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NY Times, March 26, 2020
How the World’s Richest Country Ran Out of a 75-Cent Face Mask
By Farhad Manjoo
Why is the United States running out of face masks for medical workers?
How does the world’s wealthiest country find itself in such a tragic and
avoidable mess? And how long will it take to get enough protective gear,
if that’s even possible now?
I’ve spent the last few days digging into these questions, because the
shortages of protective gear, particularly face masks, has struck me as
one of the more disturbing absurdities in America’s response to this
pandemic.
Yes, it would have been nice to have had early, widespread testing for
the coronavirus, the strategy South Korea used to contain its outbreak.
It would be amazing if we can avoid running out of ventilators and
hospital space, the catastrophe that has befallen parts of Italy. But
neither matters much — in fact, no significant intervention is possible
— if health care workers cannot even come into contact with coronavirus
patients without getting sick themselves.
That’s where cheap, disposable face masks, eye protection, gloves and
gowns come in. That we failed to procure enough safety gear for medical
workers — not to mention for sick people and for the public, as some
health experts might have recommended if masks were not in such low
supply — seems astoundingly negligent.
What a small, shameful way for a strong nation to falter: For want of a
75-cent face mask, the kingdom was lost.
I am sorry to say that digging into the mask shortage does little to
assuage one’s sense of outrage. The answer to why we’re running out of
protective gear involves a very American set of capitalist pathologies —
the rise and inevitable lure of low-cost overseas manufacturing, and a
strategic failure, at the national level and in the health care
industry, to consider seriously the cascading vulnerabilities that
flowed from the incentives to reduce costs.
Perhaps the only way to address the shortfall now is to recognize that
the market is broken, and to have the government step in to immediately
spur global and domestic production. President Trump, bizarrely, has so
far resisted ordering companies to produce more supplies and equipment.
In the case of masks, manufacturers say they are moving mountains to
ramp up production, and some large companies are donating millions of
masks from their own reserves.
But given the vast global need for masks — in the United States alone,
fighting the coronavirus will consume 3.5 billion face masks, according
to an estimate by the Department of Health and Human Services —
corporate generosity will fall short. People in the mask business say it
will take a few months, at a minimum, to significantly expand production.
“We are at full capacity today, and increased production by building
another factory or extending further will take anywhere between three to
four months,” said Guillaume Laverdure, the chief operating officer of
Medicom, a Canadian company that makes masks and other protective
equipment in factories around the world.
And though some nontraditional manufacturers like T-shirt factories and
other apparel makers have announced plans to rush-produce masks, it’s
unclear that they will be able to meet required safety standards or
shift over production in time to answer demand.
Few in the protective equipment industry are surprised by the shortages,
because they’ve been predicted for years. In 2005, the George W. Bush
administration called for the coordination of domestic production and
stockpiling of protective gear in preparation for pandemic influenza. In
2006, Congress approved funds to add protective gear to a national
strategic stockpile — among other things, the stockpile collected 52
million surgical face masks and 104 million N95 respirator masks.
But about 100 million masks in the stockpile were deployed in 2009 in
the fight against the H1N1 flu pandemic, and the government never
bothered to replace them. This month, Alex Azar, secretary of health and
human services, testified that there are only about 40 million masks in
the stockpile — around 1 percent of the projected national need.
As the coronavirus began to spread in China early this year, a global
shortage of protective equipment began to look inevitable. But by then
it was too late for the American government to do much about the
problem. Two decades ago, most hospital protective gear was made
domestically. But like much of the rest of the apparel and consumer
products business, face mask manufacturing has since shifted nearly
entirely overseas. “China is a producer of 80 percent of masks
worldwide,” Laverdure said.
Hospitals began to run out of masks for the same reason that
supermarkets ran out of toilet paper — because their “just-in-time”
supply chains, which call for holding as little inventory as possible to
meet demand, are built to optimize efficiency, not resiliency.
“You’re talking about a commodity item,” said Michael J. Alkire,
president of Premier, a company that purchases medical supplies for
hospitals and health systems. In the supply chain, he said, “by
definition, there’s not going to be a lot of redundancy, because
everyone wants the low cost.”
In January, the brittle supply chain began to crack under pressure. To
deal with its own outbreak, China began to restrict exports of
protective equipment. Then other countries did as well — Taiwan,
Germany, France and India took steps to stop exports of medical
equipment. That left American hospitals to seek more and more masks from
fewer and fewer producers.
People in the industry assured me they would prepare better next time.
“We are laserlike focused to ensure that our health care systems are
never in this scenario again,” Alkire told me. “There will be a lot more
domestic manufacturing of these products going forward.”
I don’t doubt it — but that we did not plan, as a nation, for this
entirely predictable shortage makes me wonder what other inevitable
pothole is lurking out there for all to trip over. Getting enough
protective gear was among the cheapest, most effective things we could
have done to slow down the pandemic. That we failed on such an obvious
thing reveals an alarming national incapacity to imagine and prepare for
the worst.
We will get enough masks in time for the next disaster. But wouldn’t it
be nice, for once, if we prepared for trouble before it hit us in the face?
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