Congress Must Get Ready the Strategic National Stockpile for the Next Pandemic

Get ready. The House of Representatives will soon pursue high profile investigations into the federal government’s response to the deadly COVID-19 pandemic. Among the many topics, Congress must focus on how federal departments and agencies performed, especially the Center for Disease Control and Prevention (CDC) and the management of the Strategic National Stockpile of medical equipment and supplies.

While serving as CDC Director, I viewed the agency as the “Common Defense of the Country;” an institutional fortress, charged with providing first rate scientific information, to guard against threats to Americans’ health. The job of the CDC is to work closely with state public health departments and help them implement informed responses to local health threats, and historically the agency also managed the Strategic National Stockpile, the large repository of medical supplies stored in secret locations around the country and used in national medical emergencies like epidemics. The Federal Emergency Management Agency (FEMA) can access the stockpile, as well as state public health departments following gubernatorial requests.

In 2018, the management of the Strategic National Stockpile was removed from CDC and placed under another the Administration for Preparedness and Response (ASPR), another sub-agency of the US Department of Health and Human Services (HHS). Full disclosure: as CDC Director I opposed this move, and my team at CDC made this clear to HHS leadership.

HHS, of course, houses NIH, CDC, as well as ASPR. If this Alphabet of federal agencies sounds confusing, you grasp the essential problem. Too many separate and powerful agencies are all “in charge of” the nation’s safety and security when there is a biologic threat.

In January 2022, the Government Accountability Office (GAO), the congressional “watchdog” agency, once again highlighted HHS’s failure to clarify roles and responsibilities in meeting a national medical threat. More recently, in its October 2022 report, GAO staff reviewed ASPR’s performance managing the Strategic National Stockpile for the COVID response. They noted: “The inventory planning reports did not meet most legal requirements enacted in 2019 or communicate risks associated with not meeting recommended inventory levels”.

GAO also reported that a key advisory body was inactive after reorganization. Although the Strategic National Stockpile contained most of the things needed, they were “often not in recommended quantities.” And they further concluded that HHS and Congress “…lacks assurance the department is most effectively preparing for public health emergencies.”

Not having supplies in needed quantities certainly could have contributed to federal officials’ confusing “messaging” over whether Americans should wear face masks to prevent viral spread. Initially, top federal officials, including Dr. Anthony Fauci at NIH, advised the public not to wear masks. Then federal officials told Americans that they should wear masks and make them at home from cloth. And then they recommended states impose mask mandates- even in outdoor settings.

In January 2020, the United States recorded its first case of COVID-19. About 90 percent of personal protective equipment in the stockpile was distributed in March and April of 2020. In other words, supplies quickly diminished.

In its upcoming investigations, with a view toward preparing for the next pandemic, members of Congress should not neglect the state of the Strategic National Stockpile. They should ask: “Today, are there enough masks?” They should also ask: “Did we use our experience from Ebola, including the use of masks, to inform our response to COVID?”  The deadly Ebola virus taught us that the type of mask was extremely important. Not just any mask. Finally, they should ask, “Why wasn’t there a study done to determine the type of mask that would be required to control the COVID-19 contagion?”  Congress must press home its investigative and legislative powers to make sure that we are all safer next time.

Congress also needs to clarify federal agency roles and responsibilities. We cannot simply leave it up to federal agency officials, allowing them to be judges in their own causes, no matter how good their intentions.

Today, federal public health is overpopulated with multiple masters. That puts us at extreme risk. We need a clearly identified command center to coordinate federal agency efforts to protect public health. Ideally, it should be a Cabinet level post. That official should be charged with coordinating the team responses.

The next pandemic is just a plane ride away. Taking stock of our COVID experience, Congress must ask probing questions, and that includes getting clarity about the readiness of the Strategic National Stockpile.

Brenda Fitzgerald, MD, is the former Director of the Center for Disease Control and Prevention (CDC).