As scientists race to develop a COVID-19 vaccine, some experts warned that syringes could become the next face masks — coveted items in short supply able to plunge the market into chaos.
But it appears that the federal government and health care supply companies learned a lesson from the mad scramble for masks and other personal protective equipment that came to symbolize the early weeks of the pandemic.
Rather than wait for a viable vaccine to stock up on syringes, the federal government securing them now. To date, it has signed at least $260 million in contracts for their production.
“In the U.S. we’re in a well-positioned and well-prepared place,” said Chaun Powell, group vice president of strategic supplier engagement at hospital supply-purchasing group Premier Inc.
Global demand could still drain U.S. manufacturers’ supplies, he warned, and syringe shortages could emerge if the vaccine arrives earlier than anticipated.
A vaccine could be ready by early 2021, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during the Senate Health, Education, Labor and Pensions Committee this week. But there's no guarantee, he warned.
Questions about syringe shortages began surfacing as early as May.
Dr. Rick Bright, who President Donald Trump had reassigned in April from leading the Health and Human Services office tasked with helping develop a COVID-19 vaccine, submitted a whistleblower report on May 5 that — among other things — warned the United States would need as many as 850 million more syringes.
That’s enough to give to every American two shots of the COVID-19 vaccine and to also handle the increased demand for flu shots that medical experts see after a pandemic.
In his report, Bright says that when he raised the issue to his superior, his boss told him they should worry about syringes when there was something to inject.
He eventually relayed his concerns to White House Trade and Manufacturing Policy Director Peter Navarro who wrote in a memo to the coronavirus task force: “Our current inventory of these supplies is limited and, under current capabilities, it would take up to two years to produce this amount of specialized safety needles. We may find ourselves in a situation where we have enough vaccine, but no way to deliver all of it.”
Bright says he was removed from the vaccine post because he was critical of the Trump administration’s leadership on COVID-19. His complaint said the Strategic National Stockpile had just 15 million syringes available in May.
In addition to anticipating a two-shot vaccine, Bright’s calculations included about 180 million more syringes for an increase in requests for flu shots. Powell, at Premier Group, said that makes sense.
“In any given year we typically see about a 4% annual growth rate on flu shots and last year was estimated somewhere between 130 and 150 million” shots administered, he said. “In a post pandemic outbreak year that 4% jumps to 20%. We saw it historically with Ebola, we saw it with SARS.”
But the 850-million estimate also assumes every single American will get the vaccine, which is not possible, or even necessary for herd immunity.
Still, on a May 7 earnings call, the CEO of manufacturer Becton, Dickinson and Company said manufacturers could make that many — or even a billion — syringes, but not on a moment’s notice.
“People have to be proactive in beginning to order and stockpile these devices now,” the CEO, Thomas Polen, said. “It cannot be ‘wait until the last minute’ and expect that those products will be able to be manufactured.”
He said some governments around the world acted quickly to order syringes from BD, while the company continued to stress the urgency with other countries that were not as concerned. He did not specify which countries those were. The U.S. put in an order with BD on May 27.
So how many syringes does the United States have the capacity to produce? And what’s happening with production now?
In a normal year, U.S. hospitals go through 4.5 billion disposable, plastic syringes. That doesn’t include syringes pharmacies and doctors’ offices use for flu shots. It also doesn’t include the retail market for diabetics or the flush injectors hospitals use for IV fluids.
“If we as a nation had to pivot and utilize those, we could,” Powell said.
If the market had been required to go from making 500 million syringes a year to making an additional 850 million, that would have been a problem, he said. But since the U.S. produces billions, it’s not as much of a stretch.
The U.S. Department of Health and Human Services has contracted with four companies to produce at least 820 million syringes — which includes 420 million by the end of this year and the rest next year.
Some 320 million syringes will come from two contracts with Retractable Technologies Inc. in Texas and Marathon Medical Corporation in Colorado which got contracts in May for $83.8 and $27.4 million respectively. The contract with BD is for $11.7 million.
The rest will come in phases from a $138 million contract with ApiJect Systems America.
BD is the largest syringe manufacturer in the world and had already increased its production before getting the government contract in late May, according to spokesman Troy Kirkpatrick.
“We have also been in conversations with governments around the world for years about the need to stockpile these devices for a potential pandemic like this, but prior to the pandemic, the realities of budgeting for what ‘could’ happen versus what is happening at the current moment make budget decisions very difficult for government officials,” Kirkpatrick said in an email.
“The U.S. has done a nice job of ramping up production,” Powell said.
But there are still factors that could complicate the rollout, he said. If the vaccine comes earlier than expected, manufacturers will have less time to stockpile syringes. There are also questions about whether companies will pre-fill syringes with the vaccine or distribute it in vials separate from the syringes.
Health-care providers hope to avoid the pandemonium that occurred in the early months of the pandemic as protective medical gear such as N95 masks became scarce.
Hospital administrators swapped stories of traveling across state lines to meet unknown dealers in warehouse parking lots just for a chance at a few thousand masks. Buyers were inundated with offers with no way to weed out scams. Governors called out the lack of coordination and support from the federal government.
Syringes are a different story for a couple reasons.
First, they’re simple to make. They’re basic plastic and a needle, using readily available materials. The N95 mask requires a fine mesh of synthetic polymer fibers that is largely manufactured in China and led to delays in the supply chain.
The masks were also largely manufactured overseas, whereas the syringe supply chain is more diverse, Powell said. BD has two plants in North America, three in Europe and two in Asia.
It’s unclear whether the hundreds of millions of syringes will be channeled through normal distributors to pharmacies and hospitals when the time comes to administer the vaccine.
Health and Human Services, which contracted for the syringes, did not provide details of any distribution plan after USA TODAY asked. A spokesperson said the agency is currently discussing details with officials from the White House and other federal agencies.