Is the strategic national stockpile ready for the next emergency? GAO says no.

The Health and Human Services Department still has not resolved systemic issues that states experienced when requesting and receiving items from the strategic national stockpile during the COVID-19 and mpox public health emergencies, according to a recent report from the Government Accountability Office.

“By improving coordination related to the SNS—both internally and externally—ahead of the next emergency, HHS will be better positioned to understand and manage challenges that might otherwise derail future responses,” the report said. 

The stockpile contains drugs, vaccines and other medical supplies that can be provided to states, localities, territories and tribes during emergencies. But, as one example, the watchdog said the main guidance document for the SNS has not been updated since 2014 and does not reflect that the Administration for Strategic Preparedness and Response is the current agency responsible for it. 

The GAO recommended that the ASPR work with the Centers for Disease Control and Prevention to clearly define each agency’s roles and responsibilities with respect to the SNS in an official document and develop procedures for how and when guidance, such as for requesting and receiving SNS items, is updated. 

In comments to the report, HHS agreed with the two recommendations and said that a third - to designate an entity to regularly engage with tribes on unique challenges for accessing the SNS - was already completed. 

The report did note that HHS created a new office focused on external coordination and developed a new system to track SNS requests. 

As part of the report, GAO surveyed public health officials from 62 jurisdictions, including all 50 states. It found: 

• For COVID-19 response, 35% of jurisdictions did not consider the process for requesting SNS items to have followed written guidance and 42% said the process for receiving such items did not conform with the guidance. 
• For mpox response, 30% of jurisdictions did not consider the process for requesting SNS items to have followed written guidance and 27% said the process for receiving such items did not conform with the guidance. 

Likewise, 24% of jurisdictions did not know who to contact during COVID-19 to request supplies from the SNS. 

The GAO in 2022 placed HHS’ leadership and coordination of public health emergencies on its high-risk list, partly due to stockpile coordination issues. 

The Senate Health, Education, Labor and Pensions Committee in 2023 advanced bipartisan pandemic preparedness and response legislation that would aim to strengthen the SNS. But action on it has since stalled.