WASHINGTON, DC — During the first months of the COVID-19 pandemic, the VA was called on to serve in its “fourth mission” role as a backstop to the nation’s healthcare system. According to former Acting Under Secretary for Health Richard Stone, MD, that effort highlighted flaws in the system that VA and other federal agencies need to address before the next national emergency.
Stone, who led VHA from 2018 until the summer of 2021, spoke before the House Veterans Affairs Committee last month along with Paul Kim, MD, former VA emergency management director, providing what was essentially a post-mortem on how the department fared in its backstop role during the worst national health emergency in a century.
His concerns centered on three main areas: interagency coordination; supply chain risk; and the management of state veterans’ homes.
“The National Security Act of 1947 established the current security structure that responds to national defense threats. It was not until 2012 that the Biodefense Act ordered both the creation of a national biodefense plan and also ordered the establishment of a position on the National Security Council for biodefense expertise,” Stone explained. “Unfortunately, this change did not mandate the unified governance that is needed to facilitate an agile federal response to public health threats. This lack of unified governance, with clear lines of authority, resulted in substantial delays in the delivery of much-needed federal health support to overwhelmed private sector health systems. The current approval process is not responsive or agile and should be restructured.”
“Think of a [hospital] chief of staff in Manhattan [NY] calling the governor’s office,” he continued. “The governor approving it, then sending it to the president. Having that move through the system for approval. While patients accumulate in the hallways of facilities. It’s just too slow a system. Just the ability to communicate with each other must be exercised in a more robust manner than we do today.”
Stone noted that poor communication could lead to resources being wasted and patients suffering for it. As an example, he pointed to DoD’s deployment of the USNS Comfort to New York Harbor in late March 2020.
“That took tremendous assets; patient flow was very low; and it did little to relieve the stress to New York catchment areas,” he declared. “After three weeks, they were released by the governor and the mayor. That movement took well over 1,000 uniformed personnel to accomplish.”
Stone also said that VA needs more mobile assets, in general.
“We did not have substantial ICU mobile assets prior to the pandemic,” he explained. “We also discovered that our DEMPS system—Deployable Emergency Medical Personnel System—was made up of volunteers. That was very different when the entire country was under pressure. We should develop an additional classification of employee where six-to-nine months of their work year is maintaining their skill sets, and the other months in are in readiness preparation for the next major national emergency. The expansion of that workforce would allow us to deploy a mobile 20-bed ICU to a hospital under pressure and deliver the labor force with it that was already competent.”
Stone also was critical of VA’s supply chain system and that of the country as a whole. VA’s supply chain problems were heavily documented during the pandemic, as hospitals ran low on basic personal protective equipment, and the department had difficulty tracking what supplies were needed where.
“Profound risks exists within the US medical supply chain,” Stone told legislators. “This partially occurred due to the significant amount of non-US manufacturing of consumable and pharmaceutical products necessary to deliver health care support during this emergency. Lack of a robust domestic manufacturing base for these products represents a profound security risk in our view. … [Our system] fails to recognize that even America’s closest allies will provide limited-availability medications and materials to their own citizens before meeting any contractual demands to provide them to Americans.”
War-Stopper Program
Stone pointed out that at least one model already exists to address this kind of problem—DoD’s War Stopper program, which creates a domestic industrial base and storage system for items such as nerve agent antidotes for use during wartime. Similar models of manufacturing and stockpiling could be used for PPE and pharmaceuticals, he said.