crisis worsen, he said, the stockpile stands ready with supplies of oral and intravenous antibiotics and other medical equipment that could prove useful. But beyond surgical masks and respirators, hospitals and local health departments haven’t yet found those items in short supply.
“That’s something that we are in a position to provide support for around our pandemic influenza planning and other disaster planning,” Adams said. “But that’s not been an area of need.”