1151: How States Are Strengthening Supply Chains and Stockpiles

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Tuesday, June 23, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Emergency preparedness is about far more than response plans and trained personnel. Today, Senior Analyst for Preparedness at ASTHO, Maggie Nilz, discusses how states are rethinking preparedness in the wake of COVID-19 and adapting to a changing emergency management landscape. Maggie explains how pandemic-era shortages exposed vulnerabilities in supply chains, resource distribution, and stockpile management, prompting states to take a more active role in assessing risks, securing critical supplies, and building long-term preparedness infrastructure. She also explores how new approaches to funding procurement and resource management are helping states respond more quickly while maintaining transparency and accountability.

So, Maggie, in talking about preparedness and state preparedness, it's more than response capacity. It really relies on supply chains. How did lessons from COVID sort of inform how states approach preparedness?

MAGGIE NILZ: 

COVID-19 demonstrated that having emergency plans in place is really only part of the sphere of preparedness. States also really depend on reliable systems for obtaining, distributing, and sustaining access to critical supplies when demands surge. So, during a pandemic, many jurisdictions experience shortages in things like personal protective equipment, medical countermeasures, and other essential resources, while simultaneously having to navigate disruptions in global supply chains. So, those experiences really highlighted that preparedness depends not only on kind of what we think of as traditional response capabilities, but also the systems that surround and support those response efforts. So, as a result, states are really starting to think about preparedness less as kind of a singular function and more as a broader operational capability that depends on reliable access to things like supplies, personnel, and logistics.

SHEEHAN: 

And this is also at a time when the federal government is encouraging states to be more active in their own preparedness, you know, including how they approach stockpiling and resource management.

NILZ: 

Yes, we're seeing kind of a lot of external factors influence this change in state policies. We're seeing states take a more proactive role in assessing their own risks and determining what resources they may need during an emergency that's unique to their environment, their risk factors, and their communities. Additionally, the recent executive order directing state and local governments to take a larger role in preparedness, along with ASPR's recent release of the jurisdictional stockpile program, is really reinforcing this idea that preparedness is a shared responsibility. So, states are working towards evaluating their own readiness capabilities, identifying critical resource needs, and developing plans that complement this changing federal landscape, rather than, you know, I think being more dependent on things like the strategic national stockpile.

SHEEHAN: 

Yeah, and you mentioned the strategic national stockpile in the piece, and how some challenges were exposed during COVID. Tell us more about that.

NILZ: 

So, one of the biggest lessons from COVID was that demand for critical supplies can exceed available resources very quickly, especially when there's a nationwide emergency where every jurisdiction is competing for the same products. So, states experience challenges related to supply availability, distribution, and coordination, and in a lot of cases the strategic national stockpile kind of picked up the pieces and helped fill in some of those gaps, and while it remains a really important resource, states are focusing on creating kind of additional layers. So, that they're better positioned when multiple jurisdictions are competing for the same resource on a large-scale emergency.

SHEEHAN: 

How does, you know, an increase in flexibility in funding, for example, as evidenced by Mississippi's Disaster Assistance Trust Fund, how does that better help states to respond?

NILZ: 

Yes, I think one of the really interesting things is that you know, historically we would have thought is of supply chain readiness as just as you know, having the supplies available. But one of the things states are doing is looking at the broader kind of linchpins that are involved in having a sustainable supply chain, and part of that means being able to make rapid decisions during an emergency and have immediate access to resources, and if funding mechanisms are too restrictive or not scaled to what we're seeing in modern day emergencies, it can slow response efforts for a state. So, Mississippi's approach illustrates how states are examining whether existing. Existing funding structures can support longer, larger, and bigger disasters. So, ultimately, fiscal flexibility is about giving decision makers the ability to act quickly when conditions change, rather than waiting for funding mechanisms to catch up with the emergency.

SHEEHAN: 

Sure, does that mean sort of scaling up a state's idea of what a disaster really is like, is it just, you know, planning for bigger and bigger disasters?

NILZ: 

Yeah, so I think it's sort of a combination of catching up funding structures to what we're seeing in present day. You know, we've already outpaced historical disasters year after year, in terms of how much they're costing states, thus the breadth of impact that they're having on states and their communities, and I think it's also partly forward-looking as well. I think a lot of states are starting to try and get an understanding for what disasters are going to look like down the road, and how can we be more prepared for 10, 15, 20 years down the road.

SHEEHAN: 

Right, and that sort of highlights attention as well for how states can sort of continue to ramp up that financing and those expectations of, you know, needing more and more money to cover these disasters, but also doing it responsibly and like maintaining oversight and accountability.

NILZ: 

Yeah, so I think that's a really interesting kind of contrast throughout this. You know, if we start at fiscal flexibility, we then kind of lead right into the procurement process of the supply chain mechanisms, and a lot of states are really trying to strike in the even balance between being agile and still being accountable. So, during an emergency, an agency needs to be able to move quickly, but policymakers and the people that they represent want to also ensure that there's transparency around how public funds are spent. So, we're seeing states pursue different approaches, including streamlining procurement pathways for emergency situations; creating targeted exemptions for time-sensitive activities, but also reviewing emergency contracting practices to ensure that there's appropriate oversight on those. And I think the challenge is finding a way that accelerates purchasing during emergencies, but also preserves transparency and trust, because in the end, that's really a core value to being able to effectively prepare and respond to the next emergency.

SHEEHAN: 

Yeah, and you mentioned, you know, states are now institutionalizing these stockpiles and making it part of, you know, it's long-term, no longer just sort of an emergency response type of action. What are the advantages to making it a permanent fixture rather than just sort of one-offs?

NILZ: 

So, permanent stockpiles allow states to take a more strategic approach to preparedness. So, rather than building reserves in the middle of a response to a specific event and then trying to sort of scale them back afterwards, states can establish ongoing processes for things like inventory management, demand forecasting, maintenance, and deployment of a stockpile. And permanent systems create opportunities for continuous planning and readiness and continuous improvement, which makes preparedness a sustained capability rather than an activity that only happens kind of right before a disaster.

SHEEHAN: 

As you've been researching and looking at state preparedness, is there a big takeaway in how states' actions or states' approaches to preparedness, how those situations are evolving?

NILZ: 

Yeah, so I think the big takeaway is that there are so many components to being prepared, aside from just having the immediate response plans and those trained personnel that go into the field. I think a huge thing that we have learned from COVID, and we're seeing these legislations take into action, is that preparedness means thinking about how are we funding these disasters, how are we getting supplies when we need them, how are we managing stockpiles in the long-term? If we have a, you know, a warehouse full of equipment, how are we determining what goes in that? How are we maintaining those pieces of equipment? Are we making sure that things are removed when they expire? You know, all of those pieces that are really important to making sure that you have an effective and efficient response in the long-term. And I think, you know, one of the things that's interesting is that we're seeing that sentiment both in legislation, but also seeing that idea of preparedness policy kind of extending beyond legislative policy. So, we're seeing states use things like administrative policies, interstate agreements, health care coalitions, to play a role in strengthening supply chain resilience, and I think we'll see that as threats continue to evolve that the decisions that states make today about preparedness infrastructure and supply chain resilience are going to have a significant impact on response in the future.

SHEEHAN: 

Maggie Nilz, thanks so much.

NILZ: 

Thank you so much.

SHEEHAN: 

Maggie Nilz is a senior analyst for preparedness at ASTHO.

Strong collaboration between public health agencies and health care systems is essential to preparing for and responding to emergency health threats, from supply chain distributions to large-scale public health emergencies. Coordinated planning helps ensure health care facilities have the resources they need to continue serving their communities. Find the link to the blog post about how Kentucky is improving response to emerging health threats in the show notes.

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This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.