To some extent, the President was right. The Obama administration used and failed to replace stockpiles to fight the H1N1 swine flu pandemic in 2009.
But Trump also did not replace these items, despite repeated warnings that the country was ill-prepared for a pandemic, said inventory experts.
Critics of the president also ignored a key point: the stock was never intended – or funded – to be a panacea for a pandemic. Rather, it is a piece of the global supply chain puzzle during a disaster.
Stock shortages quickly became apparent during the coronavirus pandemic – a devastating health crisis that experts have long predicted. Trump has delayed reaching deals with the private sector and invoking the Defense Production Act (DPA) to produce more medical supplies, making the situation worse. And states – bidding against each other and to other countries for supplies at high margins – turned to quick relief from the stock, only to find it under-stocked and the federal administrators overseeing it in the disarray.
The situation was further complicated when a whistleblower alleged this week that the system for deciding what to put in the stock had been corrupted by outside lobbyists and political decision-making, rather than by science.
“The people who sort of thought it was a bottomless pit filled with anything they could imagine were not paying attention,” said Tara O’Toole, doctor and former head of the Department of Homeland Security which has previously chaired an advisory committee on the stock.
If politicians were surprised to find out, “then shame on them,” she said.
Asked why his administration hadn’t replenished the bare closets he complained about, Trump suggested in an interview on Tuesday that he was too busy dealing with the scandals – the president called them “hoaxes” – which tainted the first three years of his administration.
“Well, I’ll be honest with you,” David Muir, Trump told ABC News Anchor. “I have (had) a lot going on. “
“The difference between life and death”
States quickly realized that the stock was not going to be their savior.
The federal government has assured Illinois that hundreds of thousands of N95 respirators are on the way, said Illinois deputy governor Christian Mitchell. But when the trucks arrived, the masks turned out to be surgical masks – insufficient protection for health workers treating patients with the devastating virus.
The difference in masks is “the difference between life and death,” for front-line health workers, said Mitchell. “What we took out of the national strategic stock was not what we promised or was due to us. “
Similar complaints have arisen across the country. Some states have questioned whether supplies are distributed fairly. Others said they had received supplies that had passed their expiration date, had deteriorated, or were not properly maintained.
When California received 170 fans from the non-working federal inventory, it called on Bloom Energy, which normally produces clean energy fuel cells, to help refurbish the machines.
“The only feedback we got was, ‘These fans aren’t working,'” said Susan Brennan, director of operations for Bloom.
The fans had never been used, but they hadn’t been prepared either, and no preventive maintenance had been done, said Brennan. The Bloom team replaced the batteries, calibrated the oxygen settings, tested the air flow rates and returned the rehabilitated fans in about 24 hours.
There were also maintenance issues with the remaining supplies in the inventory. The government has held 10,000 fans in reserve for a coronavirus outbreak, Trump said in April. But about 20 percent of the fans were unfit for deployment due to a breach of the government’s contract to service the machines, a source familiar with the matter said.
A spokesperson for the Department of Health and Human Services said, “All the fans deployed from the SNS are in working order and maintained according to the original manufacturer’s specifications described in the service manual. “
The HHS Inspector General announced last month that he would audit the effective management of the stock during the coronavirus crisis.
“We have always looked at aspects of the Department’s planning and response to emergencies,” said a spokesman for the Inspector General. “In this case, however, the ongoing public health crisis triggered this review. “
Greg Burel compared his work as Director of National Strategic Storage to managing a Home Depot for disasters. He kept track of some $ 8 billion in supplies and oversaw an annual budget of several hundred million dollars.
Despite his national security clearance ending with his retirement in January, a related nondisclosure agreement prevents him from saying much more about the secret national hideout that he has overseen for almost 13 years.
It will not say exactly how many facilities – which are classified – or what exactly is there – also classified.
“We keep it pretty much secret. The reason we do it is that a determined enemy cannot understand how to hurt us, “said Burel. “If someone knows what’s in there, he can say, ‘Well, if he can handle the zombie apocalypse, but he can’t do anything else, well, we will do something else. “”
Yet bits of the stock’s history can be gleaned from Congressional testimony, government websites, and obscure publications such as the Domestic Preparedness Journal, in which Burel wrote a three-part series on the SNS shortly. before retirement.
The stock was created in 1999 when there were fears of a bioterrorism attack coinciding with the failover of the Y2K computer. Nicknamed the National Pharmaceutical Stockpile at the time, the idea was to establish and maintain an adequate supply of drugs and medical equipment in strategic locations in the United States to be able to quickly assist states and local communities. following an attack with agents such as anthrax, smallpox, plague or other pathogens.
This year 2000 attack never came. But the stock was exploited following another catastrophe shortly after: on September 11, 2001, the planes delivering supplies of stock to New York were the only authorized flights in the American sky other than the military planes and Air Force One.
Following September 11, the stock received its current name: National Strategic Storage. It was used again in the early 2000s in response to a series of anthrax attacks in the United States, and ultimately provided enough drugs to treat up to 12 million people.
Since the SNS was used in response to a variety of disasters, from epidemics of Zika, Ebola and botulism to floods and 10 major hurricanes, including Katrina, Sandy and Maria.
The most comparable event to the Covid-19 crisis occurred in 2009, when the SNS was used to strengthen the response to the H1N1 swine flu pandemic. In 2003, under the George W. Bush administration, Burel said he had started stockpiling huge quantities of antiviral drugs and supplies in preparation for an influenza pandemic. It marked the first departure from its initial mission to prepare for a terrorist attack.
When H1N1 struck, the stock triggered its largest deployment to date – millions of drugs, masks and other protective equipment for health workers in all 50 states.
These supplies have never been restocked, in part because Congress has refused repeated requests from the Obama administration to increase funding.
Burel said the normally low-key SNS had received more attention following the Covid-19 crisis than at any time in its history.
One problem with all this attention, he said, is that “everyone infers when it was supposed to be the place to get everything you need for any type of health care event . But the reality is that it was never designed for this. And he was never funded for it. “
Enough supplies? “Well, of course not”
It was no secret that the United States did not have sufficient supplies to fight a pandemic. Experts have been saying this to politicians for years. Warnings continued in the Trump administration before the pandemic, which transferred management of the SNS from the Centers for Disease Control and Prevention to another branch of the HHS.
Robert Kadlec, the assistant secretary for preparedness and response who is now in charge of the stock, prioritized the preparation of a bioterrorism attack on a natural pandemic, he said in a recent Washington Post interview.
Still, he warned a congressional panel in December that “supply chain issues are among the most important challenges in preparing for an influenza pandemic as well as other infectious diseases.”
Kadlec said that America depended on overseas production for everything from gloves to pharmaceuticals.
“In a pandemic environment, this dependence could become a national security issue, as we saw during the 2009 H1N1 pandemic,” said Kadlec.
When HHS secretary Alex Azar appeared before lawmakers in February in search of additional funds to fight the coronavirus, senators asked what was already available in the stock.
Azar told them there were masks and respirators on hand.
When asked if there was enough, he replied, “Well, of course not. … This is a serious potential health problem without precedent in the world and will require additional measures. “
“It’s supposed to be our stock”
Disappointing returns from the stock and an erratic overall response from the federal government had already shaken states’ confidence in the administration.
Then came Jared Kushner.
When Kushner, the president’s senior adviser and son-in-law, was charged with working on the supply chain, it first sighed in relief, according to several government sources.
The idea of a contact person seemed a step in the right direction after the heads of HHS and the Federal Emergency Management Agency spent a month defining their respective roles in ramping up production personal protective equipment and tests required for Covid-19’s response.
But the enthusiasm quickly dissipated as it became clear that Kushner’s involvement added more confusion to the already chaotic response, said a source.
Appearing in the briefing room in early April, Kushner said: “The notion of federal stock was that it was supposed to be our stock; it’s not supposed to be state stocks they use next. “
Kushner’s assessment has flown in the face of the official stock definition of his website.
The language was quickly changed a day after Kushner’s declaration to get closer to its interpretation.
Officials across the country have been depraved.
For Illinois, it was another sign that they were alone in replenishing essential medical supplies. He left the state in a “Lord of the Flies” battle for supplies against other states and countries, Mitchell said.
“If I can get a mask, an N95 mask for a healthcare worker in the state of Illinois, it can very often mean that there is a healthcare worker in Wisconsin or Michigan or Georgia or California that no longer has an N95 mask, “said Mitchell. “We have been opposed to each other in a way that will literally cost us lives that could have been saved and that are in the White House. “
Mitchell said he was also concerned that states would be left on their own – fighting in an international auction war – to acquire a life-saving vaccine once it was available.
“Based on what we have seen, this is not a crazy scenario,” he said.
HHS spokesperson said stock is not responsible for vaccine distribution but “SNS is now working with federal and commercial supply chain partners to ensure that ancillary supplies such as needles and syringes are produced and available in sufficient quantities for a national vaccination campaign once the vaccine is made available. “
“When I took over, it was an empty box,” the president said during a briefing in March. “And I don’t just blame President Obama. You are well before. “
During the H1N1 flu pandemic, the stock distributed 12.5 million antiviral regiments, 19.6 million pieces of PPE and 85.1 million N95 masks, according to a 2016 report from the National Academies of Sciences, Engineering and Medicine.
The Obama administration did not replace these supplies, and the Trump administration did not take the initiative to do so until it found itself in the midst of a global pandemic.
The United States needed 3.5 billion N95 respirators for a “serious event,” HHS Kadlec told the Senate in March. There were only 12 million in stock, Azar said in February, as well as an additional 5 million N95s that he said had passed their expiration date.
It took weeks for politicians and healthcare workers to openly beg for supplies before Trump flipped the switch on the DPA and launched public-private partnerships to alleviate shortages.
A few months before the administration accelerated production, at least one large mask maker contacted the federal government to warn that shortages were imminent. But Kadlec and others have ignored repeated offers from the mask maker to increase production, according to the whistleblower’s complaint by Dr. Rick Bright, a senior HHS official and one of Kadlec’s deputies.
When the administration finally entered into production agreements, it would take even longer for American manufacturers, who have moved so much production abroad, to develop their production capacity in the United States.
When Moldex-Metric, the second largest manufacturer of disposable respirators in the United States, won a major mask manufacturing contract with HHS, it also began to look for ways to add equipment and lines of production.
“There is little capacity to manufacture them in the United States. Most of the manufacturers here have their factories, and we can operate them 24/7, “said James Hornstein, general counsel for Moldex-Metric, last month. After H1N1, “No one came to us and said that we want you to increase your automated manufacturing lines, so you can do more when you turn on the switch. “
The failure to keep American cupboards filled with essential medical supplies spreads through administration and party lines.
Public health and national security experts say politicians have yet to address public health issues, such as emerging infectious diseases and the fragile supply chain around them, as a serious threat to national security.
Pointing the stock “is the fact that politicians are distracting from the fact that they were basically careless,” said O’Toole.
Profitable contracts based on political relationships »
In a whistleblower’s complaint Tuesday, Bright said the stockpile’s mission had been compromised by politics long before it started making headlines about the coronavirus.
Bright has been involved in the purchase of drugs and other materials for the SNS and said he was pressured “to award lucrative contracts based on political relationships and cronyism”.
Bright, who was reassigned from his post as director of the Biomedical and Advanced Research Development Authority, said the pressure included a “disproportionate role” played by a pharmaceutical consultant who represented a company whose CEO is said to have ties to Kushner.
Bright’s complaint details Kadlec’s alleged efforts to direct contracts with the companies represented by the industry consultant with whom he had “a long-standing relationship.”
In one case, Kadlec paid $ 40 million to SNS to finance a drug that expert advisers deem “inferior” to the alternatives, according to the complaint. In another case which was the subject of a generation of inspectors investigation, a $ 55 million contract was awarded – despite the objection of expert advisers – to a company that the consultant represented, according to the complaint from Bright.
Bright’s allegations reflect the concerns raised by Tom Frieden, who was director of the CDC under Obama.
In an interview with CNN last month, Frieden lamented what he called the “flawed, politicized and corrupt” transfer of the SNC from the CDC to the Kadlec office in late 2018.
Other experts on the stock supported the change, but Frieden said the change ushered in a new standard for the way the SNS did business.
“Before, the decision was how to save the most lives,” he said. “Now, this is how to satisfy the most lobbyists. “
Kadlec could not be reached to comment on Bright’s complaint. A statement released by HHS after it was filed on Tuesday did not provide a detailed response to the document.
A “10 times” larger stock
There are signs that the administration is already rethinking how to prepare the stock for the next disaster. Congress has allocated $ 16 billion in one of the coronavirus relief programs to boost the supply of supplies such as masks, respirators and pharmaceuticals.
Trump has sworn, “We are building our stock again like crazy. And White House business advisor Peter Navarro said the United States needed “bigger and better insurance policies.”
“So we’re going to be looking at stocks that are probably 10 times the size,” Navarro said last week during a visit to a General Motors fan factory.
Despite assurances, a FEMA spokesperson said, “So far, no effort is being made to rebuild the stock. The available inventory is used to meet the urgent needs of states to help mitigate PPE burning rates. “
Experts are skeptical that a stock of any size can adequately prepare the United States unless there are other changes, including larger domestic manufacturing of medical supplies and a commitment of hospitals to keep more protective equipment on hand.
“We cannot store our output from these situations, regardless of the size of the stock,” said O’Toole. “We have taken our eyes off the ball by allowing our entire supply chain to move to other countries. “
Navarro said the administration “would also think differently about how stocks actually exist”, which could include ensuring that American manufacturers have spare capacity that they can quickly put online if crisis.
Burel is watching the crisis unfold from his new post as president of a consulting firm. He left his position as inventory manager on January 3, 2020, the retirement date he had planned for shortly after he started working for the government as an intern.
If he had known in advance that Covid-19 was coming, he said, “I would have delayed everything.”
On the sidelines, he said he hoped that this crisis would result in a permanent increase in its funding rather than a punctual infusion.
“If the country wants the SNS to be the savior of this sort of thing,” Burel told CNN, “Congress will have to be told to fund it.”
The price to pay for this, he said, would be in the billions of dollars a year.
Katelyn Polantz, Kristen Holmes and Priscilla Alvarez of CNN contributed to this report.