Health Systems Need Better Options to Address the PPE Shortage

Ratan B. Milevoj, MBA

From education to public safety, the COVID-19 pandemic revealed countless fractures in nearly every system in the nation. Perhaps most troubling, the global outbreak shed light on failures to protect our most essential workers. Nowhere was this failure more apparent than the shortage of life-saving personal protective equipment for healthcare professionals.

Before the pandemic, my own institution — a 358-bed pediatric hospital in Central California — was using just over two dozen N95 masks a day. By the middle of the pandemic, we were using more than 1,000 daily — a 3,000% increase.

We were overwhelmed with need.

Desperation to protect patients and staff led hospital leadership to convene an internal task force to explore solutions to acquiring PPE, including manufacturing our own supplies. Even after hundreds of hours attempting to develop a plan, however, we continued to reach the same conclusion: producing PPE would be too costly and fail to meet California’s environmental regulations.

We were discouraged, especially as we witnessed how PPE shortages were having a measurable impact on quality of care, risk of patient-to-patient transmission, staff fear and burnout, and increased exposure to the disease among frontline workers.

How We Got Here

Today, almost 90% of the PPE supply in the U.S. is made in Asia, where environmental laws are less stringent and production costs far lower than domestic manufacturing. According to the Children’s Hospital Association Group Purchasing Organization, while the domestic manufacture of PPE at the scale required at the peak of the pandemic may have been feasible in the short-term, the long-term path to produce PPE in the U.S. is practically impossible.

This reality is exacerbated by new legislation that requires health systems to maintain reserves of PPE. In the past year alone, Congress introduced just under 100 pieces of legislation related to the pandemic. And at the state level, additional PPE mandates — including California’s Healthcare and Essential Workers Protection Act — require that institutions establish a pandemic-level PPE stockpile for healthcare workers and essential workers. Hospitals and healthcare facilities must also maintain a stockpile of new, unexpired PPE for use in a health emergency.

This is an untenable bind for health systems struggling to provide PPE to their workforce.

As the dust of COVID-19 settles, it’s imperative that we create a sustainable PPE supply chain for the next pandemic, as well as interrogate the market factors that led to the shortage. We cannot continue to rely on a supply chain that causes confusion, costly competition, and puts healthcare workers and the populations they serve at undue risk.

Now’s the time to harness the same innovation that drove vaccine discovery and develop creative solutions to ensure protection and safety. Because if there’s one thing the pandemic has made clear, it’s that the health of every individual contributes to the collective health of our nation. We can do better.

Ratan B. Milevoj, MBA, is a fellow of The Carol Emmott Foundation and the Director of Innovation and Organizational Renewal at Valley Children’s Healthcare