U.S. medical stockpile wasn't built to handle current crisis, former director says

The Strategic National Stockpile, a once little-known resource, has turned into a political tug-of-war as states scramble for gowns, masks, ventilators and other equipment during the coronavirus pandemic.

But it was never intended to be able to meet massive, simultaneous demand from 50 states, its former director said.

“The Strategic National Stockpile is great as a fallback" that can be tapped after private sector supplies and state and local government supplies are exhausted, said Greg Burel, who is now president and principal consultant at Hamilton Grace, a consulting firm focused on preparedness and response.

“From what I've been seeing, and you've probably seen the same thing, it seems like almost from day one, everybody's turned and looked at the SNS," Burel said in an interview with POLITICO.

President Donald Trump has blamed the Obama administration for not refilling the reserve. "The previous administration, the shelves were empty. The shelves were empty," Trump said last week.

However, the stockpile has also been underfunded for years, including during the Trump administration. The latest congressional appropriations enacted in November allotted about $700 million.

"What we had told Congress at the time though is that to get everything on the shelf that we wanted on the shelf at the time, that we needed a little over $1 billion in one appropriation and then we could smooth that out over the years,” Burel said.

The Trump administration’s official budget request for the SNS in fiscal 2020 was $705 million, or $95 million more than Congress approved for the prior year.

During the Obama administration, annual funding levels ranged around $500 million to $600 million. The Trump administration initially followed that pattern, requesting $575 million for the stockpile for both fiscal 2018 and 2019.

With the stockpile now quickly burning through badly needed supplies, Congress included $16 billion for the SNS in H.R. 748 (116), the $2 trillion coronavirus virus relief package that passed last month.

Burel noted that the added money won't go that far because of the many ventilators that the SNS has sent to states that will need to be replaced or repaired at great expense when the current crisis is over. In addition, the stockpile’s pre-crisis supplies of masks, gloves and other personal protective equipment are nearly, if not completely, gone.

“There are a large number of materials that we have invested in for a number of years that by the end of this event will be completely gone,” Burel said. “A bunch of that $16 billion is just going to be eaten up with replacing what's going out, recovering what's gone out, cleaning it and putting back on the shelves — and then to manage a future vaccine campaign.”

Vice President Mike Pence acknowledged on Tuesday that materials in the SNS had already been “largely deployed” and were only being partly restocked with shipments coming in from overseas in air cargo planes arranged by the United States. That so-called Air Bridge is intended to get vitally needed supplies to health care workers faster than can done by boat. Trump said Tuesday five more planes had landed and 27 more would be on the way in coming weeks.

All of the SNS supplies that are “clearly useful in this particular event” have probably been distributed through allocations based on each state’s population, Burel said. But Burel said there is no reason to doubt the stockpile still has supplies for its original mission, responding to the chemical, biological and nuclear events.

Agency searches for leader

Burel was director of the SNS for nearly 13 years, starting late in the Republican administration of George W. Bush. The longtime federal employee retired in December, just before the coronavirus pandemic surfaced in China.

The Department of Health and Human Services, which houses the SNS, was in the middle of a nationwide hunt for Burel’s successor when the outbreak hit the United States. The job is not a political post appointed by the president but is intended to be filled by a career civil servant.

The agency is being led by acting director Steven Adams, who has been deputy director since the agency was created in 1999.

Its origins lie in the unfounded concern that the Y2K computer problem would cause catastrophic disruptions to the nation’s infrastructure when 2000 rolled around. It was ramped up after the Sept. 11 terrorist attacks on the United States.

The exact amount of material the government has in the stockpile is a closely held secret, as are its network of warehouses around the country to store the materials. That’s a safeguard against a possible attack, as well as against local citizens mobbing the warehouse during a crisis to try to obtain supplies.

“The strategic national stockpile was never really intended to respond to a nationwide pandemic when it was established,” Burel said. “It was intended to respond to these more regionalized potential chemical, biological, radiological and nuclear events, whether they were of a terrorist nature or an accident.”

Beginning around 2005, Congress appropriated additional money for a few years to purchase supplies to respond to the threat of pandemic influenza. But those supplies were handed out to states in 2009 in response to the H1N1 pandemic and never replenished, Burel said.

While neither the Obama or the Trump administration requested funds to replenish the supplies, Congress also failed to act on its own, Burel noted. In addition, many states which previously held their own stockpiles have stopped doing that, he said.

What's needed next

The coronavirus pandemic has exposed the need for all elements of the emergency response network to keep more supplies on hand, Burel said.

That potentially means both manufacturers and hospitals keeping 60 to 90 days' worth of personal protective equipment on hand, as well as state and local governments beefing up their own supplies.

Congress should also “fully fund” the SNS to ensure it has the supplies it needs to respond to pandemics and other threats, although it will never be able to respond to all eventualities, Burel said.

The emergency response veteran also said he favors producing more of the material in the United States and supplementing that with imported supplies.

"There has to be that swell of safety stock. We can't fight this kind of pandemic event that has disrupted the supply chain beyond what the normal usage is unless there is some stock somewhere,” Burel said.