HIDA has recommended to the government a pandemic framework that builds on the lessons learned from the spread of COVID-19. Policymakers, healthcare providers, manufacturers and distributors have learned that they need to prepare now for future pandemics by working to
- make the supply chain more robust;
- diversify sourcing;
- expand and support surge manufacturing infrastructure; and
- prevent development of a fraudulent, opportunistic marketplace.
A national strategy must support, not supplant, the commercial supply chain. We must make available and continuously replenish medical products to satisfy massive, sustained demand from healthcare providers, consumers, first responders, states and essential workers. Planning should build on the strategy to support and leverage private infrastructure to develop a “whole supply chain” effort to leverage every global and domestic manufacturing source, medical distributor and distribution center in the U.S. to contribute in partnership with government before and during a pandemic.
The future pandemic response infrastructure should be built on a foundation of four key components:
Forward-Deployed Personal Protective Equipment (PPE) Reserve: Create stocks of federally funded and controlled pandemic supplies in up to 500 commercial distribution locations throughout the U.S., positioning inventory close to every healthcare provider and designed to meet their “first-call” needs until surge manufacturing capability can be mobilized.
Diversified Surge Manufacturing Capability: Identify and establish a strategic blend of U.S. manufacturing facilities capable of surging to meet pandemic level demand, coupled with established near-sourced and global sources of low-cost, high-volume manufacturers that can increase volume to keep customers and stockpiles supplied.
Sustainable And Replenished Stockpiles: Require centralized stockpiles to be replenished, as needed, by the surge manufacturing infrastructure to support state and local government needs during a crisis and serve as a backstop to the commercial supply chain.
End-User Aligned Supply Chains: Align distribution channels to categories of end users to avoid surge-driven competition for products that drives up prices and encourages profiteering brokers to enter the marketplace.
We must coordinate every global and domestic manufacturing source, medical distributor and distribution center in the U.S. to contribute in partnership with government agencies and planners before and during a pandemic.
Putting the framework into action: National legislation building on PAHPAI
This framework is a public-private partnership that draws on the respective strengths of the federal government and the private sector. On the public side, before a crisis, the government can set priorities regarding which products to stockpile and where to source them. It can provide the resources for “flex” reserves that can be drawn upon when a crisis suddenly drives up demand. On the private side, distributors are equipped to do what the government is not: handling the logistics of producing, managing and delivering billions of units of PPE and supplies during a time of crisis. Fortunately, there is already a model for deploying this type of partnership: the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (PAHPAI).
PAHPAI addressed all aspects of pandemic preparedness. It establishes a public-private partnership to assist the Assistant Secretary for Preparedness and Response (ASPR) in the development of various preparedness response programs. This includes the Strategic National Stockpile, the Hospital Preparedness Program and for hospitals, healthcare facilities, and other public and private sector entities in order to increase medical surge capacity before, during, and after public health emergencies. In the beginning of 2020, HHS was in the initial stages of pursuing the mandates set out in PAHPAI when the COVID-19 pandemic struck. It was already taking advantage of a productive partnership with HIDA and its members through various work groups.
A call for new legislation building on the PAHPAI model
New legislation would require a more comprehensive public-private partnership than is currently provided by PAHPAI. The establishment of a forward-deployed PPE Reserve, maintenance of dynamic national stockpiles and development of surge manufacturing capacity are interconnected issues that would require a commitment of resources and multi-year planning. Using the workgroup model, an ongoing public-private partnership would assist the ASPR and the Strategic National Stockpile to identify 1) how much of which products to have in the distributor-managed PPE Reserve 2) which products and quantities should be in Strategic National Stockpile and 3) how to work with manufacturers to develop additional capacity and production diversification.
The Medical Supplies For Pandemics Act of 2020 : H.R. 6531, the Medical Supplies for Pandemics Act of 2020, and its companion in the Senate, S. 2827, provide for the establishment of the public-private framework described in this paper. Both bills were introduced with bipartisan sponsors and support, and HIDA and its members are working for their passage.