We've all heard the harrowing, heart-wrenching accounts of brave doctors and nurses short on critical supplies treating COVID-19 patients at overcrowded hospitals. To many, it is inconceivable how a country with the resources of the United States has found itself scrambling to obtain and manufacture masks, ventilators and other life-saving personal protective equipment and supplies in real-time.
Much attention has been focused on the Strategic National Stockpile (SNS), which has received more press coverage in the last two weeks than since its creation in 1999. Ideally, this scrutiny will lead to more robust funding and support for this national asset. Unfortunately, it also may undermine this highly capable organization, potentially compromising its mission.
Though relatively unknown to the general public before March, the question of why the SNS was allegedly ill-equipped to do its job is now burning in the minds of many. But even the framing of this question reflects a blatant misunderstanding of the Strategic National Stockpile.
Albeit a convenient scapegoat for those seeking one, the SNS was never envisioned to be the first stop in response to pandemics and emerging infectious disease. Instead, its primary purpose was to prepare for potential chemical, biological, radiological and nuclear events. Over time its highly specialized material and medical logistics capabilities became apparent, and it gradually expanded to an all-hazards mission. Instead of "mission creep," we experienced "mission gallop." Such a leap cannot occur, however, without corresponding increases in funding.
So, while it is reasonable to question why the Stockpile lacked sufficient medical supplies for COVID -19 response, the answer, perhaps an unpopular one, is three-fold.
First, the law requires a threat-based annual review to drive decisions around funding. However, Congress has never funded the SNS at a level that would enable it to be even close to a comprehensive source of every necessary supply in a pandemic. In the early 2000s, Congress authorized funds for a minimal level of pandemic influenza supplies, including PPE. Those items were largely depleted following a highly successful response to the 2009 H1N1 pandemic flu and were never reauthorized. Dr. Robert Kadlec, the assistant secretary for Preparedness And Response (ASPR) at HHS, could not have been more clear in his 2018 testimony to Congress when he stated that that the agency is "working with half an aircraft carrier" to address the needs of 320 million people in the event of a public health emergency.
Second, while critical, the SNS was also designed to be just one piece of the public health preparedness puzzle. The commercial market must take responsibility for developing flexibility in a currently very lean, just in time system. Safety stocks to withstand any supply chain disruption must be accumulated at points of care and at other vital links in that chain.
Third, public health generally and preparedness specifically must be funded at all levels of government. Before H1N1, many states were invested in their stockpiles that the SNS could supplement and replenish. Following the 2008 financial crisis, these state stockpiles were some of the first programs to be slashed.
Notably, the law requires that SNS prioritize products unavailable in the commercial market. Simply put, many things procured by the SNS wouldn't be developed or manufactured otherwise. A 2015 botulism outbreak in Ohio proved far less deadly because the SNS mobilized to distribute a large quantity of antitoxin for the those affected, many gravely ill. Many other critical vaccines and therapeutics which would prevent mass loss of life, from bioterrorism, for example, wouldn't exist without SNS investing its limited monies to buy them.
Recent proposals questioning whether SNS should be moved from HHS are nothing short of reckless. There is no organization in either the government or the private sector better prepared to handle complex rapid medical logistics than SNS, including DoD, and it should remain under HHS.
It is for good reason that the SNS has been the envy of the preparedness experts all over the world. Its record of achievement in accomplishing its intended mission is exemplary. If we now want this critical strategic asset to surpass prior expectations, we must fund accordingly.
Our national health security is threatened. We wouldn't expect the U.S. military to go into battle with half of its firepower. And we cannot expect the SNS to arm our nation for success against an invisible yet ruthless enemy without the necessary resources to do so.
Greg Burel is president at Hamilton Grace LLC, a consulting firm focused on preparedness and response. He served as the Office of the Assistant Secretary for Preparedness and Response (ASPR) Director of the Strategic National Stockpile (SNS) from March 2007 until late last year. Before his leadership at SNS, Mr. Burel developed an extensive background in federal government service that began in 1982. In 2016 Mr. Burel was awarded the Samuel J. Heyman Service to America Medal for Management Excellence and selected as a Fellow, National Academy of Public Administration (NAPA).