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Strategic National Stockpile (SNS)

Who authorized the SNS program?


  • In 1998, Congress appropriated funds for the CDC to acquire a pharmaceutical and vaccine stockpile to counter potential biological and chemical threats and widespread diseases that could affect large numbers of persons in the civilian population.
  • The program was originally called the National Pharmaceutical Stockpile (NPS) program, but it has since been extended to involve much more than just drugs.
  • On March 1, 2003, the NPS became the Strategic National Stockpile (SNS) program managed jointly by DHS and HHS.
  • With the signing of the BioShield legislation, the SNS program was returned to HHS for oversight and guidance.
  • In 2018, oversight of Strategic National Stockpile was transferred to HHS/ASPR from HHS/CDC.
  • The SNS is designed to supplement and resupply state and local public health agencies in the event of a national emergency anywhere and at any time within the United States or its territories.

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What is in the SNS?


  • The SNS is a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items.

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Who manages the SNS program?


  • HHS/ASPR is the primary agency responsible for maintenance and delivery of SNS assets, but state and local authorities must plan to receive, store, stage, distribute, and dispense the assets.

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When would the stockpile be used?


  • The plan is to deliver critical medical resources to the site of a national emergency when local public health resources would likely be or have already been overwhelmed by the magnitude of the medical emergency.
  • Examples might be emergencies resulting from a major earthquake, pandemic flu, a smallpox event, and terrorist events of chemical, biological, radiological/nuclear, or explosive incidents.
  • Pre-event requests for SNS resources might include
    • Actionable intelligence indicating an impending chemical, biological, radiological/nuclear, or large explosive attack or overwhelming public health disaster
    • Analysis of data derived from syndromic or epidemiologic surveillance
    • A sentinel event, such as a single case of smallpox

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Who can request assets of the SNS?


  • State departments of health, usually in conjunction with the state governor
  • National agencies e.g., FEMA, FBI in certain circumstances
  • To receive SNS assets, the affected state's governor's office would directly request the deployment of the SNS assets from HHS.

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Whose decision is it to release assets from the SNS?


  • HHS/ASPR and other responding federal agencies will evaluate the request, the situation, and determine a prompt course of action to release those assets that are most appropriate.

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What kinds of things are in the stockpile?


  • 12-Hour Push Packages (less than 5% of the SNS inventory)
    • Broad-spectrum oral and intravenous antibiotics
    • Other medicines for emergency conditions
    • IV fluids and fluid administration kits
    • Airway equipment, such as ET tubes, stylettes, oropharyngeal airways, Ambu-Bags, and CO2 detectors
    • Bandages
  • Managed inventories housed in the SNS or maintained by specific vendors or manufacturers
    • Antibiotics
    • Vaccines
    • Antitoxins
    • Ventilators
    • Additional quantities of 12-Hour Push Package items

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What specific agents are in the stockpile that could be used for medical problems related specifically to radiological/nuclear events?


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Where are the SNS assets stored?


  • This is not public information
  • The SNS is a network of strategically located repositories located throughout the United States that houses a vast inventory of antibiotics, antitoxins, antiviral drugs, vaccines, medical supplies and materials, and other pharmaceuticals.
  • Commercial partnerships are in place for the storage, maintenance, and rapid transport of SNS assets.

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How fast can the SNS assets be deployed?


  • To respond to an ill-defined threat in the early hours of an event, HHS/ASPR is committed to delivering SNS' 12-Hour Push Packages anywhere in the United States or its territories within 12 hours of a federal decision to deploy.
  • The 12-Hour Push Packages have been configured to be immediately loaded onto either trucks or commercial cargo aircraft for the most rapid transportation.
  • In an event when a threat is known, HHS/ASPR will provide SNS managed inventory tailored to most effectively responding to that specific threat.
  • At the same time assets from the SNS are deployed, the SNS program can provide to the state and local public health jurisdictions deployable teams of personnel that will assist with effectively receiving and distributing SNS assets.

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Are there specific agents available in the SNS for chemical emergencies?


  • Yes, the SNS has forward placed CHEMPACKS throughout the United States to provide quick access to nerve agent antidotes that can be used in the event of a nerve agent attack that overwhelms locally available resources.
  • CHEMPACKS are placed in all U.S. states and territories and are integrated into local hazardous material response plans.

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References

  1. How to Steward Medical Countermeasures and Public Trust in an Emergency, a Communication Casebook for FDA and its Public Health Partners (PDF - 10 MB) (UPMC Center for Health Security, November 2016)
  2. Need JT, Mothershead JL, Strategic National Stockpile Program: Implications for Military Medicine. Military Medicine 2006, 171:698-702
  3. Development of Stockpiles for Radiation Emergencies (PDF - 1.85 MB). Report of the Radio-Nuclear Working Group, WHO consultation meeting on Development of Stockpiles for Radiation and Chemical Emergencies (WHO, February 2007)
  4. Building a National Capability to Monitor and Assess Medical Countermeasure Use during a Public Health Emergency, Going Beyond the Last Mile (Proceedings of a Workshop, National Academy of Science, 2017)