America Needs to Mobilize its Medical Production

In order to save lives and mitigate the impacts of the economic shutdown, there is an acute need for national direction to orchestrate and coordinate medical supply production — and it needs to happen quickly.

(Photo via New York National Guard)

by Arielle Kane, Director of Health Care | Progressive Policy Institute

When the U.S.N.S. Comfort sailed past the Statue of Liberty most Americans felt something — whether it be pride or hope — there is no denying that people felt emotional to a large scale, coordinated response to help a city ravaged by COVID-19.

As this pandemic worsens, state and hospital leaders have been asking for help: they are in desperate need for personal protective equipment (PPE) for health care workers and ventilators to treat sick patients. If the United States is going to protect the health care workforce and return to normal activity, there needs to be huge increases in PPE production and distribution.

In order to save lives and mitigate the impacts of the economic shutdown, there is an acute need for national direction to orchestrate and coordinate medical supply production — and it needs to happen quickly.

Yet rather than coordinating medical supply procurement, President Donald Trump has left states to compete for limited supplies: bidding against each other and commissioning their own cargo jets to fly PPE from international suppliers back to the U.S. According to New York Governor Andrew Cuomo, this has led to them paying 10 times the normal price for medical supplies.

While Trump has invoked the Defense Production Act to make more ventilators, he has failed to make vigorous use of the full scope of its powers to spur production of everything else the country needs. The federal government could have spent the last two months expanding capacity by providing loans, expediting regulatory reviews, accelerating the customs process, and shipping goods from international suppliers to hospitals in need. But instead he has been holding daily press conferences that often result in spreading conflicting, confusing or incorrect information. The delay in coordinating efforts cost the U.S. what could have been a month of testing and slowed the spread of the virus.

Now we are in a crisis and nationwide coordination is paramount. The federal government should establish a Medical Production Board, led by a someone with deep manufacturing and distribution expertise. The production czar should be empowered to cut across bureaucratic lines of jurisdiction to increase access to medical supplies. This can either be done by working with domestic manufacturers or through expedited sourcing from abroad.

The surge in demand for PPE and ventilators has been exacerbated by a global supply chain — requiring 700 to 1,500 various components from more than 12 countries — that has broken down:

• Demand for PPE is about 100 times higher than normal. PPE makers, such as Premier, use factories in Hubei Provence, the epicenter of the pandemic in China. To combat the spread of the virus, China issued shelter in place order months ago — and work at factories was shuttered. Though work has resumed, it takes about a month to ship goods to the U.S.
• Ventilators are made by domestically by companies like G.E. but single use tubes for the ventilators are from Costa Rica, Japan and South Korea. The U.S. has an estimated 160,000 ventilators but experts predict that 740,000 could be needed if the COVID-19 is as severe as the Spanish flu of 1918.
• And while the CDC has been working overtime to develop test kits, the swabs for the sample are usually made in northern Italy. Because of the outbreak there, swabs have been in short supply.

There are roughly 160,000–200,000 ventilators in the United States but COVID-19 could lead to as many as one million patients requiring intubation, according to the Society of Critical Care Medicine. The federal government has done little to alleviate address these shortages. After waiting weeks to announce how many ventilators were in the national stockpile (12,700), some of them were delivered broken or missing parts. Furthermore, it seems that the administration is rewarding its political allies rather than directing goods to where they are most needed. States like Oklahoma and Kentucky have received more equipment than they requested, while others like Illinois, Massachusetts and Maine have received less. This has left hospitals scrambling: struggling to procure additional ventilators, repair the ones they have, and pulling older models out of storage.

The need for increased supplies will hit different cities and regions at different times as the virus moves between communities. A centralized distribution effort could help alleviate shortages and save lives. To further encourage companies to increase capacity, the federal government needs to sign long-term contracts with PPE suppliers. If the pandemic winds down, the increased supply can be used to build up the national stockpile. Companies that step in to meet demand should not be left hanging with no where to offload their goods.

Furthermore, if the country is going to return to normal activity, testing and proactively quarantining people will be necessary. This requires increased testing supplies and PPE.

The U.S. has a history of centralizing and coordinating manufacturing to meet national needs.

In the lead up the U.S. entry into WWII, automakers voluntarily began manufacturing airplane parts in 1940. After Pearl Harbor, the Office of Production Management prohibited the production of all non-military vehicles. With contracts from the federal government, automakers transitioned their factories to instead make tanks, trucks, airplanes, helmets, and ammunition under contracts issued by the government. As a result, there are no American made cars from 1941–1944.

When people talk about the lack of cars from this era, they don’t bemoan it, they cite it with pride. Because it happened with a combination of patriotic duty from domestic manufacturing companies and federal contracts to buy the goods they were producing.

We need this kind of centralized coordination and direction today.

It’s clear that domestic manufacturing companies want to rise to the occasion. Without government involvement, General Motors contracted with a small ventilator manufacturer, Ventec Life Systems, to combine manufacturing prowess with medical technology and increase ventilator supply. Furthermore, Ford and Tesla have also expressed interested in using their factories to make ventilators. But switching from manufacturing auto parts to medical equipment is time consuming and President Trump has done nothing to accelerate the process.

The problem is these efforts are uncoordinated and piecemeal. This would be tantamount to the Pentagon announcing it needed more fighter jets and missiles but failing to provide direction on the amounts needed and where they should be allocated to.

This is further compounded because of a lack of central leadership and coordination. Currently it is not clear who is in charge of the coronavirus response: Is it Vice President Mike Pence who allegedly leads the White House taskforce? Or is it Secretary of Health and Human Services Alex Azar who says he is supporting the White House effort? Or is it Jared Kushner, presidential son-in-law and adviser, who has been leading a private-sector effort to address COVID-19?

Never before has there been such a need to centralized authority to organize the acquisition and dispersal of desperately needed supplies. The Medical Production Board should be collaborative and transparent — without redundancy or competition.

States and hospitals cannot be left to fend for themselves. The single most important thing to combat the pandemic is to ramp up production of PPE, ventilators and testing supplies needed to fight virus. This is a crisis and the full power of the national government should work to meet this national imperative. If President Trump won’t do it, Congress should.