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America’s emergency medical stockpile is almost empty. Nobody knows what happens next.

The Trump administration apparently wants states to take care of themselves before bugging the federal government.

A photo of a highway near downtown Los Angeles with almost no traffic during rush hour on April 2, 2020.
Few cars occupy the Arroyo Seco Parkway toward downtown Los Angeles during rush hour on April 2, 2020, during the coronavirus pandemic.
Mark J. Terrill/AP
Adam Clark Estes is the technology editor of Vox. Prior to joining Vox, Estes covered the intersection of technology and politics at Gizmodo, Vice, and the Atlantic.

The Strategic National Stockpile, a relatively obscure office in the federal government that manages the country’s emergency medical supplies, exists to respond to a crisis like the coronavirus pandemic.

As the United States faces hundreds of thousands of Covid-19 cases, a widespread shortage of medical supplies is reaching a critical point. States lacking essential equipment like ventilators and masks need relief quickly. But as President Donald Trump struggles to coordinate a cohesive response to the pandemic — fighting with state governors over how these supplies will be distributed and reportedly seizing shipments from private companies before distributing supplies to political allies — the stockpile is becoming a contentious subject. It’s also starting to run out of supplies.

That’s why Jared Kushner, senior adviser to the president, prompted controversy when he made a rare public appearance at the April 2 coronavirus task force briefing and commented on the federal stockpile. When asked about states’ needs for supplies, Kushner said the stockpile was “supposed to be our stockpile.” The president’s son-in-law added, “It’s not supposed to be states’ stockpiles that they then use.”

Then, the following morning, the Strategic National Stockpile website had been changed to deemphasize its commitment to helping states and to downplay the size of its inventory. This particular description online now refers to the federal stockpile as “a short-term stopgap buffer.”

Part of this new definition of the Strategic National Stockpile does reside in the general vicinity of reality. The stockpile is running low. The Trump administration admits it. And no, this is not the states’ fault. But it’s not entirely clear what will happen when it’s emptied out.

What is the Strategic National Stockpile, anyway?

The Strategic National Stockpile, like the nuclear arsenal, is something government officials hoped they would never need to use. Formed in 1999 as anxiety over Y2K mounted, this federal stockpile was designed to prevent an interruption to hospital supply chains, if all the computers ended up melting down on New Year’s Eve. That never happened, but because biological attacks were becoming a growing threat, the US government outfitted the stockpile in the interest of national security. If a bioweapon struck an American city, for example, officials could quickly access vaccines and antitoxins to fight back against nerve agents or diseases like smallpox.

These biological countermeasures still exist and are stored in six warehouses located in strategic, undisclosed locations across the country, where they are maintained by a staff of about 200. The exact inventory of the Strategic National Stockpile is classified, though journalists have reported that it contains over 1,000 categories of drugs and medical items worth about $8 billion.

In the 20 years since the stockpile was established, it was first mobilized after 9/11 and the anthrax attacks that followed. Later, the US government deployed it in response to various major hurricanes, as well as to the H1N1 pandemic in 2009-2010, during which the stockpile sent flu medication to all 50 states.

Since then, the office of the Strategic National Stockpile has been preparing for the next outbreak, though no one knew when or what it would be. With an annual budget of about $600 million, the stockpile has maintained a large supply of personal protective equipment, including N95 masks, face shields, and surgical gowns, as well as medical equipment like the ventilators that hospitals so urgently need now to treat Covid-19 patients.

A significant challenge is that many of these items have a shelf life.

“Part of stockpiling is not just accruing the necessary equipment, but also maintaining it and replacing it as needed,” Andrew Lakoff, a professor of sociology at the University of Southern California who studies health preparedness, told Recode. “So it’s sort of an ongoing, indefinite process that takes a lot of resources that may or may not prove to be necessary.”

A woman stands on transport-ready containers at a US Strategic National Stockpile warehouse.
A woman stands on transport-ready containers at a US Strategic National Stockpile warehouse.
Courtesy of Centers for Disease Control and Prevention

While the Strategic National Stockpile was originally part of the Centers for Disease Control and Prevention (CDC), the Trump administration moved it to a different part of the Health and Human Services Department in 2018. At the time, this concerned certain experts and lawmakers, who worried that the move could disrupt the delicate process of managing the stockpile. As the Washington Post reported at the time, some even worried then that the Trump administration’s plan would “politicize decision-making about products bought for the stockpile.”

It’s important to note that the mission of the Strategic National Stockpile is ultimately of limited scope. As spelled out in the law that established it, the federal stockpile is intended “to provide for and optimize the emergency health security of the United States.” The word “emergency” does a lot of work in that sentence.

Richard Branson, a respiratory care specialist and professor at the University of Cincinnati Medical Center who advises the federal government on ventilator supplies, explained to Recode that the federal stockpile was designed to meet initial needs in a crisis, until industry could ramp up production. Because ventilators are such specialized pieces of equipment with parts sourced from all over the world, quickly manufacturing more is a uniquely difficult challenge.

“This is the first time in 20 years ventilators from the stockpile have been used,” Branson told Recode. “If last year, you had known that fact and there were 80,000 ventilators in the stockpile that had never been deployed, you would be asking me why this money was wasted while people went without health care.”

But there aren’t actually 80,000 ventilators in the federal stockpile. As of early March, the Strategic National Stockpile only had 16,600 ventilators. It has even fewer now: On April 3, the Federal Emergency Management Agency (FEMA) told Recode the federal government has just 9,800 ventilators available. There are 9,054 remaining in the Strategic National Stockpile, and the Department of Defense has 900.

New York Gov. Andrew Cuomo said that just his state, which is currently at the epicenter of the pandemic, will need as many as 37,000 ventilators at the peak of the outbreak. After waiting for relief from the Trump administration, Cuomo ultimately enlisted the National Guard to relocate ventilators from upstate facilities to New York City. As far as the rest of the country is concerned, it’s safe to say that the Strategic National Stockpile isn’t even close to meeting the overall demand that’s expected during the coronavirus pandemic.

Besides ventilators, the Strategic National Stockpile is running low on other urgently needed supplies as well. On April 1, the Washington Post reported that the federal stockpile’s stock of personal protective equipment, including N95 masks, was almost depleted. A Department of Homeland Security official told the paper that the stockpile was only “designed to respond to a handful of cities,” pointing to a global shortage of these products.

And experts and lawmakers are concerned that the Trump administration’s uneven distribution of supplies is driven by political goals. In early March, when Washington state requested 233,000 N95 respirators and 200,000 surgical masks, the Strategic National Stockpile sent them less than half that amount. Illinois, Massachusetts, and Maine also said they received fractions of what they requested from the federal government.

But on March 10, after Washington’s request, Florida asked for 430,000 surgical masks, 180,000 N95 respirators, and other equipment. The full order arrived three days later. One anonymous official told the Washington Post, “The president knows Florida is so important for his reelection … He pays close attention to what Florida wants.”

Trump’s brazen behavior isn’t going unnoticed. Adam Schiff, chair of the House Intelligence Committee, said that in the distribution of medical supplies there should be “no favoritism in terms of political allies, no discrimination against states or governors based on lack of presidential flattery.”

Sen. Cory Gardner of Colorado sent a letter to the Health and Human Services inspector general requesting an investigation into the Strategic National Stockpile’s supply of ventilators. Gardner told Politico that “any kind of mismanagement or abuse needs to be rooted out and those responsible held accountable.” And Connecticut Gov. Ned Lamont called the state of the stockpile “disturbing.”

Senior White House adviser Jared Kushner and President Donald Trump stand next to each other during a press briefing.
Senior White House adviser Jared Kushner and President Donald Trump speak in the press briefing room with members of the White House Coronavirus Task Force on April 2, 2020, in Washington, DC.
Win McNamee/Getty Images

After Trump declared a national emergency over the novel coronavirus crisis on March 13, he told states to order their own medical supplies, kicking off a process that has led to governors entering bidding wars with each other and even with the federal government over essential goods like ventilators and N95 masks. “It’s like being on eBay with 50 other states, bidding on a ventilator,” Cuomo said in a daily press briefing at the end of March.

“What we’re seeing now is a sort of competition on the open market among states trying get ahold of stuff that the stockpile doesn’t have enough of — or is running out of,” said Lakoff, the USC professor. “Everyone’s scrambling to try to figure out how to get ahold of this stuff.”

What happens when the stockpile is emptied

We don’t really know what happens when the Strategic National Stockpile runs out of essential supplies. But we might learn soon enough.

“FEMA planning assumptions for Covid-19 pandemic response acknowledged that the Strategic National Stockpile alone could not fulfill all requirements at the state and tribal level,” a FEMA spokesperson told Recode. “Therefore, the federal government will exhaust all means to identify and attain medical and other supplies needed to combat the virus.” The agency added that it would meet additional demand through the private sector or the Pentagon.

This effort includes a public-private partnership called Project Airbridge which will include 20 flights transporting supplies from Asia to various cities in the US in early April. FEMA says these flights are transporting masks, gloves, goggles, and surgical gowns, all of which go first to medical distributors and then to hospitals and health care facilities. The new project is not without its own controversy. In the days after its launch, several state and local governments as well as private hospitals reported that the federal government was confiscating their shipments of medical supplies in order to redistribute them as it saw fit. This practice would directly contradict the Trump administration’s earlier statements about states fending for themselves.

Trump has also invoked the Defense Production Act to order GM to begin producing ventilators and 3M to produce more N95 masks domestically, as well as ordering 3M to cease exports of these products. (3M has warned, for what it’s worth, that ceasing exports will actually make the mask shortage in the US worse.)

Meanwhile, private corporations and everyday Americans have been making an enormous effort to fill in the gaps the government has failed to close. Elon Musk has promised that his companies, Tesla and SpaceX, will start building ventilators. Hobbyists are coming up with new designs for cheap breathing machines that can be built out of simple materials. Automotive parts factories have changed their workflows to start producing face shields and other supplies, and a movement of people sewing face masks out of leftover fabric is taking the country by storm. Put quaintly, everybody is doing their best.

The federal government, on the other hand, seems to be getting worse at dealing with the Covid-19 crisis. After spending the first two months of the year denying the severity of the coronavirus outbreak, it’s now clear that the Trump administration has settled on deflecting blame and establishing a posture of unaccountability. As Vox’s Matthew Yglesias puts it, the “federal government, led by Donald Trump, has essentially abdicated its traditional role of spearheading a coordinated response.” Coming up with a response, it seems, is the states’ problem.

This is what makes the shifting role of the Strategic National Stockpile so frustrating for so many people right now. Before Kushner’s appearance at the coronavirus task force briefing, the stockpile’s website said the “Strategic National Stockpile is the nation’s largest supply of life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.” The following morning it read, “The Strategic National Stockpile’s role is to supplement state and local supplies during public health emergencies.”

So the stockpile that was designed to help the entire nation in an emergency is now a backup plan. Also, it’s basically gone. What Kushner said about the federal government not being there to help out with supplies? Unfortunately, that’s true. The states are on their own, and that reality is starting to sink in.

Update, April 7, 11:15 am ET: This piece has been updated to include reports of the federal government confiscating medical supplies from state and local governments.

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