D uring the ongoing COVID-19 pandemic, the USA is experiencing a severe shortage of personal protective equipment (PPE) that threatens care delivery and the safety of medical staff. 1 In a normal year, the USA spends approximately $5 billion on PPE, with imports constituting more than 20% of the supply. 2 Specialized PPE is particularly dependent on imports. For example, an estimated 90% of N95 masks are imported, mostly from China. This heavy dependence on foreign-made specialized PPE makes its supply chain vulnerable and exposes health care workers and patients to substantial risks. When countries, states, cities, hospitals, and clinicians are all competing for the same limited international supply during the pandemic, the risks are escalated to crises that challenge public health and national health security. By some estimate, clinicians account for nearly 20% of the COVID-19-infected cases in the USA. 3 This is in contrast to countries such as Singapore and South Korea where clinicians have been rarely infected due to sufficient domestically supplied PPE.

The current shortage of PPE in the USA, especially N95 masks, is predictable and preventable. Both the 2009 H1N1 influenza pandemic and the 2014 Ebola virus epidemic exposed a shortage of domestically produced PPE. On February 25, 2020, Alex Azar, the Health and Human Services Secretary, informed Congress that at least 300 million N95 masks were required for the upcoming battle against coronavirus and there were only 30 million available in the Strategic National Stockpile. In spite of these and other warnings, the supply of PPE continues to be severely limited and dependent on international supply with devastating impact on clinicians treating COVID-19 patients. The USA stands out as a developed economy—ranked No. 1 in health care spending 4—that failed to improve the availability of crucial PPE. Many other economies, in contrast, were able to successfully ramp up their production capacity