America’s broken PPE supply chain must be fixed now

Almost everyone knows by now that the U.S. was ill-prepared to combat Covid-19. But few realize that the structural problems in the supply chain that plagued the government’s response haven’t been fixed.

It’s crucial to address these vulnerabilities now. There’s no telling when the inevitable next health crisis will hit.

Consider the government’s disastrous distribution of emergency medical supplies. The Federal Emergency Management Agency (FEMA) is in charge of the Strategic National Stockpile of personal protective equipment (PPE) such as N95 respirators, gloves, gowns, and face shields, along with ventilators and certain pharmaceuticals, such as antibiotics and antitoxins.

Yet public records requests have shown that when the pandemic began, FEMA had no established criteria for distributing supplies to states. And the system it ultimately put in place was problematic.

It distributed PPE based on calculations that had nothing to do with the number of cases in a state. As a result, less-populous states with comparatively few Covid-19 cases, including Alaska, Hawaii, Montana, and Vermont, received the highest number of PPE items per case of Covid-19. Meanwhile, states that were besieged with cases, including California, Connecticut, and Massachusetts, received the fewest masks, gloves and shields per case.

When states did manage to get supplies from the FEMA stockpile, they often got the wrong items, and nearly always received smaller shipments than requested. Doctors and nurses were forced to reuse the same N95 masks for a week, even though they’re designed to be discarded after seeing each patient.

This federal failure of the supply chain forced states to bid against other states, as well as against the federal government, for items like medical-grade face masks and disposable gloves. At one point, bidding wars and price gouging drove the price of a ventilator that typically cost $25,000 to more than $45,000. Health care facilities were paying $5 for N95 respirators that had cost 50 cents before the pandemic emerged.

Instead of supplies going where they were truly needed, they went to the highest bidder. Frontline health care workers, patients, and taxpayers all paid a hefty price for this inefficient system.

There’s a simple way to prevent a catastrophe like this from happening again. Congress could authorize and fund a federal information-gathering and dissemination network for PPE, drugs, and other medical items. This would allow officials, likely at the Food and Drug Administration, to properly inventory and deliver health care supplies to patients and health care workers in regions of need.

Of course, monitoring and distributing stockpiles is only half the battle. The best monitoring system in the world can’t get masks or medicines to hospitals if there’s a severe nationwide shortage of them. And that’s exactly what happened last year.

Over the years, many hospitals and medical equipment distributors had become dependent on bottom-dollar manufacturers in other nations, especially China. But China restricted exports of personal protective equipment when its own coronavirus crisis began.

In response, large and small U.S. manufacturers jumped into action, investing millions of dollars in the equipment and people needed to boost domestic production of masks, hand sanitizer, face shields, and other protective gear needed to weather the pandemic, along with ventilators and other medical equipment.

But those domestic manufacturers are now facing canceled contracts, as large suppliers, hospital systems, and even state governments once again turn to overseas manufacturing. China is currently flooding the market, selling some surgical masks for one cent, while American companies are struggling to survive. The New York Times recently reported that the 27 members of the American Mask Manufacturer’s Association have laid off 50% of their workers.

Pivoting to China for supplies isn’t merely shortsighted: It’s a national security threat.

It is absolutely critical for the U.S. to boost domestic production of PPE for future health crises. That means more federal contracts, or even public-private partnerships, to build and maintain not just stockpiles of masks, medicines, and ventilators, but the spare manufacturing capacity needed to make more in a hurry. Maintaining that excess capacity would effectively act as an insurance policy that enables us to scale up production when needed.

Congress owes it to Americans to appropriately fund such supply chain investments so the General Services Administration can start soliciting bids right away.

American-made PPE might be slightly more expensive than Chinese-made equipment. But that money would be well-spent: Reestablishing trusted supply chains and maintaining spare manufacturing capacity will pay huge dividends, in both lives saved, jobs created, and economically devastating lockdowns averted.

Too many Americans needlessly died from Covid-19 because the federal government didn’t have a suitable method for managing and distributing emergency medicines and health care equipment. Congress must implement a better system before the next public health crisis strikes.

John Wharton, a U.S. Major General (retired) who most recently served as commanding general of the United States Army Research, Development and Engineering Command at Aberdeen Proving Ground, Md., currently advises global governments and major cities on risk management, infrastructure, and resiliency initiatives.