PPE Supply Chain Needs Data Transparency and Stress Testing
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Johns Hopkins University, Carey Business School, Baltimore, USA; 2Johns Hopkins University, School of Nursing, Baltimore, USA; 3Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA; 4Johns Hopkins University, School of Medicine, Baltimore, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-05987-9 © Society of General Internal Medicine 2020
the ongoing COVID-19 pandemic, the USA is D uring experiencing a severe shortage of personal protective equipment (PPE) that threatens care delivery and the safety of medical staff.1 In a normal year, the USA spends approximately $5 billion on PPE, with imports constituting more than 20% of the supply.2 Specialized PPE is particularly dependent on imports. For example, an estimated 90% of N95 masks are imported, mostly from China. This heavy dependence on foreign-made specialized PPE makes its supply chain vulnerable and exposes health care workers and patients to substantial risks. When countries, states, cities, hospitals, and clinicians are all competing for the same limited international supply during the pandemic, the risks are escalated to crises that challenge public health and national health security. By some estimate, clinicians account for nearly 20% of the COVID-19-infected cases in the USA.3 This is in contrast to countries such as Singapore and South Korea where clinicians have been rarely infected due to sufficient domestically supplied PPE. The current shortage of PPE in the USA, especially N95 masks, is predictable and preventable. Both the 2009 H1N1 influenza pandemic and the 2014 Ebola virus epidemic exposed a shortage of domestically produced PPE. On February 25, 2020, Alex Azar, the Health and Human Services Secretary, informed Congress that at least 300 million N95 masks were required for the upcoming battle against coronavirus and there were only 30 million available in the Strategic National Stockpile. In spite of these and other warnings, the supply of PPE continues to be severely limited and dependent on international supply with devastating impact on clinicians treating COVID-19 patients. The USA stands out as a developed economy—ranked No. 1 in health care spending4—that failed to improve the availability of crucial PPE. Many other economies, in contrast, were able to successfully ramp up their production capacity
Received May 14, 2020 Accepted June 12, 2020
of PPE within a short period of time. For example, a consortium of Taiwanese manufacturers built a daily capacity of 15 million masks, making Taiwan the second largest producer of medical masks in the world in a matter of weeks. Supply chain management theory categorizes products into four types, depending on their internal value and external supply risks. The internal value captures the importance of the product to the mission, whereas the external supply risk measures “supply scarcity, pace of technology and/or materials substitution, entry barriers, logistics cost or complexity, and monopoly or oligopoly conditions.”5 High-value, highrisk product categories, such as N95 ma
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