Institutional IQ or leadership or anything else like that does you no good when your country no longer has the manufacturing infrastructure to make PPE anymore and the countries which can would rather use it to protect their own citizens, and it's mostly the anti-populists which seem to be doubling down on denying that simple fact.
It actually does. For example, for things that cannot be produced locally in sufficient quantities (such as oil prior to the fracking boom), the US did maintain a strategic reserve. Even to this day, it still has a strategic oil reserve.
Lack of institutional IQ/leadership manifests in myriad of ways, such as the dismantling of California's emergency medical supply reserve in 2011 [0], defunding of organizations that address the current risks [1], and so on.
Addressing potential systemic risks through domestic production is only one potential way that leadership can handle them. Creating reserves and funding preparedness are some of the other ways to handle such risks.
The trouble with stockpiling PPE is that it's bulky, it expires in storage, and you need an awful lot of it to handle a crisis of this size. For anything beyond a short-lived, localized crisis, building out the production capacity to actually be able to make PPE in sufficient quantities seems a lot more feasible than a massive billion-item stockpile. The strategic oil reserve has the advantage that it can just pumping oil into well-selected holes in the ground.
Maintaining emergency stockpiles is the only solution to these episodes of commodity shortages, whether they're caused by increased demand or interrupted supply.
During normal times, the US may use several million masks per week. During epidemics, we may need more than 2 billion masks per week (1 per citizen per day).
We can't financially maintain 1000x production capacity for every potential emergency item. Businesses get screwed when they try to provide surplus capacity for our nation that it doesn't need the other 99% of the time: https://www.dallasnews.com/news/watchdog/2020/04/03/if-you-i... Even if we could it would be cost wasteful vs. stockpiles.
People talk about bringing all the production home, but that may be like getting rid of all your off-site backups and doing all backups onsite. It concentrates risk. What if there's a fire/pandemic/regional event that makes it so you need the emergency supplies, but also knocks out your plants that produce those emergency supplies? At least with some plants here, some plants there...if one country gets sick before the other, the currently-not-sick country can provide some supplies to the now-sick country, and vice versa when the pandemic ends in that place and moves to the other.
We probably need at least a 90 day supply of this stuff for the next pandemic. For n95 masks, I guess that's potentially 350 million * 90 days = 31 billion N95 masks. If they expire in 5 years, then we only need to manufacture 500 million per month to keep them up-to-date, and can pay maintainers to keep the supply rotating. We don't have to throw out soon-to-expire masks, we can sell them from the back of the stockpile at a small discount to end-users who need them regularly, like normal hospital or industrial use.
> building out the production capacity to actually be able to make PPE in sufficient quantities
as you put it, would require us to be able to make 10 billion masks per month (350 million * 30days), instead of just half a billion per month. Thats way more expensive. And those plants would sit idle for decades - who knows if they'd even turn on again? A rotating stockpile can be sold to hospitals for regular use, so we could constantly validate that the goods are good.
There are a few practical issues with this massive stockpile idea. Firstly, this pandemic looks like it might go on for about a year rather than 90 days, which puts the stockpile size required to have one mask a day for everyone to more like 130 billion masks. With a five-year lifespan, that means producing about 2 billion a month, only a fifth the rate at which you'd have to produce them with no stockpile at all - except you have to do that all the time, whether there's a pandemic or not, and store, rotate, and dispose of all them. Secondly, you can't just dispose of the expiring masks by selling them to people who'd need them normally, because the pandemic-level demand is so much higher than normal demand that just refreshing the stockpile produces way more masks than we'd normally need. 3M's normal global production of these masks is apparently around 50 million a month, meaning that even your 90-day stockpile would involve continuously producing and disposing of about ten times the normal, non-pandemic demand.
Also, if countries bring their production home with some surge capacity, then this actually gives really great redundancy compared to the status quo because all the countries which do this end up with production capacity that can be used to sell supplies to other countries in the case of some regional crisis there. It's much better than centralizing it in the lowest-cost country as often happens now.
I figure that a 90-day (or so?) supply would buy us the time needed to build additional production facilities to bring us up to the necessary continuous supply.
Taiwan had a huge stockpile, and that let them increase their production from 100,000 N95 masks per day to 20 million per day while drawing down the stockpile. Asia has had success building these factories in ~14 days from pouring cement to startup, USA might need a bit more time of course.
The way forward is sturdier masks that last "forever", with removable filters that can be sterilized in boiling water, exposure to the UVC in sunlight, drenching in household bleach or thorough washing with water and detergent.
This is exactly the way the Czech Republic is going, with several companies now churning out such masks and the government being the bigger buyer. Stockpiling billions of expiration-sensitive disposable masks is more expensive, compared to pre-distributing one reusable mask to every citizen.
