In a new report on the US Strategic National Stockpile (SNS), the Government Accountability Office (GAO) noted that, during recent public health crises such as COVID-19 and mpox, local officials weren't clear on how and from whom to request supplies, and some tribal officials cited a lack of the facilities to receive and store delivered supplies.
The report is based on surveys conducted with health officials from 62 jurisdictions in the United States.
The SNS is supposed to help guarantee health and safety in the face of infectious disease outbreaks and crises, but both the COVID-19 pandemic and the global mpox outbreak showed that accessing the national inventory of medical countermeasures, vaccines, and medical supplies is often confusing and inefficient.
In fact, 35% of jurisdictions during COVID-19 and 30% during mpox said the process for requesting SNS inventory did not follow written guidelines.
"Jurisdictions also reported challenges related to understanding federal agencies' roles and navigating outdated guidance. These challenges led to jurisdictional confusion during response efforts," the authors wrote.
These challenges led to jurisdictional confusion during response efforts.
HHS needs to define SNS roles, departments
The GAO report found many problems with SNS accessibility, namely that the main guidance document for accessing SNS assets has not been updated since 2014 and does not reflect the agency currently responsible for the SNS.
The GAO’s first recommendation is having the Department of Health and Human Services (HHS) define and share SNS roles and develop procedures for updating guidance.
During the start of the COVID-19 pandemic in 2020, 16% of jurisdictions (10 of 62) said they did not understand enough about what assets were in the SNS inventory to plan response efforts, with some describing a pandemic "guessing game" of requests. And 24% of jurisdictions (15/62) did not know whom to contact to access the SNS in the first months of the pandemic.
Jurisdictions also said that once supplies were increased and accessed during the COVID-19 pandemic, they received no federal help to manage growing stockpiles of equipment and vaccines.
Mpox outbreak highlighted same problems
A global mpox outbreak began in the summer of 2022, but the problems seen with the SNS during 2020 remained: "According to our survey, 38 percent (23/60) of jurisdictions did not know whom to contact to request SNS assets during the mpox response," the GAO report said.
One respondent said they were given six different email addresses that they were instructed to use for ordering SNS assets during the mpox response.
Unlike the COVID-19 response, however, jurisdictions had more clarity during mpox about when requested assets would be made available. Ninety percent of jurisdictions said they knew when assets would be delivered during mpox, compared to just 42% of jurisdictions during the first months of COVID-19.
The GAO also said HHS needs to address specific problems that arose with tribal leaders accessing the SNS during both outbreaks. According to the report, guidance from the Administration for Strategic Preparedness and Response dictates that how the country's 574 diverse tribes request, receive, and store SNS assets may differ from the way jurisdictions request and receive assets.
"GAO found that Tribes experienced various concerns with requesting and receiving SNS assets. In response, an HHS working group is focused on clarifying the ways Tribes can request SNS assets, " the report read. "However, HHS has not assessed the unique challenges—such as geography and infrastructure—that could affect Tribes’ ability to receive SNS assets. "
