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Thursday, June 20th, 2024

Pandemic proves Strategic National Stockpile needs a revamp, say lawmakers, experts

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The Strategic National Stockpile (SNS), which is tasked with supplementing state and local supplies of antibiotics, vaccines and other critical drugs and medical products, woefully needs a revamp to help the nation better prepare and respond to public health emergencies like the current COVID-19 pandemic, according to lawmakers and experts.

“As the men and women working tirelessly to address the current demand develop data and models, that information needs to be captured and put to immediate use updating and redesigning the structure and management of the SNS,” said U.S. Sen. Ron Johnson (R-WI), chairman of the U.S. Senate Homeland Security and Governmental Affairs Committee.

During the committee’s Wednesday hearing held via video conference — entitled The Role of the Strategic National Stockpile in Pandemic Response — Johnson agreed with testifying witnesses that the SNS is underfunded, but said that the first step should be the development of a mission statement to better clarify, codify and articulate how the stockpile is operated, overseen, managed, and held accountable.

There seems to be a more pervasive problem of a lack of clarity and understanding of exactly what the SNS’s role is and what it should be, said Johnson.

“To the extent there has been a congressional or executive branch articulated mission statement, it has evolved over time, and outside the managing department or agency, it has not been generally understood,” he said. “We are paying the price for this lack of articulation and clarity during the current pandemic.”

U.S. Sen. Gary Peters (D-MI), ranking member of the committee, called the current SNS “a serious national security vulnerability,” a description further highlighted by the ongoing pandemic.

“Ensuring the preparedness of the Strategic National Stockpile is an issue of national security and should be treated as such. We cannot allow a disaster of this magnitude to catch our government off guard again,” said Peters. “We must provide steady funding to all pandemic response efforts and also ensure the Strategic National Stockpile is well maintained and prepared to address a broad range of possible threats.”

Sen. Peters also suggested that communication be improved between states and the federal government regarding available resources; the U.S. government’s role should be strengthened to manage supplies during such crises; and steps be taken to address the nation’s over-reliance on foreign manufacturers of critical drugs and medical supplies.

Expert witnesses agreed.

“I believe the time is now to systematically examine how to best strengthen the SNS performance to be the most effective, efficient and responsive during a pandemic,” testified Dr. Julie Gerberding, former director (2002-2009) of the Centers for Disease Control and Prevention (CDC) at the U.S. Department of Health and Human Services.

Gerberding concurred with Sen. Johnson that the core mission of the SNS should be clarified, saying the original mission – which envisioned the SNS as a lead national mechanism charged with strategically anticipating and answering the needs of states and localities across the full range of public health emergencies – must be restored.

At the same time, COVID-19 provides the United States with an opportunity to make pragmatic changes to ensure the nation avoids “becoming complacent and finding ourselves in the same position when the next pandemic occurs,” said Gerberding, who now co-chairs the Commission on Strengthening America’s Health Security at the Center for Strategic & International Studies.

The inconsistency that exists regarding what the stockpile must accomplish and at what scale have led to a ping-pong approach to preparedness — essentially just bouncing around from the last crisis to the next crisis and not building a level of preparedness, she said, noting that the federal budget determines what actually gets procured for the SNS and the current budget isn’t sufficient.

Gerberding made several recommendations to committee members, including long-term financing of capacity-building among low-income partner countries; establishing permanent leadership at the National Security Council to guarantee effective oversight of global health security and biodefense policy and spending; and enhanced commitments to accelerate new vaccines, therapies and diagnostics, among others.

Daniel Gerstein, senior policy researcher at the RAND Corp., said the federal government’s slow and inconsistent response to COVID-19 has exposed weaknesses in the nation’s preparedness and response, chief among them being the historical underfunding of the SNS.

“The stockpile contains approximately $8 billion worth of supplies and requires rotation of stocks to ensure they remain current. The annual budget is approximately $575 million,” Gerstein testified. “However, neither the stockage levels nor funding were ever considered to be adequate for large-scale biological events, certainly not ones that affected all 56 states, territories, and the District of Columbia simultaneously.”

Congressional underfunding of the SNS also has resulted in shortages in the stockpile — most notably, 85 million N-95 masks — while shortfalls in resources for state and local public health departments also have resulted in underperformance during the COVID-19 response, said Gerstein.

Among several recommendations, Gerstein said years of underfunding public health should be reversed, and he noted that perhaps an “important issue to be addressed is the utility of having the national capacity for a more operationally focused national public health enterprise.”

W. Gregory Burel, former director (2007-2020) of the SNS and president and principal consultant at Hamilton Grace LLC, agreed, saying the stockpile’s lack-of-funding constraints hindered efforts to respond to a pandemic.

“Unfortunately, this pandemic has illustrated the high cost of not making the necessary investments in public health,” Burel testified. “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.

“Our way forward must include improved funding,” he said.

Andrew Phelps, director of the Oregon Office of Emergency Management, who testified on behalf of the National Emergency Management Association, said that partnerships across the public and private sector have proved invaluable as Oregon has utilized federal, state and private industry to strengthen and maintain its supply chain during its continued and active response to COVID-19.

Overall, any failure in the nation’s response system does not rest solely with the SNS, Phelps said.

For instance, the supply chain for personal protective equipment relies too heavily on foreign entities and lacks transparency to state emergency managers, he said, adding that there’s also a lack of expectations management that exists for what the SNS can or cannot do for officials trying to manage a complicated event within their state or community.

“Moving forward, addressing such interrelated issues will allow for a more sustainable and flexible response system through which states utilize the SNS efficiently in times of critical need,” he said.