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Trump's use of medical stockpile veers from past administrations, leaving states in the lurch

With a more than $7 billion medical stockpile, Trump tells states "we're not an ordering clerk."
Image: President Donald Trump at a coronavirus task force briefing at the White House on April 2, 2020.
President Donald Trump at a coronavirus task force briefing at the White House on April 2, 2020.Jabin Botsford / The Washington Post via Getty Images file

WASHINGTON — President Donald Trump is telling state governors battling the coronavirus to get ventilators and protective gear on their own, but officials who helped build the national stockpile say the trove of medical material was designed for this moment.

Triggering confusion and competition among state governments, Trump has insisted that the more than $7 billion stockpile of medical supplies is not there simply to be deployed to states, but also for the federal government to use, adding states should have had their own reserves.

Presidential son-in-law and senior adviser Jared Kushner summed it up when he said last week that it is “supposed to be our stockpile, it’s not supposed to be states’ stockpiles that they then use.”

The Strategic National Stockpile was amassed for 22 years, and those involved in both the Bush and Obama administrations say its sole purpose is to be deployed to states in a moment like this.

“The idea the stockpile is ours and the governors have got to have their own stockpile, they are changing the narrative,” said Lt. Gen. Russel Honoré, who served as the Joint Taskforce commander during Hurricane Katrina. “That is bulls---, and Jared Kushner doesn’t know what he is talking about.”

In 1998, President Bill Clinton, growing increasingly concerned about how the U.S. would respond to a bioterrorism attack, signed a law allocating $51 million for the stockpiling of drugs and vaccines.

Subsequent administrations have built up the stockpile to respond to a range of medical emergencies the country could face, from a terrorist attack to a natural disaster, like a hurricane or tornado. In addition to drugs and vaccines to treat known pathogens, the stockpile has been expanded under each previous administration to include additional medical supplies and even the ability to set up a 250-bed hospital in a disaster zone.

Much about the stockpile has been kept secret, including the locations and number of warehouses storing supplies. Past reports have said there are at least six storage facilities spread across the country, packed with $7 billion to $8 billion worth of supplies in warehouses that look like those used by Amazon or Walmart to distribute merchandise.

The center are strategically placed to be able to get supplies to anywhere in the country within 12 hours, said Thomas Frieden, who was the director of the CDC in the Obama administration.

During the H1N1 pandemic, the stockpile released a quarter of its inventory of antiviral drugs, personal protective equipment, and respiratory protection devices to help every state respond. The stockpile was also used to assist with the response to Ebola cases in the U.S. and during the Zika virus outbreaks, Frieden said.

"There isn’t an 'ours' or a 'theirs,' it’s supposed to be considered as a single, centrally managed federal resource for rapid deployment to wherever it is needed," Frieden said.

When Nicole Lurie was assistant secretary for preparedness and response during the Obama administration she said there would be a process across the government each year to look at what the priorities were and what needed to be replenished and how to get scarce resources.

“For some things it is a stopgap. For some things it is the only place that you can get those sorts of things, like an anthrax or smallpox vaccine,” Lurie said.

Under the Trump administration, the management of the stockpile was moved out of CDC and into the Department of Health and Human Services, something former CDC Director Thomas Frieden warned at the start of the coronavirus pandemic could make it more difficult for resources to be quickly and effectively allocated.

The Trump administration, after Kushner's comments last week, went so far as to change the website description for the stockpile to downplay its use by the states, removing language saying that it was intended to be used by state, local, tribal and territorial responders who "request federal assistance."

Under the Obama administration, when a state needed something, like during the H1N1 pandemic, they would put in a formal request to the federal government, which would review it and allocate what was needed to the states to then distribute to their local hospitals.

That appears to be what governors expected from the Trump administration, but instead are getting mixed results.

But as states have gone out on their own to get the supplies and equipment they need, it has created a Wild West-style system with governors competing against one another and FEMA, driving up the price and having contracts canceled when a higher bidder comes along.

While some states have received ventilators from the stockpile, New York is still short of the number needed and has continued to look elsewhere, Gov. Andrew Cuomo said last week.

The state got 1,000 ventilators over the weekend from China after the Chinese government facilitated a donation from billionaires Jack Ma and Joseph Tsai, the co-founders of the Chinese e-commerce giant Alibaba, Cuomo said. The state of Oregon volunteered to send 140 machines.

Yet Trump said on Sunday that the U.S. still had about 10,000 ventilators and was in need of accurate information from the states about the number of ventilators and other supplies they have so the federal government could determine where to send resources.

While the stockpile is massive, it wasn’t intended to have everything that would be needed for every part of the country. Instead, part of the stockpiling process during the Obama administration included developing plans for how to quickly obtain and manufacture what could be needed but wasn’t on hand, like having contracts in place to quickly scale-up manufacturing of masks, Lurie said.

“The stockpile is there as a reserve for the unfortunate times you need something that doesn’t exist anywhere else or something is in short supply in a state or local government,” Lurie said. “It was never intended to and it would be impossible to stockpile everything that one could need for any kind of contingency event that would be enough for the entire county. That is not practical or realistic.”