Bringing it in

In the early days of the COVID-19 pandemic hospitals in New Jersey and the New York City area were flooded with thousands of patients and images began to emerge of fatigued nurses using trash bags as makeshift personal protective equipment. The images and anecdotes painted a dire picture of the state’s health care infrastructure: with hospitals overwhelmed and the global supply chain collapsing, many medical professionals were left without the basic materials needed to do their jobs.

“It was kind of like a national security issue,” said Chris Chafe, who organized manufactures in New Jersey and across the country to switch gears to personal protective equipment. Chafe, head of consulting firm Growth Squared, continued that “[a]s a country, we’ve got to learn how to have certain capacities to do certain things.”

And as caseloads worsened and more patients needed intensive care like intubation, concerns among public health officials mounted that there would not be enough ventilaors to go around. The fear was that people could die due to simple lack of equipment.

In May, Gov. Phil Murphy signed an executive order in conjunction with the governors of Connecticut, Delaware, New York, Pennsylvania and Rhode Island to coordinate the purchase of medical supplies and PPE – for a combined $5 billion – so the states would not have to barter and compete against each other.

One problem was that the supply chain from China — which provided a large quantity of the materials — had collapsed, leaving many manufacturers, hospitals and public health departments scrounging for equipment.

Meanwhile, the Trump administration was criticized for adopting a hands-off approach, “where it was every state for themselves,” said Mitch Cahn, founder and president of Newark-based Unionwear, which manufactures hats, bags, binders, and other promotional materials. Unionwear shifted last year to making PPE, such as plastic face shields, gowns, and non-surgical facemasks.

Last year’s approach was largely an emergency triage system, Cahn said. States coordinated to get PPE where it was most needed, while manufacturers switched to PPE. “We got a baseball uniform maker to create masks and gowns out of baseball uniforms,” Chafe said.

But memories are short. With the supply chains between China back online, many are simply “chasing the lowest-cost product,” Chafe said. “The risk that we take in returning to that is what if it happens again,” he warned. “It’s just the good fortune of having been able to cobble together the supply chain that saved us this past time.”

But the barriers to building a robust domestic manufacturing sector are well-known. The obstacles have plagued the nation for generations as factories closed or moved overseas.

John Kennedy, CEO of the New Jersey Manufacturing Extension Program, has been generally optimistic about the prospects for New Jersey. Nevertheless, establishing a permanent source of PPE manufacturing in the Garden State is far easier said than done. Murphy said during his announcement last spring that the state was tapping NJMEP for a “partnership” to have more of those products made here in New Jersey.

Kennedy said NJMEP has since then worked with nearly 300 New Jersey companies that could supply specific components or entire PPE products. And they are studying how to use COVID-19 relief funds to finance an aid program that would walk manufacturers through the task of mass-producing scientifically proven PPE.

That includes getting state and federal regulatory approvals, the ability to ramp up production as needed, and how to effectively store raw materials and finished products. “Generally [raw materials] have a longer shelf-life than finished goods,” Kennedy said. The NJMEP and involved companies want to find ways to develop even better products, like masks that offer better protection. Kennedy did not have a price tag for this new system but indicated that it would be presented to the Legislative Manufacturing Caucus in November once the midterm elections have passed.

“What was the cost last year when we did not have enough for our hospitals and first responders?” Kennedy said. “How about the costs when we all wore masks that — mostly — had little safety value because of materials used or mask design usage?”

The idea is that the stockpile could be tapped into by medical personnel and first responders, followed by front-line workers, schools and the general public. New Jersey holds 2.1 million face shields, 117.3 million gloves, 4.5 million surgical gowns, close to 5.9 million N95 masks and 14.3 million surgical masks, according to the New Jersey State Office of Emergency Management.

Under the $14.5 billion economic incentive package Murphy signed in January, the state is putting earmarking $10 million a year for three years for companies that spend on PPE production between 2020 and 2022. The program includes hiring and spending requirements and an emphasis on setting up facilities in lower-income communities across the state or partnering with apprenticeship programs, educational and research institutions.

The awards are capped at $500,00 per project, which is being run by the New Jersey Economic Development Authority. The agency did not comment for this story, while Murphy, when asked on Sept. 20 on the state of New Jersey’s PPE manufacturing capability, had no updates.

But Cahn cautioned that incentives — or top-down mandates for domestic manufacturing — do not necessarily work because of underlying structural problems.

Chafe contended that more progress has been made at the federal level, at least in the short term. For example, the Biden administration “has been fundamentally more productive in creating a … federal marketplace for domestically made PPE.” The American Rescue Plan included billions that went towards the domestic production of PPE.

And Biden’s infrastructure package would require that federal PPE contracts go to domestic manufacturers. “This bill will help onshore critical production of PPE by guaranteeing long-term contracts for domestically produced PPE and ensuring that taxpayer dollars are utilized to bolster the federal purchase of American-made PPE,” reads an August statement from Kim Glas, president and CEO of the National Council of Textile Organizations.

There are a number of state-level bills the NJMEP said could improve the state of New Jersey’s manufacturing sector. A measure now on Murphy’s desk would require the state’s homeland security and preparedness apparatus to prioritize New Jersey manufacturers when buying PPE. It was sent to Murphy on June 1.

“We have capable and successful manufacturers that can produce protective equipment in New Jersey. We should be helping keep them in business,” reads a May statement from one of the bill sponsors, Assemblywoman BettyLou DeCroce, R-26th District, a member of the Manufacturing Caucus.

Hospital stockpiles

In August New Jersey Health Commissioner Judith Persichilli said that the state’s 71 acute-care hospitals “did not report hearing any calls” for more PPE. “In terms of being in-state, we’re comfortable that we have what we need,” she continued.

All of New Jersey’s hospitals have at least a 30-day PPE supply on hand, said Kerry McKean Kelly, a spokesperson for the New Jersey Hospital Association, a trade group for all 71 hospitals. The NJHA has 105 mostly U.S-based PPE suppliers, “about one-quarter of them” in New Jersey and including four vendors that “manufacture their product in New Jersey , producing N95s, face shields and hand sanitizer.”

Meanwhile the state’s largest hospitals said they were comfortable with their current PPE levels.

Holy Name in Teaneck and Newark’s University Hospital — the state’s only public hospital — were both widely regarded as hot zones in the early days of the pandemic. And both said they had sizable stockpiles of PPE ready to go. Holy Name said its supply could last at least six months. University Hospital said it has a 90-day supply and that they are currently “not experiencing any shortage of equipment or having difficulty in obtaining more.”

Hackensack Meridian Health, one of the state’s largest hospital and health care networks, likewise has a six-month PPE supply, according to spokesperson Ben Goldstein. “We continue to leverage our strong relationships locally, nationally and across the globe to ensure our supply consistently remains at current levels and replenished as needed,” he said in a statement.

Doug Haarris, a spokesperson for Trinitas Regional Medical Center in Elizabeth, said the hospital has “more than 50 pallets” of PPE which would last at least 90 days.