As of this writing, 922 U.S. health care workers have died fighting COVID-19, with nearly one-third lacking adequate amounts of personal protective equipment (PPE) during the initial months of the disease’s outbreak. In those early months, global supply chain issues and the rapid depletion of Strategic National Stockpile (SNS) resources illustrated serious gaps in America’s pandemic preparedness. Today, we continue to feel the ramifications as parents, educators and students face an uncertain return to the classroom.
In the future, these shortages could be avoided through the creation of something similar to the SNS: Strategic State Stockpiles.
States need to play a larger role in pandemic preparedness to “fill the gap” if, and when, the federal government is unable to do so. They can build independent emergency medical stockpiles mirroring the SNS, but with an emphasis on low-cost, high-yield items such as PPE and portable ventilators. This would allow states to protect against the types of shortages we’ve seen during this pandemic while keeping within their budgets.
Although the Strategic National Stockpile exists as an effective short-term stopgap to provide essential emergency medical materials while the private sector ramps up production demand, its effectiveness during a months-long pandemic is limited, given its construction. The SNS was designed to serve as a resource for acute, regionalized public health emergencies (e.g., bioterror attacks, floods, hurricanes), and the emergency preparedness network operates on an assumption that unaffected states can help heavily affected states during an emergency. It is an effective strategy during hurricanes or tornadoes, but not as much during pandemics. Thus, a structural gap remains that could be best addressed by the states.
In many ways, pandemic preparedness funding is analogous to investments in higher education. The return on investment may take time to materialize, but when those benefits do occur, they are invaluable.
For instance, Jonas Salk’s 1955 discovery of the polio vaccine at the University of Pittsburgh offered incalculable benefits to society after a decade of research. Similarly, University of North Carolina researchers worked since 2014 to help develop the most effective antiviral medication to date: Gilead’s Remdesivir. Just as investments in higher education can provide incalculable long-term benefits, so too can calculated investments in pandemic preparedness.
While states don’t possess the same buying power as the federal government, they hold more precise knowledge of their own emergency medical needs and how to strategically apportion state funds. Thus, state stockpiles should focus on bulk-purchasing less-expensive but highly essential PPE to supply the health care workforce, essential workers, and (potentially) the general public.
More-expensive investments (e.g., high-end respirators, bulk vaccine orders) should only occur prudently or be deferred to the federal government, so as to maximize state funds. Hypothetically, this would have paid dividends in the school re-opening debate.
For months, school systems debated whether to reopen in the fall, with teachers hesitant to return to the classroom without proper protection, sanitation, and ventilation. In fact, some teachers never received the PPE promised to them upon reopening. Had the states possessed readily available caches of N95 masks and face shields, educators could have been made safer without waiting on delayed supply chains. Tragically, stories of young teachers — aged 28 and 34 — contracting COVID-19 and passing away from the disease now exist.
Moreover, if state stockpiles provided PPE for schools in advance, the news about FEMA no longer funding cloth face masks in schools would be less contentious (or unnecessary), and the agency could divert pandemic funds elsewhere.
What’s more, nursing home and long-term care communities account for more than 40 percent of all COVID-19 related deaths but represent just 0.6 percent of the population. Nearly nine months into the virus, 1-in-5 nursing homes still report severe shortages in PPE. Shockingly, 22 states report between 50 to 81 percent of all COVID-19 deaths occurring within long-term care facilities. Four states — Minnesota, Connecticut, Rhode Island, New Hampshire — admit figures above 70 percent. In the future, it is imperative to outfit nursing homes and long-term care facilities immediately with proper PPE, which can only be realized when PPE supplies already exist to meet local demand.
Pandemic preparedness is often thought about as an abstract concept. But preparedness requires tangible products. The concept of Strategic State Stockpiles makes the abstract concrete and provides a material foundation for America to construct an effective future pandemic response.
Mark E. Dornauer is a visiting fellow at the Foundation for Research on Equal Opportunity. Previously, he oversaw the writing of pandemic response strategies relating to the Strategic National Stockpile and medical countermeasures for the U.S. Department of Health and Human Services.