The Strategic National Stockpile (SNS), originally called the National Pharmaceutical Stockpile (NPS), is the United States' national repository of antibiotics, vaccines, chemical antidotes, antitoxins, and other critical medical supplies. Its website states: "The Strategic National Stockpile's role is to supplement state and local supplies during public health emergencies. Many states have products stockpiled, as well. The supplies, medicines, and devices for life-saving care contained in the stockpile can be used as a short-term stopgap buffer when the immediate supply of adequate amounts of these materials may not be immediately available."
Locations The actual supply of drugs and supplies that make up the SNS are located in 12 secret locations strategically placed throughout the US. The locations appear to look like ordinary commercial warehouses. Inside the warehouses, supplies are stacked on shelves that can measure five stories high. Armed personnel guard the warehouse contents and, according to NPR in 2020, during the COVID-19 global pandemic, "rows of ventilators, which can support people who are having trouble breathing, are kept charged up and ready to roll at a moment's notice."
Composition The SNS holds a variety of items that would be helpful to the general population in the event of a widespread disease outbreak.
12-hour push pack Each push pack weighs about . Its contents include broad-spectrum oral and intravenous antibiotics, emergency medicines, IV fluids and kits, airway equipment, bandages, vaccines, antitoxins, and ventilators. The material deploys by unmarked trucks and airplanes within 12 hours of the receipt of a request by the CDC. The U.S. Marshals Service provides armed security from these federal sites to local destinations. The SNS has adequate vaccines and countermeasures in its stockpile, including 300 million smallpox treatment courses and enough anthrax vaccines to handle a three-city incident.
CHEMPACK CHEMPACKs contain nerve agent antidotes to help in the event of a nerve agent attack or industrial accident. As of 2015, 1,960 CHEMPACKs were forward-deployed in more than 1,340 locations across every state and territory of the United States.
History
Cold War era
During the first decade of the Cold War, the United States accumulated a civil defense medical stockpile at 32 storage facilities. The supplies began to degrade in the 1960s, and were disposed of and the stockpile program closed in 1974.Coronavirus: Strategic National Stockpile was ready, but not for this
Clinton administration
In April 1998, President Bill Clinton read the Richard Preston novel The Cobra Event, a fiction book about a mad scientist spreading a virus throughout New York City. As a result, Clinton held a meeting with scientists and cabinet officials to discuss the threat of bioterrorism. He was so impressed that he asked the experts to meet with senior-level aides at the Department of Defense and in the Department of Health and Human Services. At that time, the government had stockpiles of medications for military personnel, but did not have them for civilians. Shortly after, The Washington Post wrote that Clinton surprised many in Washington at how fast he and his National Security Council had moved to change that. By October, Clinton signed into law a new budget of $51 million for prescription drugs and vaccine stockpiling to be carried out by the CDC.
The US Congress appropriated funds for the CDC to create a prescription drug and vaccine stockpile to handle biological and chemical threats from disease that could affect large numbers of the US civilian population, in Public Law 105–277 dated October 21, 1998. The original name was the National Pharmaceutical Stockpile (NPS) program, but additional materials have been added to the stockpile since the original authorization.
Bush administration
The federal government implemented a pandemic blueprint for distribution of Personal Protective Equipment (PPE) from the Strategic National Stockpile, in coordination with public and private efforts.
On March 1, 2003, the NPS was renamed the Strategic National Stockpile (SNS) program with joint management by Department of Homeland Security and Department of Health and Human Services.
In 2005 and in preparation for a predictable pandemic influenza, the Bush administration called for the coordination of domestic production and stockpiling of PPE. In 2006, the US Congress funded the integration of protective equipment to a Strategic National Stockpile: 52 million surgical masks and 104 million N95 air-filtration masks were acquired and added.
Public Health Emergency lists large-scale deployments from the SNS in response to emergencies.
The SNS successfully deployed 12-hour "push packages" to New York City and Washington, D.C., in response to the September 11 attacks, and managed inventory (MI) to numerous locations in response to the anthrax terrorist attacks of 2001.
Following the landfall of Hurricanes Katrina and Rita on the Gulf coast of Mississippi and Louisiana in September 2005, the CDC deployed SNS assets, technical assistance, and response units, plus the newly developed and rapidly deployable "federal medical contingency stations" to state-approved locations near or in the disaster areas. The contingency stations, later renamed Federal Medical Stations (FMS), are caches of equipment and supplies provided by the SNS, set up in local "buildings of opportunity" and staffed by local or federal medical personnel to provide triage, low acuity care, and temporary holding of displaced patients for whom local acute care systems are damaged or destroyed.
Obama administration Since the original deployment following Hurricane Katrina, FMSs have been deployed to support other major disaster responses including Superstorm Sandy. The FMS program is a collaboration between CDC and the Office of Emergency Management under the HHS Assistant Secretary for Preparedness and Response. In 2014, responding to stakeholder feedback, a 50-bed FMS cache was developed and made available in addition to the original 250-bed FMS.HHS, ASPR FMS Concept of Operation, 2014
The SNS released one-quarter of its antiviral drug inventory (Tamiflu and Relenza), personal protective equipment (PPE), and respiratory protection devices, to help every US state respond to the H1N1 Influenza 2009 swine influenza outbreak in the United States.
After the 2009 flu pandemic in which tens of millions of masks were distributed, fiscal constraints imposed by the agency's $600 million annual budget led officials to decide that replenishing a large inventory of N95 face masks was of less priority than stockpiling other equipment and drugs for diseases and disasters.
First Trump administration
During the first Trump administration, Trump falsely claimed his administration inherited an ‘empty’ stockpile from the previous administration.D'Angelo Gore Trump Falsely Claims He Inherited ‘Empty’ Stockpile April 3, 2020 FactCheck.org
From 2017 to 2019, the Trump administration failed to replace masks and other supplies used in earlier disasters. In May 2020, in a House subcommittee meeting, whistle-blower Dr. Rick Bright, previous director of Department of Health and Human Services’ Biomedical Advanced Research and Development Authority, explained that the Trump administration had ignored his early warnings to stock up on masks and other supplies to combat the coronavirus.
The Office of the Assistant Secretary for Preparedness and Response (ASPR) of the Department of Health and Human Services managed the Strategic National Stockpile from October 1, 2018. Prior to that, the stockpile was managed by the Centers for Disease Control and Prevention (CDC).
2020 COVID-19 pandemic
At the beginning of the COVID-19 pandemic, SNS was involved in providing supplies to the repatriation efforts of State Department employees from China and Japan. It also shipped thousands of N95 masks to the states of Washington, Massachusetts, and New York to respond to their surging infection rates. In March 2020, SNS director Steven Adams said it had stockpiled 13 million masks and had placed an order for 500 million more by September 2021. The SNS was criticized for containing over 5 million expired masks.
In the early stages of the pandemic the availability of mechanical ventilators to sustain patients became a serious concern. The stockpile had added ventilators to its inventory during the 2000s and 2010s and established plans to distribute them, although a series of studies and reports expressed doubt that the ventilators would be sufficient in an influenza pandemic. Although ventilators were ordered for the stockpile under the Defense Production Act, medical practices shifted toward other respiratory treatments as understanding of the disease improved, resulting in a surplus of unused machines.
On March 29, 2020, HHS accepted a donation of 30 million doses of hydroxychloroquine sulfate from Sandoz and one million doses of Resochin (chloroquine phosphate) from Bayer Pharmaceuticals for use in treating hospitalized COVID-19 patients or in clinical trials. The SNS will work with the Federal Emergency Management Agency (FEMA) to deliver the doses to states. The U.S. Food and Drug Administration later withdrew Emergency Use Authorization for these drugs after studies found they had no benefit for treating COVID-19.
On April 1, 2020, Department of Homeland Security officials told reporters that the cache of personal protective equipment stored by the SNS was almost depleted due to the COVID-19 pandemic in the United States. This was later confirmed by President Donald Trump. PPE from the SNS was sent directly to health facilities across the country.
During the COVID-19 pandemic, states criticized the lack of availability of medical supplies from the federal stockpile. At a White House press conference on April 2, 2020, senior advisor Jared Kushner commented "The notion of the federal stockpile was it's supposed to be our stockpile. It's not supposed to be states' stockpiles that they then use." The idea that the stockpile was not a backup for states that run out of supplies was disputed by Governor Laura Kelly of Kansas, among others.
The description of the stockpile, as listed on its website, was changed the day after Kushner's remarks to better align with them, from: "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. When state, local, tribal, and territorial responders request federal assistance to support their response efforts, the stockpile ensures that the right medicines and supplies get to those who need them most during an emergency. Organized for scalable response to a variety of public health threats, this repository contains enough supplies to respond to multiple large-scale emergencies simultaneously." to: "The Strategic National Stockpile's role is to supplement state and local supplies during public health emergencies. Many states have products stockpiled, as well. The supplies, medicines, and devices for life-saving care contained in the stockpile can be used as a short-term stopgap buffer when the immediate supply of adequate amounts of these materials may not be immediately available."
Washington State announced on April 5, 2020, that it would return more than 400 ventilators it had received from the Stockpile "... to help states facing higher numbers of COVID-19 cases."