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Using primary data collected from interviews with federal and state government officials and secondary data related to PPE distribution and state healthcare statistics, we discovered evidence that the use of the Strategic National Stockpile (SNS) to distribute personal protective equipment to state and local agencies in need during the height of COVID-19 was indeed poorly designed to cope with the COVID-19 emergency, leaving many states with shortages of badly needed medical supplies. As a result, many states struggled to organize an uncoordinated procurement response – which we suggest is due to federalism issues. To overcome federalism challenges and increase future disaster preparedness, we recommend four necessary reforms to the SNS that include 1) the incorporation of uncompensated industry experts into SNS administration, 2) the provision of an emergency production board for times of crisis, 3) elevated political leadership for the SNS, 4) improvement of federal-state supply chain governance.

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DOI: 10.1111/puar.13656

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