When the COVID-19 pandemic hit the United States in March 2020, it exposed the shortcomings of the nation's stockpile of emergency medical supplies.

The secretly located Strategic National Stockpile had supplies, but not enough to handle this particular pandemic. For example, there weren't sufficient N95 masks because they were used during the 2009 H1N1 outbreak.

While campaigning in 2020, Joe Biden promised to prepare the country for future pandemics by rebuilding critical health stockpiles, being able to boost manufacturing as needed and reviewing supply chain vulnerabilities. Biden has taken steps toward rebuilding the stockpile, but Congress has not provided long-term funding for it.

The Strategic National Stockpile was created in 1999 to prepare for chemical, radiological, biological or nuclear attacks. It's expanded to include tools to respond to terrorism attacks, hurricanes, the H1N1 flu and ebola. The stockpile contains supplies like N95 masks, medicines and devices that can be used when local and state supplies run out. 

Annual appropriations for the stockpile have risen in recent years, from about $705 million in fiscal year 2021 to $845 million in 2022 and $965 million in 2023. But Congress has largely ignored Biden's requests for $88 billion over five years  to prepare for biological threats and other pandemics. 

In December, the White House said it had added more at-home COVID-19 tests to the stockpile. Federal officials said that they have "hundreds of millions of N95 masks, billions of gloves, tens of millions of gowns, and over 100,000 ventilators" ready to ship out to states. 

But Biden's promise is  not exclusively related to COVID-19. New pandemics or threats can emerge, such as monkeypox. Politico reported that before the 2022 monkeypox outbreak     that officials knew for years they didn't have enough smallpox vaccine to combat monkeypox.

Ellen Carlin, a Georgetown University assistant research professor, said, "There's been movement and effort in the right direction, but it won't be enough if we were hit with another pandemic tomorrow, or even in the next couple of years."

The U.S. is already years behind where it needs to be for a stockpile that is comprehensively prepared for unknown threats, Carlin said. 

"I'm not seeing a marked pivot toward really building a no-holds-barred modern stockpile (whether physical or virtual) that can ready the nation for a quick and successful response to the next unknown virus domestically, nor one that is oriented toward helping to stop outbreaks in other nations from becoming pandemics to begin with," Carlin said.

The COVID-19 pandemic exposed weaknesses in the nation's supply chain, including its reliance on foreign manufacturing.

Biden vowed to be able to increase U.S. manufacturing during crisis, and to regularly review supply chain vulnerabilities. 

Biden in 2021 issued an executive order directing officials to identify supply chain risks and solutions for multiple industries, including health care.

The Biden administration has developed a National Strategy for a Resilient Public Health Supply Chain and elevated an office to a stand-alone agency to help handle emergencies including pandemics. 

But two supply chain experts told us that the Biden administration hasn't taken enough steps to increase domestic manufacturing. The U.S. needs a domestic manufacturing ecosystem that includes everything from new product innovation to job training to manufacturing to distribution, said Tinglong Dai, professor of operations management and business analytics at Johns Hopkins University's Carey Business School. 

A small number of U.S.-based personal protective equipment manufacturers emerged during the pandemic's first year, but they're facing "a survival crisis if they have not gone bankrupt," Dai said.

The federal government's supply chain response to monkeypox "contradicts any assumptions of progress made during the COVID-19 pandemic," in terms of our ability to respond to a surge in demand, Dai said. "I don't think the U.S. is any better off now than before in terms of being able to quickly make more supplies if we need to."

The Biden administration's solutions "are predominantly government-driven, and less about industry-driven solutions," said George Ball, an expert on supply chains and associate professor in Indiana University's Kelley School of Business. Making U.S. tax policy more attractive than overseas options will bring back manufacturing, Ball said. 

"Manufacturers respond moderately to government spending, but sustainable profitability is more likely when tax policies change," Ball said.

Where does this leave Biden's promise to rebuild health stockpiles and be ready for crises? His administration has requested more funding for the Strategic National Stockpile, added supplies to combat COVID-19, and is trying to improve U.S. supply chains. But experts say more work is needed.

We will continue to monitor progress on this promise. For now, we rate it In the Works. 

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