U.S. Pandemic Could Severely Strain Face Mask, Other PPE Supply Pipeline

Fears of an avian influenza or Severe Acute Respiratory Syndrome (SARS)-like pandemic in the United States may have subsided somewhat in the years since H5N1 first ravaged parts of Asia, but concerns linger about our nation’s supply of face masks should a pandemic erupt. Pandemic planning is an imperfect science because it is difficult to impossible to know when and where the outbreak will occur, as well as the duration and severity of the event. Also, it is challenging to predict which influenza strains will be implicated in a pandemic outbreak, with annual influenza strains often evading public health experts’ forecasts and scientists’ formulations for the current season’s flu vaccines.

According to the Pandemic Influenza Plan of the Department of Health and Human Services (DHHS), the U.S. must have a national stockpile of 40 million doses (two doses per person) of vaccine against influenza virus subtypes considered to pose a substantial pandemic risk (currently avian H5N1). Additionally, the plan calls for domestic influenza vaccine manufacturing capacity to produce sufficient pandemic vaccine for the U.S. population within six months of the onset of an influenza pandemic. The plan also calls for the availability of at least 81 million treatment courses of approved antiviral drugs, enough for treatment of approximately one-quarter of the U.S. population, and 6 million additional treatment courses in reserve for domestic containment. The plan alludes briefly to the necessity of maintaining equipment and supplies in the Strategic National Stockpile (SNS) and state stockpiles sufficient to enhance medical surge capacity.¹

Influenza vaccines and antiviral drugs are normally the first defense against the flu, but availability and immediacy could be problematic during a pandemic. A pandemic may be particularly devastating because human populations will have little, if any, baseline immunity to an entirely new, mutated viral strain. What is critical to remember is that during a pandemic, the primary prevention strategies of vaccines and antiviral prophylaxes are likely to be either unavailable or initially limited in quantity and availability, so reliance upon secondary prevention strategies, including the use of face masks and respiratory etiquette, may be more of a last resort. In the absence of primary prevention, measures to prevent or slow transmission of the virus in both the healthcare and community sectors must be used. Such measures include isolating patients, limiting contacts with infected persons, and otherwise minimizing the likelihood of exposure to the virus, as well as frequent handwashing and requiring infected individuals to be quarantined or equipped with medical masks that might limit respiratory transmission of the virus.²