As the COVID-19 epidemic exploded across the United States in 2020, America’s supply of personal protective equipment collapsed. Some healthcare facilities were so desperate that people were turning to plastic trash bags as a substitute for medical gowns.
In New Hampshire, tech entrepreneur Dean Kamen made headlines by using his business contacts to arrange for a cargo plane full of desperately needed PPE to fly to the state.
How did the greatest manufacturing nation in history find itself in such desperate straits during a public health emergency? One key detail in the Kamen story provides the answer: He had to fly the PPE from China.
According to the International Trade Commission, by 2019, more than 70 percent of the U.S. supply of face masks and respirators was produced in China. About half of all surgical gowns and gloves were also from China.
In the wake of the COVID crisis, steps were taken to ensure the United States would never again be caught unprepared. The strategic national stockpile of PPE — depleted during the H1N1 epidemic and never replenished — has since been restored to a 90-day supply.
However, advocacy groups and industry leaders warn that global health threats remain ever-present, and more work needs to be done to ensure a reliable, domestic supply of healthcare equipment.
“The need for a robust domestic PPE supply is clearer than ever,” said Eric Axel, executive director of the American Medical Manufacturers Association, a group representing domestic PPE manufacturers. “Disasters don’t wait, and ongoing crises demand a manufacturing base right here in America.”
The PPE shortage also triggered a surge in counterfeit and often substandard products. During the pandemic, international criminal groups sold fake PPE online or ran scams in which they collected payment for items that were never delivered.
To combat this, the United States spent $1.28 billion to help domestic companies increase PPE capacity and raw material production. It also allocated $2 billion for testing capacity and materials.
Axel said the funding helped companies build the infrastructure needed to compete on a global scale. Legislation like the Make PPE in America Act requires federal agencies to award contracts to U.S.-based PPE companies to help ensure the country is prepared for the next pandemic.
These investments helped the medical industry avoid even more severe shortages of PPE and other essential products.
Still, China remains the dominant player in PPE production. It continues to supply more than 90 percent of the plastic medical gloves used in the United States.
That’s why some believe another tool is needed to maintain U.S. self-sufficiency in PPE. It’s President Trump’s favorite word: Tariffs.
“U.S. companies are ready to step up, meet domestic needs, and compete with global competitors when it’s a fair fight,” said Tom Allen, the president of Altor Safety, a New York-based bulk PPE manufacturer. “Our goal isn’t to cut global vendors out, but to ensure a meaningful baseline of domestic supply, ready for whatever comes next.”
Another AMMA proposal is to offer financial incentives such as increased Medicare reimbursements for hospitals purchasing U.S.-made PPE, or tax credits for distributors expanding domestic sourcing. “Medicare is running a successful pilot program utilizing rebates for domestic purchases,” according to an AMMA white paper. “This program needs to be expanded.”
The group also recommends that the Strategic National PPE Reserve be stocked exclusively with supplies from domestic manufacturers.
Critics argue that subsidizing domestic production is inefficient, and if healthcare dollars can buy less expensive products abroad, that’s the more innovative approach.
American Hospital Association President and CEO Rick Pollack urged the administration to lift tariffs on Chinese PPE to protect healthcare workers.
“Healthcare workers need gowns, gloves, face masks, respirators and other equipment, much of which is manufactured in China and cannot be easily replaced by domestic manufacturers,” Pollack wrote. “In 2023, Chinese manufacturers provided the majority of the N95 and other respirators used in healthcare. Additionally, China was the source for one-third of the disposable face masks, two-thirds of the non-disposable face masks, and 94 percent of the plastic gloves used in healthcare.”
To advocates for American PPE self-reliance, that’s precisely the problem.
Axel emphasized he’s not calling for an abandonment of the global market. Instead, he’s urging the federal government and the healthcare industry to commit to purchasing a fixed percentage of domestic PPE — “guaranteeing America can look after its own when disaster strikes.”
“Real security comes from buying commitments, not excuses,” Axel said. “Let’s have our health systems and government agencies buy American-made medical supplies and PPE to build America where it matters most.”
