A secretive cache of medical supplies to save Americans from deadly disasters for years lacked the funding to prepare for a pandemic as widespread as the coronavirus, former managers of the stockpile told USA TODAY.
Overseen by a cadre of scientists, disease specialists and others at the U.S. Department of Health and Human Services, the Strategic National Stockpile houses roughly $8 billion in inventory for rapid deployment to anywhere in the nation in under 12 hours.
But its inadequate supply of ventilators, respiratory masks and other personal protective equipment will leave critical shortages for U.S. hospitals scrambling to respond to the mounting coronavirus pandemic.
New York state requested 30,000 ventilators, and New York City alone asked for 15,000 of them, as well as for 3 million N95 masks. California has requested 10,000 ventilators and 20 million N95 masks.
The stockpile had just 16,600 of the breathing machines and an estimated 12 million N95 masks at the start of the pandemic – not enough for those two states, much less the rest of the country.
Year after year, former managers say, they were forced to choose between spending its annual budget – which for the past six year has averaged $595 million – on various threats like anthrax or flu or botulism. But could never properly prepare for the kind of mass event now sickening tens of thousands and killing hundreds.
The shortage of masks and other supplies for the coronavirus response reflects a federal failure to prepare for medical emergencies, said Andrew Sole, managing member of a company with stakes in a producer of an antiviral medication to combat smallpox. Sole is upset the stockpile didn’t acquire more of the medication he believes is needed.
“If COVID-19 tells us anything, it tells us we are firmly unprepared for any biological outbreak, intentional or otherwise,” Sole wrote in an email. “The government’s belief that it can simply order up more drug(s) in a potential outbreak has been proven as pure folly in that it took them weeks to order, produce and deliver millions of N95 masks.”
Health and Human Services officials didn’t respond to requests for comment late Thursday.
Priorities for stockpile spending shift based on the perceptions of current threats and their urgency, said Deborah Levy, chair of epidemiology at the University of Nebraska Medical Center, who oversaw the stockpile as acting division director under the CDC in 2013-2014.
The further a public health event like SARS or the H1N1 flu pandemic recedes into history, the less money goes to responding to such threats, Levy said.
Spending decisions are made by a group of experts at the Health and Human Services’ Public Health Emergency Medical Countermeasures Enterprise that include Homeland Security, the CDC and the Department of Defense.
“There is never enough money there for everything,” Levy said. “You need to decide what the threat is, what the cost is, what can be negotiated with companies.”
The problem is twofold, said Greg Burel, director of the stockpile for more than a decade before retiring in January. The stockpile has limited funds, and it must use them to buy costly treatments that aren’t mass-manufactured because the afflictions are so rare.
For example, its botulism antidotes have a short shelf life and limited use. Even though such outbreaks may happen only once in a generation – such as a 2015 botulism poisoning that sickened more than two dozen people and killed one in Ohio – if the stockpile doesn’t purchase them, they won’t get produced.
“If we stop buying it, it’s not going to be made,” Burel said. “And if it stopped being made, you can’t get it made again instantaneously if you need it.”
The stockpile’s budget reached a high of $596 million in 2010, then dropped year after year until reaching a low of $477 million in 2013. Much of the funding was restored the following year, but the budget stayed flat at about $575 million through 2018 – the same year it was transferred from the CDC to the Office of the Assistant Secretary for Preparedness and Response.
The 2020 budget appropriation was $705 million.
But the repository was never designed to meet every need, Levy and Burel said. It was meant to serve as a backup plan for state and local health officials to weather sporadic crises – and, in particular, terrorist attacks, including biological, chemical, or radiation.
“We have found ourselves in a perfect storm today in that we saw an immediate cut-off of product that was coming from outside the United States,” Burel said, referring to the critically needed personal protective equipment, including N95 masks.
“Secondly, the next thing that happened is, there were immediate surge requirements where people tried to stock up on this product as we started to hear about coronavirus and cases started to appear in advance. So that was putting additional pressure on the limited supply that is being made in the United States.”
U.S. manufacturers began getting hit with big orders from Asia in mid-January, said Dan Glucksman, public affairs director for the International Safety Equipment Association. Because they had little inventory in warehouses, they quickly began hiring and ramping up production with triple shifts.
Companies are putting out product as fast as they can and he has not heard of any materials shortages, he said. “I think the crunch they’re under is maintaining a three-shift force while also making sure the workers themselves don’t get coronavirus.”
At Bullen Ultrasonics, a family-owned company in Eaton, Ohio, that produces glass wafers for pressure sensors used in ventilators, workers are rushing to try to make them in two weeks when it usually takes eight.
“The U.S. government has come to our customers and said, ‘We need you to ramp up production. Anything you have we’ll take,’” company president Tim Beatty said.
The company anticipated a ventilator shortage might be looming a few months ago, he said, and was able to stock up on the supplies it needed beforehand.
But the International Safety Equipment Association began warning stockpile managers of a mask shortage in 2009, Glucksman said. When he’d ask about it year after year, he said: “The answer was, ’We’re studying this. We’re evaluating that.’ And, of course, we now know they never did.”
The stockpile received special funds to purchase N95 respirator masks before the 2009 flu pandemic. It distributed 85 million of them, according to Shirley Mabry, logistics branch chief at the Division of Strategic National Stockpile, in a 2015 presentation.
But, afterward, it never fully replenished its supply.
“Once we used it,” Burel said, “the money was not there to rebuy it.”
Contributing: Dennis Wagner, USA TODAY, and Katie Wedell, Erin Mansfield and Doug Caruso, USA TODAY NETWORK