In the early days of the Covid-19 pandemic, medical supply shortages got so severe that nurses fashioned masks and gowns out of pool noodles and trash bags.
Many factors have been blamed: inadequate stockpiles, slow government action, equipment hoarding. But one that has been especially relevant—and is relevant again today as international tensions heat up—is US reliance on foreign personal protective equipment (PPE), supply chain experts told us.
The government invested more than $1 billion to bulk up domestic PPE manufacturing during that first pandemic year, but five years later, the companies that emerged from those efforts have mostly shut down, and the US still relies heavily on foreign manufacturers for PPE and other medical necessities. The American Hospital Association calculated in April the US imported over $75 billion in medical devices and supplies in 2024 alone.
Some experts worry this means the next public health emergency could send the country right back to March 2020.
“If we don’t change the trajectory we are in right now, we’re guaranteed to repeat the same thing,” Tinglong Dai, Bernard T. Ferrari professor of business at Johns Hopkins University, told Healthcare Brew.
The past
Prior to Covid, PPE wasn’t a concern for Premier, a large healthcare group purchasing organization (GPO) that works with more than 4,350 hospitals and health systems. But hospitals needed 17x their usual supply of N-95 masks after they began admitting Covid patients, according to Premier’s April 2020 survey of nearly 1,600 hospitals.
“PPE was always a low variability, very transactional category for our hospital supply chain until Covid hit,” Kyle MacKinnon, senior director of operational excellence at Premier’s supply chain strategic operations, told Healthcare Brew.
Brokers hoarded and price gouged PPE early in the pandemic. Supply and demand surged unpredictably and quickly as pockets of the world were exposed to the virus, MacKinnon said.
Another issue is GPOs like Premier didn’t—and still don’t—have data down to the stock-keeping unit on which locations and manufacturing plants products come from, Mark Hendrickson, Premier’s director of supply chain policy, told us.
He said Premier now asks suppliers for “very specific, very detailed data” on their product volume, reliability, and manufacturing locations. The company is lobbying for the US government to track this data better as well.
“We need more transparency on where products are coming from. We need more reporting from manufacturers to the FDA so they can understand where they can pull levers in an emergency,” he said.
The present
Amid 2020’s uncertainty, the federal government invested more than $1 billion in subsidies to increase domestic PPE production. As a result, dozens of domestic startups emerged to manufacture masks, medical gowns, and gloves.
GPOs and hospitals relied on those startups amid increased demand, MacKinnon said. But today, he said, they have largely returned to pre-pandemic purchasing patterns.
“As an industry, we shifted back from that ‘just-in-case’ scenario planning and supply planning to ‘just-in-time’ where now you have to be cost-conscious and get back to a leaner, more profitable organization,” MacKinnon said.
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An April 2024 analysis of US import data by the American Medical Manufacturers Association (AMMA)—a trade association that lobbies against US reliance on Chinese-made PPE—estimates the US uses about 110 billion to 120 billion nitrile gloves each year.
The fact is, China can offer cheaper PPE and a larger portfolio of product models compared to those US pandemic-era startups, Dai said. The US startups couldn’t compete.
“A lot of the companies that were standing up during Covid, as you go back to the beginning, disappeared because they were just undercut overnight,” AMMA Executive Director Eric Axel told us.
The future
MacKinnon said Premier learned from the pandemic and is set up to be “more resilient” during the next one. The industry now has a “thorough playbook” with better data and technology to manage supply chains and anticipate demand, he said.
But this return to foreign reliance, Dai warned, may weaken the supply chain when the next emergency comes, whatever it is.
“We have basically moved back to the same—if not worse—dependence on foreign manufacturers for most of the PPE needs here in the US,” Dai said.
US manufacturers could lower costs and compete more effectively with foreign PPE manufacturers if they invested in newer, large-scale production technologies, according to Dai.
The problem? They need large orders with up-front payments to afford those upgrades.
Dai thinks the government could help here by filling its national PPE stockpile with 100% Made in USA PPE to bring “stable demand” to domestic manufacturing, along with other steps, like tax incentives. AMMA has lobbied for those changes, too.
Increasing any manufacturing—not just PPE manufacturing—would be helpful, Dai added, because other manufacturing operations can be converted into PPE assembly lines in emergencies.
July’s One Big Beautiful Bill Act includes provisions that help domestic medical manufacturers, like bringing back R&D tax credits, Axel said.
He added tariffs are another tool to “even the playing field” for domestic manufacturers.
Companies like Abbott Laboratories, Merck, and Roche have announced plans since early this year to invest more in US manufacturing, though they did not directly attribute their decisions to tariffs. On the flip side, some experts previously told Healthcare Brew tariffs could strain the supply chain.
But Axel argues the medical supply chain is already strained because it relies on foreign manufacturers, some of which have been flagged for creating allegedly unsafe supplies. (The FDA has identified safety issues in several brands of syringes from China, for instance.)
Axel also believes the US has seen—and will see again far before a global pandemic occurs—repercussions from its lack of diverse domestic manufacturers. He pointed to disruptions from labor strikes, for instance.
“Covid is already a lesson from a different era,” he said.
This is one of the stories of our Quarter Century Project, which highlights the various ways industry has changed over the last 25 years. Check back each month for new pieces in this series and explore our timeline featuring the ongoing series.
