Strategic Stockpiling: How New State Policies will Impact Emergency Preparedness

September 09, 2024 | Maggie Nilz

Preparedness is a vital component of public health, especially in the wake of the Mpox response and ongoing H5N1 outbreak. As states work to implement lessons learned from these events, stockpiling essential supplies is a critical part of the discussion. Stockpiling ensures that resources are available during emergencies allowing for a swift and effective response. To enhance preparedness policy, it’s important to understand the history of the Strategic National Stockpile (SNS) and how it has shaped recent state readiness legislation.

Understanding Stockpiling

Stockpiling in public health is the strategic accumulation of critical medical (e.g., PPE, ventilators, medications, and medical countermeasures) and non-medical supplies (e.g., food, water, shelter materials) to prepare for unforeseen emergencies. This cache acts as a safeguard, ensuring that resources remain readily available when demand spikes unexpectedly during natural disasters, pandemics, or other crises, and the market may not have time to rapidly produce needed supplies. Strategic stockpiling can mean the difference between a well-coordinated, rapid response and a delayed and chaotic one.

The Strategic National Stockpile (SNS) is not just a national repository and primary stockpile of critical medical supplies maintained by the federal government; it's a lifeline. Its primary purpose is to supplement and resupply state and local public health agencies during emergencies. Since its inception, the SNS has evolved to address various public health threats, from bioterrorism to pandemics to natural disasters, often responding to multiple large-scale emergencies simultaneously. The SNS contains many supplies and equipment, including vaccines, antibiotics, chemical antidotes, antitoxins, and other critical materials. These items are selected based on their necessity for treating or preventing the most likely public health emergencies.

The federal government, specifically HHS, manages the SNS through the Administration for Strategic Preparedness and Response (ASPR). During emergencies, supplies are distributed to states based on specific protocols prioritizing areas with the greatest need. In the face of a public health threat, state, tribal, local, or territorial health officials may request federal SNS assistance. Requests come from a governor or their designee in a state, tribal entity, directly funded city, or territory; this federal-state coordination is crucial.

Maintaining and distributing the SNS presents significant logistical challenges (e.g., dealing with product expiration and complex distribution of supplies). The COVID-19 pandemic highlighted the opportunities for better coordination between federal and state levels and more robust stockpiling strategies to prevent shortages. Recently, the Senate Health, Education, Labor, and Pensions Committee considered specific language revisions to the current statute that would strengthen the Public Health Emergency Medical Countermeasures Enterprise and require the U.S. Government Accountability Office to evaluate the impact of regional stockpiling. Such revisions include recommendations to extend state stockpile pilot programs through 2028, improve interstate coordination through a consortium, and require a threat-based review of the SNS.

State Actions

To date in 2024, several states have proposed or enacted policies to bolster preparedness efforts through stockpiling, including at least four states considering bills that would change how stockpiling is managed at the state level.

Statewide Stockpiles

• California AB 2101 requires the State Department of Public Health to establish a statewide strategic stockpile in coordination with the Office of Emergency Services and other relevant coordinators.
• Pennsylvania HB 2368 establishes a program to create an emergency stockpile and procure medical countermeasures, including issuing RFPs to administer the program and contract with third parties.
• Massachusetts H 732 would task the Massachusetts Emergency Management Agency to establish a permanent state-wide emergency stockpile in collaboration with other stakeholders.

New Jersey has four bills related to stockpiling specific items, and two additional bills.

• A 4580 requires the Division of Purchase and Property to contract for PPE procurement for a stockpile, with distribution managed by the Office of Emergency Management (OEM) during public health emergencies.
• S 3215 directs the OEM and other entities to establish a process for evaluating and approving PPE, prioritizing New Jersey-based manufacturers for stockpiling.
• A 3571 requires the Department of Health to maintain an adequate emergency stockpile of insulin
• A 3500 creates a stockpile of protective masks for first responders.
• A 4325 gives the Department of Health authority to directly purchase medical countermeasures if necessary for public health and safety.
• A 1483 establishes a disaster relief grant program to provide local municipalities with supply stockpiles and technology.

As states refine their stockpiling strategies, ongoing assessment and adaptation will be paramount to future successes. The path forward involves strengthening federal-state coordination, ensuring stockpiles remain up-to-date and sufficient, and directly addressing the shortcomings exposed during recent crises. By prioritizing continuous evaluation, states can proactively identify areas for improvement and strategically deploy resources to safeguard public health when it matters most. A robust, adaptable stockpiling system is not merely a policy goal—it is a vital investment in the resilience and well-being of our communities.