In times of crisis, access to essential medications can be a matter of survival. Critical pharmaceuticals, vaccines, and supplies — known as medical countermeasures — are vital in preventing, mitigating, or treating adverse health effects during pandemics, natural disasters, bioterrorism events and other emergencies.

In my work to contribute to strengthening health system resilience across the U.S., I’ve observed how the distribution of these life-saving resources often falls short of equitable. People who are medically underserved bear the brunt of this inequality, as seen during disasters like Hurricane Katrina, when vulnerable communities struggled to obtain the medical supplies and treatments they desperately needed.

Equitable access to medication can have life-saving impacts. During the COVID-19 pandemic, jurisdictions that prioritized communities who are medically underserved and people from racial and ethnic minority groups achieved higher vaccination rates and quicker containment of the virus. Ensuring that state-managed medication reserves and other medical countermeasures are accessible to all communities is not only a moral obligation — it’s a strategic necessity for effective emergency response. This commitment to healthcare equity is at the core of our mission.

Our recent research examined state-manage medication stockpiles, revealing where the U.S. stands if another pandemic arises. The study emphasized equity as a key factor driving the development of state stockpiles. Two critical findings emerged:

• Public and private sector partners share significant concerns surrounding current and future impacts of drug shortages on patient care, especially during emergencies.
• State-managed stockpiles can be a factor in helping ensure there is an equitable approach for vulnerable regions, communities, and facilities serving people who are medically underserved to have access to medications in case of an emergency event, including during critical drug shortages.

During our research, we engaged with representatives from both the public and the private sectors to discuss their efforts to advance regional and national preparedness. One public sector participant shared that during COVID-19, their jurisdiction convened an advisory group of stakeholders and experts to establish stockpile-related processes prioritizing equitable distribution among communities hardest-hit by COVID-19. The advisory group emphasized the importance of supplying products to non-major hospitals, which typically have the staffing and resources to manage supply chain issues internally.

It is encouraging to see that states are increasingly working toward medication stockpiling. Participants from two states shared that they established state-managed stockpiles because of their large, rural geography. In the pursuit of improving equity, research participants also highlighted that understanding equitable access to ensure that underserved populations are reached is one of the most significant opportunities for a state-managed stockpile. Public and private sector participants agreed that state-managed stockpiles have a stronger chance of ensuring equitable access than provider-managed stockpiles, as they can incorporate the appropriate equity plans into distribution processes rather than focusing solely on serving their own patients.

Collaboration with local health departments and community organizations is essential for the effective distribution of medical countermeasures. Public sector participants stressed the importance of identifying end-consumers and involving relevant communities or representatives in the discussion and implementation of a stockpile. They also raised concerns about how facilities in rural areas, safety-net hospitals, and other facilities that lack the resources to manage excess inventories could be better supported.

Leveraging existing pillars of trust between communities and institutions is one way to ensure a more efficient response. By involving these stakeholders, states can tailor their emergency preparedness strategies to meet the specific needs of diverse populations within their jurisdictions. However, balancing transparency and accountability among multiple stakeholders amidst the oft shifting landscape during a crisis event remains a significant challenge.

State oversight is crucial to ensuring transparency in the allocation and distribution of medications during emergencies. Transparent practices build public trust and accountability, which are essential for effective crisis management and community resilience. This report highlights the growing awareness that stockpiling efforts have the potential to help address gaps in healthcare access, but this requires adequate coordination and investments in resources. This includes the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), which was notably not reauthorized in September 2023, marking the first time since it was signed into law in 2006.

To protect lives and uphold the principles of fairness and solidarity, we must prioritize equitable access to medical countermeasures through state-managed stockpiles. This is the only way to ensure that no one is left behind in times of crisis.