Biden’s N95 mask giveaway prompts fears of supply crunch

Stung by criticism from health experts that it did not prepare enough for the Omicron variant, Joe Biden’s administration has said it will begin distributing 400m high-quality N95 masks free of charge to the public from next week.

It follows a promise last week to hand out 1bn free rapid antigen tests as the government attempts to reboot its pandemic response in the face of record Covid cases and hospitalisations that pushed the death toll in the US beyond 850,000 this week.

However, the mask giveaway, which amounts to one of the largest deployments of personal protective equipment in US history, has drawn a mixed response from healthcare providers, trade unions and local manufacturers.

Some organisations welcomed a move that could offer better protection for the public from infection while others warned that giving away N95 respirators — the gold standard in terms of protection from Covid — could disrupt supply chains, lead to shortages and create a boom for counterfeiters.

Premier, one of the largest purchasing groups for US hospitals, said providing N95s to all Americans in such a compressed period of time was a “misguided” policy that could eradicate the strategic national mask stockpile and throw the healthcare supply chain into disarray.

“While most healthcare providers are not experiencing shortages of these masks, supply remains fragile,” said Blair Childs, Premier’s senior vice-president of public affairs.

“These proposals will prompt bad actors to buy the remaining N95 and KN95 supply [a Chinese equivalent] in anticipation of shortages, which will lead to a re-emergence of shady, grey market brokers and price spikes, as well as potentially counterfeit or subpar masks that don’t provide 95 per cent filtration.”

Some nurses’ unions also expressed concerns about mask supply as the health system struggles to cope with record numbers of patients hospitalised with the virus. Some hospitals are trying to conserve supplies of medical grade N95 masks, even as the federal government prepares to ship supplies to pharmacies and health centres for the general public.

Last week, Mass General Brigham hospital in Boston notified staff that the use of N95s had doubled since early December and requested that they keep wearing the same mask as they move from patient to patient rather than discarding it, according to a letter seen by the Financial Times.

“It’s insane to start distributing that many N95 masks to the general public when we are facing shortages in our hospital,” said Jim McCarthy, a recovery room nurse at the hospital and a committee member of the Massachusetts Nurses Association.

The Biden administration has dismissed concerns about disruption to the supply chain, pointing out that it has tripled the strategic national stockpile of N95 masks to 737m since January 2021.

“Today, there is ample supply of high-quality masks for healthcare workers, and high-quality masks are also widely available to the American public online and in stores,” said a US official.

The policy shift follows a campaign by some public health experts who have long argued the US should follow Germany and Australia in recommending the use of N95 equivalent masks.

Last week the US Centers for Disease Control and Prevention revised its guidance to recommend people wear the “most protective mask you can” but stopped short of advocating nationwide usage of N95 respirators.

When properly fitted, N95 respirators can filter up to 95 per cent of airborne particles, including those that may contain viruses, and therefore offer higher levels of protection against infection from Covid-19 than cloth coverings. The filtration material on the mask is tightly woven and contains an electrostatic charge that helps to intercept airborne particles.

Whether N95 masks can be reused depends on how long, and in what circumstances, they have been worn. But, as a general rule, respiratory experts suggest they can be reused up to five times.

Project N95, a group campaigning for greater public access to high-quality respirators, said it supported the decision to distribute N95s to the public for free.

“In the beginning of the pandemic, when quality N95s were in short supply, our focus was on getting those masks to healthcare workers first,” said Anne Miller, executive director of Project N95.

“We now make high-quality masks available to anyone, to provide protection regardless of their ability to pay. Despite temporary supply chain issues affecting some makers, there is now no shortage of these masks, thanks to a robust domestic manufacturing sector.”

Supplies of personal protective equipment were tightly constrained when the pandemic struck in early 2020, prompting a global supply crunch that forced many doctors and nurses to ration their use of N95 masks.

This led to an explosion in counterfeit masks flooding the US. More than 55m counterfeit respirators have been seized by US authorities in conjunction with 3M, the largest manufacturer of N95s, since the pandemic began, according to 3M.

CDC studies found 60 per cent of KN95 masks, a Chinese equivalent to the N95 respirator that is commonly purchased on ecommerce sites, did not meet US regulatory standards.

“We’ve seen examples of counterfeiting and fraud in many places around the globe. Usually the manufacturing does not originate in the US but we’ve seen many cases of bad actors in the US distributing fake products,” said Dan O’Connor, director and general counsel to 3M’s personal safety division.

He said incidents of fraud have reduced since the company began a legal campaign including 41 lawsuits targeting alleged perpetrators. But the practice still exists and is not limited to 3M products, added O’Connor.

3M said it had tripled N95 production during the pandemic and now has capacity to produce 100m of the respirators per month in the US and 2.5bn annually globally.

Honeywell, another large manufacturer of N95s, said the Biden initiative should not lead to supply chain disruptions because it draws from the strategic national stockpile.

But an industry lobby representing smaller N95 respirator manufacturers said the Biden administration had not done enough to guarantee local supply and the US would continue to rely on Chinese imports.

“We cannot produce enough masks and respirators for all of the US right now,” said Lloyd Armbrust, founder of American Mask Manufacturer’s Association. “We had the capacity to be self sufficient but when China came back online everyone [suppliers] preferred to go back there.”