Washington — For more than 15 years, "Project BioShield" has guided the federal government's plan for threats and global health crises like COVID-19, amassing vaccines and other critical supplies in the Strategic National Stockpile.
The priorities paved the way for hundreds of millions of dollars in new smallpox vaccines and anthrax antibiotics, but as coronavirus has spread globally, the U.S. stockpile had only 30 million masks for health care professionals — nowhere near the amount needed.
Now in an election year, political leaders are denying responsibility, as the public tries to understand what led to the nationwide shortage of the relatively cheap N95 face masks, the protection recommended by the Centers for Disease Control and Prevention (CDC).
A review by CBS News finds that for the past decade, a combination of differing priorities, underfunding and slow responsiveness all contributed to the shortfall of masks, leaving thousands of medical professionals now at greater risk of contracting COVID-19.
At the beginning of the Obama administration in 2009, the H1N1 influenza pandemic strained emergency medical resources and forced the CDC to declare a public health emergency. More than 39 million N95 masks were sent to states from the national stockpile, according to a 2009 CDC response report. Later that year, an additional 59.5 million N95 masks were also released.
But the stockpile was never fully replenished. In February, the stockpile had only 30 million masks, according to Senate testimony by Alex Azar, the secretary of Health and Human Services (HHS), who also said the country would need at least 300 million.
Industry professionals say they had long warned of shortages.
"Since 2009, the safety equipment industry has consistently advocated that the Strategic National Stockpile should be replenished," International Safety Equipment Association President Charles Johnson told CBS News. "The original target set by the government for respirators was 100 million masks, and unfortunately that would have been insufficient for this Coronavirus outbreak."
Who's to blame?
Former stockpile overseers told CBS News that specific decisions about the national stockpile are not made public for national security reasons. The stockpile supplies are pre-packed in warehouses throughout the country and ready for transport with "rapid delivery anywhere in the United States within 12 hours of the federal decision to deploy," according to HHS.
But the priorities of each administration can be gleaned from the work at the Biomedical Advanced Research and Development Authority (BARDA), a division overseeing stockpile research at HHS. A review by CBS News of funding allocations showed similar priorities between the end of the Obama administration and into the the first two years of the Trump administration. Stockpile funding was largely devoted to ensuring the ability to respond to threats that included anthrax, smallpox and radiological or nuclear attacks. HHS estimated the necessary funding to be $325 million per year.
An administrator from the Obama administration said one focus after the 2009 H1N1 pandemic was developing new types of masks instead of restocking N95 masks that already existed in the commercial market. In the event of a crisis, the thinking went, the government could quickly buy existing models on the open market.
It was a strategy that funded three different research projects during the Obama administration and continued during the Trump administration, according to a report by HHS.
"There was a strong interest in developing better, more comfortable, reusable masks, which could then be purchased and stockpiled," Dr. Nicole Lurie, a former HHS assistant secretary for preparedness and response whose division led the stockpile from 2009 to 2017, told CBS News.
"There were also processes for getting a very rapid assessment of the entire U.S. inventory, and for ramping up quickly at the very first sign they might be needed," Lurie said.
The strategy worked well during the response to Ebola in 2014 and 2015, according to a 2016 HHS strategy plan, which noted that "the CDC developed an Ebola protective equipment "calculator tool" to work with treatment centers and hospitals to assess their ongoing needs."
"For COVID, this [rapid assessment period] would have been late December or early January of this year," Lurie said. But the ramp-up and acquisition of masks never happened.
"[Preparation] is not a partisan issue — it is more of a human issue," Michael Osterholm, author of "Deadliest Enemy: Our War Against Killer Germs," told CBS News. "Humans lack the creative imagination to understand what Mother Nature can really do."
"Since 9/11, the Bush administration, the Obama administration and the Trump administration — nobody worked to build up the stockpile," said Osterholm, who has held a health preparedness and advisory position in each of these administrations.
Nonetheless, in an already intense election year, the politics of emergency preparedness has emerged, as the nation processes the dystopian images of medical professionals improvising sheet protectors and Halloween costumes to be used as face protection.
The president's reelection campaign has been blaming the shortages in the mask stockpile on the Obama administration's most visible defender: Joe Biden, Mr. Trump's likely general election opponent.
The Obama-Biden administration "literally did not refill the stockpile," Trump campaign national press secretary Kayleigh McEnany said during a livestream on Thursday.
"President Trump is cleaning up the mess of Joe Biden," McEnany added.
Asked by CNN on Friday if the Obama administration should have replenished the mask stockpile, Biden avoided blame. "Well, we spent a lot of time — I was not part of it — our administration spent a lot of time working with the incoming Trump administration, laying out exactly what exactly could happen with a future pandemic."
"I just don't think [President Trump] has taken this seriously from the outset," Biden said.
Kathleen Sebelius, who ran HHS during the Obama administration from 2009 until 2014, suggested that it's a little late for Mr. Trump to be faulting the previous administration.
"The current occupant of the White House will blame anybody — particularly President Obama — for his failures," Sebelius told CBS News in an email. "And since the national stockpile has been 'his' for 38 months, he owns this!"
Biden began criticizing the president's COVID-19 preparedness in late January, noting "Draconian" cuts to health initiatives and staff throughout the Trump administration, and he also seems to be taking some credit for some of Mr. Trump's recent actions to address the problem. Biden, on a livestream with first responders on Friday, said the president had "finally done what some of us have recommended for some time" and ordered General Motors to produce much-needed ventilators under the Defense Protection Act (DPA), marking the first time the act was used for a health emergency.
But experts like Osterholm question the efficacy of using the DPA for the production of highly technical medical supplies, even if manufacturers are partnering with medical technology companies. "I believe General Motors was almost forced by public relations to get into this deal," Osterholm said, noting that devices like ventilators have thousands of complex parts: "They know they have no expertise making ventilators."
However, Biden says the president needs to use the DPA to order even more companies to boost production of medical equipment.
Congress has appropriated $500 million for protective equipment like masks, and Mr. Trump on Thursday announced 20 million masks had been secured by the Federal Emergency Management Agency. Mr. Trump said some were being sent to states that need them.
The former chief scientist of the Food and Drug Administration, Dr. Jesse Goodman and Lurie wrote an opinion piece recently recommending the federal government work with mask manufacturers to immediately consolidate data of federal orders to locate additional stockpiles of masks held by other federal departments.
"It cannot continue to be left to hospitals and healthcare providers to call everywhere looking for supplies," the paper states. "If we can ship cell phones and televisions for same-day delivery across the country, surely we can rise to the challenge for [masks] and ventilators."
But in the Rose Garden on Sunday evening, Mr. Trump questioned why hospitals were using masks so quickly. "How do you go from 10,, 20,000 masks to 300,000?" Mr. Trump asked with his hands up.
"Where are the masks going?" Trump continued. "Are they going out the back door?"