WASHINGTON — Hospitals need better incentives to beef up their stockpiles of personal protective equipment (PPE) and other needed supplies in case of an emergency such as the COVID-19 pandemic, witnesses told a Senate panel on Wednesday.
“What we’ve noticed is that they don’t have supply on hand for much more than a few days,” Elizabeth Zimmerman, former associate administrator of the Office of Response and Recovery at the Federal Emergency Management Agency (FEMA), said during a Senate Homeland Security & Governmental Affairs Committee hearing on lessons learned from the pandemic. Hospitals use “just in time” inventory, she continued, “so that they can get the supplies they need for their day-to-day operations to come in, and they don’t have to also have a huge warehouse to store them. They rely on the private sector for doing that.”
“‘Just in time’ can work fine in smaller events … but when it really comes to a global event like this, ‘just in time’ doesn’t work when we don’t have manufacturing ready to go to bring in those commodities at the numbers that were needed,” Zimmerman added.
Sen. Josh Hawley (R-Mo.) asked Zimmerman how hospitals could reduce their reliance on a “just in time” model. “I think immediately we need to look at what supplies are in hand,” including in the Strategic National Stockpile, Zimmerman said. “They use the Defense Production Act to change over manufacturing from cars to ventilators, so how do we really do that? What are those key critical things that we need? Last year, we saw the PPE and the supplies that were needed by the medical first responders, so we need to make sure that we have a way of getting those within this country.”
Joseph Nimmich, a former deputy administrator at FEMA, said he had some “pretty strong opinions” about moving away from a “just in time” system. “The national stockpile is a good thing, but it’s not the only thing we can do,” he said. In addition to bringing supply manufacturing onshore and better understanding the Defense Production Act, “I think we could look at ways of incentivizing hospitals and medical facilities to keep 110% of what their daily requirements are, and that 10% the federal government or the state could reallocate to other areas,” he said. “You’ve now distributed your stockpile across the nation, and it’s closer to where you’re going to need it whenever you need it.”
Nimmich said that a Supply Chain Stabilization Task Force set up during the Trump administration by FEMA and the Defense Department “performed admirably once it had been established and they understood each other’s roles, but you have to have the infrastructure in place to understand how you’re going to do this before an event. Creating it during the event reduces that time to perform.”
Nicole Lurie, MD, former assistant secretary for preparedness and response at the Department of Health and Human Services, noted that “we experienced shortages in H1N1 and Ebola, and found that in different places in the private sector and in government, there were actually large supplies that were double- and triple- ordered, But the government didn’t necessarily have the mechanism to go to all the manufacturers and distributors and ask where it was in the system. Some clarifying authorities to be able to do that in an emergency — so you can see where it is and redistribute it quickly — I think would be very, very helpful.”
Sen. Ron Johnson (R-Wis.) asked about bringing manufacturing back to the U.S. not only for active pharmaceutical ingredients but also for precursor chemicals. Former CDC director Julie Gerberding, MD, who is now an executive vice president at Merck, responded that “all of us in the context of COVID have been examining our supply chains, not just for vaccines in the most critical countermeasures, but for our entire supply chain … Our vulnerabilities are clear now and we’re going to need to do more to make sure we can sustain our most critical, essential medicines and vaccines in times of international stress.”
China’s role in the pandemic was on the mind of Sen. Rob Portman (R-Ohio), who asked Gerberding for her thoughts on whether the CDC should have detected the scope of the disease earlier. “We had some information about the extent of spread in the Wuhan province,” said Gerberding. “We had examples of pretty well-documented spread from travelers into work settings in other parts of the world. I think the clues were there that this was a very transmissible infection, unlike SARS was in 2003.”
The other issue was testing, she added. “I think it was unlikely even under the most rehearsed scenario that we would have been able to immediately deploy a test for a brand new pathogen to 300 million people on short order, but we certainly could have utilized the tests that were available elsewhere in the world and have proven to be useful, and we could have worked much faster to bring the scale of testing up to speed with better cooperation and earlier engagement of the academic sector as well as the private sector.”
Lurie agreed. “It was clear very early on that we were going to need an awful lot of tests and tests were developed around the world — some of the worked quite well — and we couldn’t use them,” she said. “BARDA [the Biomedical Advanced Research and Development Authority] should have exercised its authorities and gotten in early on to stimulate the development of diagnostic tests across the private sector and in the academic sector, so that you would have had a variety of tests earlier.”