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.
What is in the SNS?
- The SNS is the nation’s largest repository of emergency medicines and supplies to help the country prepare for, respond to, and recover from chemical, biological, radiological, nuclear, and high-yield explosive threats as well as pandemics and emerging infectious diseases.
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.
When would the stockpile be used?
- In the face of a public health threat that overwhelms locally available resources, a state, tribal entity, large metropolitan area, or territory can request federal assistance for emergency countermeasures from the SNS.
- HHS may also direct the SNS to proactively deploy lifesaving medicines and supplies to jurisdictions during a widespread national emergency or due to a threat of national concern.
- Examples might be emergencies resulting from a pandemic flu, a smallpox event, and terrorist events of chemical, biological, radiological/nuclear, or explosive incidents.
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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 emergency
- Analysis of data derived from syndromic or epidemiologic surveillance
- A sentinel event, such as a single case of smallpox
Who can request assets of the SNS?
- States, directly funded cities, tribal entities, and territories may request federal assistance for emergency medical countermeasures from the SNS.
- Requests can come from a governor or a governor’s designee or senior health officials in a state, tribal entity, directly funded city or territory.
- The four large metropolitan areas which are funded through the Public Health Emergency Preparedness Cooperative Agreement include Chicago, Los Angeles County, New York City and Washington, D.C. These four jurisdictions can directly request SNS assistance.
- Tribal nations and urban Indian organizations have defined pathways to access stockpiled medical countermeasures from the SNS.
- For more on requesting stockpile assets, please visit https://aspr.hhs.gov/SNS/Pages/Requesting-SNS-Assets.aspx.
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.
What kinds of things are in the stockpile?
Medical countermeasures are primarily held in SNS for chemical, biological, radiological, nuclear, or high-yield explosive threats, and many are not available from any other source. Stockpiled inventory includes:
- Antibiotics
- Antitoxins
- Antidotes
- Antiviral drugs
- Vaccine
- Ventilators and ancillary supplies
- Burn/blast supplies
- Other medical supplies
What specific agents are in the stockpile that could be used for medical problems related specifically to radiological/nuclear events?
- Chelating agents: Calcium and Zinc DTPA
- Prussian Blue
- Growth Factors/Cytokines for White Blood Cells
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.
How fast can the SNS assets be deployed?
- Depending on the threat, the SNS can deliver medical countermeasures anywhere in the United States in 12 hours or less of a federal decision to deploy. The speed at which medical countermeasures are delivered is determined by clinical timelines for prophylaxis and treatment of specific disease threats.
- Medical countermeasures in the stockpile are configured in containers or on pallets that can be easily loaded onto either trucks or commercial cargo aircraft for the most rapid transportation.
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.
References
- 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)
- Need JT, Mothershead JL, Strategic National Stockpile Program: Implications for Military Medicine. Military Medicine 2006, 171:698-702
- 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)
- 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)