Optimizing chemical agent medical countermeasures in the Strategic National Stockpile

Abstract

Chemical agents, unlike biological agents such as bacteria or viruses, include toxic chemicals that cause adverse effects such as death, temporary incapacitation, or permanent harm to humans or animals. These agents are structurally and functionally diverse, leading to a wide range of possible dangers. However, federal threat assessments over the years have deemed chemical agents a lesser threat than biological agents. This, in turn, has led the Department of Health and Human Services to deprioritize critical research and investment into the stockpiling of medical countermeasures (MCMs) that can save lives in the event of an exposure, resulting in lowered appropriation levels toward developing MCMs against chemical agents for the Strategic National Stockpile (SNS). Additionally, annual reviews of the SNS that directly inform budget allocations and appropriations for future years were not conducted from FY2017 to FY2019, further weakening SNS preparedness against chemical threat agents in a constantly changing threat landscape. As such, there are gaps in the inclusion and pursuit of medical countermeasures for chemical agents into the SNS. Costs for non-procurement spending, transitioning MCM integration, and maintaining repositories of existing MCMs from fiscal years (FYs) 2020 and 2021 were calculated based on planned spending costs for the SNS as published in Appendix A of the Public Health Emergency Medical Countermeasures Enterprise Multiyear Budget for FY18-22. The allocated SNS funding for FYs 2020 and 2021 combined is insufficient to maintain an updated repository of existing medical countermeasures to be drawn from in the case of a public health crisis while simultaneously growing to integrate newer countermeasures compared to planned spending for those years. As such, regulatory policies that enforce annual SNS reviews are recommended. Additionally, increased direct appropriations and bolstering alternative funding avenues for MCM development are essential for research and development of MCMs for emerging threats.