Transcripts For KQED Frontline 20240712

Still rising why wasnt the United States more prepared . You cant be prepared if youre not funded to be prepared. Narrator who is accountable . Do you think that this administration has done what it needs to do to protect healthcare workers . I think a lot more could be done. Narrator and what will happen when a vaccine is ready . Given the abject failure, of the administraon we do worry. Narrator now on frontline americas medical supply crisis. Frontline is made possible by contributions to your pbs station from viewers like you. Thank you. And by the corporation for puic broadcasting. Major support is provided by the john d. And catherine t. Macarthur foundation, committed to building a more just, verdant and peaceful world. More information at macfound. Org. The Ford Foundation working with visionaries on the frontlines of soal change worldwide. At fordfoundation. Org. Additional support is provided by the abrams foundation, committed to excellence in journalism. The park foundation, dedicated to heightening Public Awareness of critical issues. And by the frontline journalism fund, with major support from jon and jo ann hagler. It hit the whole hospital hard. Everybody knew sandyvery lab, xray, the respiratory therapists. You know, she always had a smile for them, or a kind word for them. Were a family, and it w devastating. My sister was a nurse. voice breaking she would tell us that she was going to go to work with no fear, that she knew that god was with her and he was going to protect her. Narrator it was the start of the corovirus pandemic in california, and nurs Sandy Oldfield were short on masks and gowns and gles. It was hard. Our morale was pretty low. We still weren getting the ppe on our floor, on our unit. It was tough. She didnt feel safe. I even had made a comment to her. I said, just dont go to work. She was, like, we have to. Weve already, i mean, you dont just not show up, you know . But she said everybody felt the same. I mean, they felt that they just were not being protected. She cared for a patient that was asymptomatic. He showed no signs of the virus or anything. And my sister, unfortunately, was exposed. She called me in the morning and said that she was positive. Narrator after nine other nurses in the same hospital came down with covid19, the nursing staff started protesting. What do we want . Ppe were all saying the same thing. Give us our ppe. The hospital says safety is the ghest priority. We are seeing a l of our healthcare workers come down with this illness. Narrator inside the hospital, sandy oldfie getting sicker. She told me, the doctors are going to put me on a ventilator. And i said, were going to be right here when you open your eyes. I told her i loved her, and that was the last time i spoke to her. A somber night in fresno as nurses mourn the loss of one of their own to covid19. Sandy oldfield died on moay after battling the virus for two months. She was very wellliked and had many friends, many of which gathered here. We welcome all of our sisters and brothers here tonight, to honor the tragic loss of our first nurse to the coronavirus pandemic here in fresno county. It just really hurt my het just to know that my sister wasnt protected. All of ts could have been avoided. In a plane crash situation, you put your mask on first. You need to put your ppe on so that you could take care of them. Ifou get sick, you cant help them. You cant help anybody. I feel if she wouldve had the proper ppe, she would be alive today. What do we need . Ppe. What do we want . What do we need . Ppe we are demanding ppe so that we can protect ourselves and our families. Narrator Sandy Oldfield was one of the countless americans left unprotected when the coronavirus hit. Left without essentials like gloves, gowns, masks. A major problem amid this crisis a National Shortage of personal protective equipment, or ppe. Narrator forced to reuse personal protective equipment or make their own even healthcare workers, around a thousand of whom have died from the virus. This is deplorable. You know, when yand think that we send soldiers into battle with the equipment that they need, yet we were asking nurses to do the exact same thing, but without the equipment that they needed. Theres a failure in the system. I think those who are in position to ensure that the supply chain was being maintained, they failed us, big time. Narrator for the past seven months, frontline and Associated Press reporters Juliet Linderman and Martha Mendoza have been examining that failure and the unheeded warnings, interviewing manufacturers and government officials, analyzing records, and tracing key medical supplies along a fragile global chain. Mendoza i did a run of n95 masks. Narrator from the earliest days, they were tracking a database of medical supply imports. Mendoza most all coming from china. Narrator within the numbers, one detail stood out. Mendoza you see this graph . Linderman yeah, yeah. Narrator beginning in march, the usual flow of tons of ppe from china to the u. S. Had plummeted. Linderman what were seeing here is, like, pretty consistent. 25 shipments. 22 shipments. 23 shipments. And then, just, whoosh. Drops to three shipments in all of march. Complete dropoff. Narrator china was dealing with its own outbreak. China has identified a previously unknown coronirus. Narrator . And the u. S. Was left desperately short. Its thought to have originated in the ci of wuhan. Narrator u. S. Officials began urging the public to conserve supplies. Right now in the United States, people should not be Walking Around with masks. It can lead to a shortage of masks . Exactly, thats the point. It could ld to a shortage of masks for the people who really need it. Narrator but then, in la march, there was a sign of relief. Import records showed ppe shipments were slowly starting up again. One of the first was a planeload of n95 masks destined for this warehouse in santa barbara, california. This is the first shipment that weve got in from china in the past two months. These are the n95 masks that are in such high demand right now. Narrator the charity direct relief, which normally helps with disasters around the world, had turned its focus on e u. S. To help fill the gap in the mask supply. Its just such a scramble because of the huge demand and the scary time were in. So what youre seeing now is a Global Demand spike. Because of the outbreak in china itself, i think the demand was all gobbled up. That is now just starting to loosen up. Narrator direct relief planne planned to distribute these chinesemade masks to healthcare workers across the country. Looking at the footage wed shot, the Associated Press reporters made a surprising discovery. Linderman looks like hes inspecting them, right . Mendoza those, those are ear loops, not a head strap. Narrator the straps on the masks looked different than normal. Mendoza i dont think theyre supposed to have an ear loop lderman no, theyre definitely not. Narrator we sent some of the masks to be tested at an environmental medicine lab at the university of north carolina. All of these products that arrived, even though theyre labeled clearly n95, and they show the lady in the picture is wearing a mask with head straps, it has ear loops, so thats a dead giveaway that its a counterfeit product. These were all counterfeit that we tested. Narrator his tests showed that the counterfeit masks did not meet requirements to filter at least 95 percent of harmful particles. Direct relief never sent out the masks, but around the country as more shipments began to arrive from china, more counterfeits began turning up. And now federal agents say that they are seeing criminals preying on people during the coronavirus pandemic. Narrator . Just as Health Officials were reversing course and urging everyone to wear masks. Counterfeit masks, hand sanitizers, fake covid19 testing kits. Customs inspectors have been seizing fake medical supplies as scammers try to take advantage e of the crisis. Narrator we wanted to talk to the fbi about the rash of counterfeits. They were part of a task force investigating the problem. Linderman my colleagues and i were working on a story about a nonprofit organization. They were getting one of the first shipments of medicalgrade n95 masks. They opened it up and it turned out that they were all counterfeit masks. How does Something Like this happen . Under the covid circumstances, supply and demand changed rapidly, and the demand became so great that it overtook what we really had in our stock. So that didnt change that, the fact that the medical professionals and First Responders really needed that. Theres a lot of money out there and, you know, working for the fbi, it becomes clear on your first day here that when there is an opportunity for a criminal to make money, they will explore that. Linderman what is the risk of having counterfeit or substandard masks actually make it to frontline medical workers . If, when you put on a set of ppe, you assume that its going to protect you. Thats what its for. And if its not dog that job, it really is putting the most Vulnerable People at risk. So that is something that should scare every one of us. Narrator as we continued investigating medical supply shortages, we followed a trail leading back more than a decade, to the story of a maskmaker in texas. The mask capital of the world was fort worth, texas. I was with some Amazing Companies that did se incredible things. Great products, great company, very innovative, very efficient. We ruled the world on face masks. Narrator dan reese is one of the last domestic mask manufacturers. He told us a turning point for the industry ce in 2001. China was vo the World Trade Organization today narrator . When the wor trade organization welcomed its newest member. The peoples republic of china. That was the beginning of the end. Theres nothing to stop them, so were left competing agnst china. Narrator by the late 2000s, most of the masks used in the United States were produced outside the country. This is a huge security issue for this country. They can stop it, saying, were not going to ship to you because we need it. R reese had officials from the department of health and Human Services visit his factory in 2007, and warned them the u. S. Risked losing control of its mask supply. The ppe, the things tt we have to have in an emergency, we, as a country, cannot hand this control over to a foreign government, say, okay, if youre okay with it, send it to us. And thats what we did. Thats the security issue. Narrator it wasnt long before his fears were aying out. The world is now at the start of the 2009 influenza pandemic. H1n1 has spread to 46 states. More than 1,000 americans have died, and more than 20,000 have been hospitalized. Narrator amid the h1n1 pandemic, officials believed the u. S. Might need as many as five billion n95 masks nearly 50 times what the country had on hand. Public Health Experts are expressing concern about whether hospitals could handle the onslaught. We received a call from the government that says, prestige, we have a situation. So they ask us to ramp up, ramp up hard, do everything we could do. Save the cntry. And ouresponse was, were small. Were t that big, you know . We dont have huge market share. But what we did, with our own money, our own investment, we went round the clock. We built machines as fast as we could possibly build them. We went from having probably 60 employees to having 260. And we respond as much as we possibly can for the country. Narrator with much fanfare, reese cut the ribbon on a new facility that they called the Global Pandemic preparedness and Response Center. Its kind of a dream to be this Pandemic Response center. 15 years ago, nine out of ten masks were made right here in the United States of america. In less than a decade, that flipped, where one out of ten masks is now made in this country. But this company, this company made the commitment to turn that around. Narrato texas congressman michael burgess, whos also a physician, understood the importance of what was happening. It is important that those masks function as required, and the only way to ensure that is to have those masks made by you in the United States of america. Are we willing to spend a few pennies more for a mask, but have a reliable mask availle, and the supply of masks that we need . I think thats the question that has to be answered. Linderman so what happened to that Response Center . sighs the amount of product that was purchased diminished. The pandemic w over, everyones attention got diverted to something else, then the monies dried up. One day, america realizes, were not going to die from h1n1. It looks like swine flu is history. The World Health Organization just declared an end to the h1n1 pandemic alert. Narrator with the outbreak under control, prestige ameritechs orders werent renewed. Hospitals went back to buying cheaper masks from their overseas suppliers. Reeses business nearly went bankrupt. The people that wed hired, these people thastepped in to save america, they were rewarded by getting in an unemployment line. Mendoza when they asked you to ramp up, didnt the government guarantee anything to help support you . No. Mendoza nothing. No. Narrator reese showed us letters he and his colleues wrote to the Obama Administration insisting that america must resecurits mask supply chain. They said h1n1 was a wakeup call, and warned that in a major pandemic, china could stop shipping maskso the u. S. But in washington, officials had moved on. Their fallback would be an emergency stockpile meatockpt to cover medical needs in such a crisis. The stockpile fills a gap. If the Strategic National stockpile did not exist, we would have very limited or no capability to respond to these types of events. Narrator greg burel ran the Strategic National stockpile, thsns, a series of governmentrun warehouses filled with medical supplies like ventilators and masks, which were critically important during the h1n1 pandemic. Linderman the sns response to h1n1 was the rgest deployment of the stockpile. What was your focus during that tim during h1n1, we sent out personal protective equipment that we had stocked for a pandemic influenza event ahead of a great deal of disease spread, so it was already in place. We showed we could get that material out rapidly, and it could be made available. Narrator the problem was, h1n1 ended up depleting the stockpile. And in the ensuing years, Neither Congress nor the white house moved to substantially refill it. One government report found that many of the n95 masks in the stockpile were past their Expiration Date some broken, gathering dust and mold. We bought the n95 masks that are in the stockpile with funds that were appropriated in the early 2000s. Theyve passed their expiry date, but we didnt have additional funds to buy more, so weade the difficult decision to hold on to those. You cant be prepared if youre not funded to be prepared. Linderman why do you think you didnt receive those appropriations . Youd really have to ask the congress. Well, yeah, congress does bear a significant amount of responsibility. There are always going to be competing budgetary priorities. Its difficult when you talk to the people in the Budget Committee to say, these are the dollars were going to need to purchase n95 masks. I think if wed had that discussion a year and a half ago, youd have got a lot of blank stares. Narrator but, in fact, in those precovid years, we found repeated warnings from inside and outside the government that the country was being left without a safety net. That the government needed to strengthen the supply of ppe. And it wasnt just masks. It was ventilators, too. At that time, the ventilators in the stockpile were pretty old. And we really wanted to set out to modernize the stockpile. Narrator nicole lurie was in charge of preparedness and response at the department of health and Human Services. In the wake of h1n1, she tried to do something about the dire situation. How can we make a better ventilator . How can we make it cheaper . And how, then how can we have enough . And so we contracted with a couple of Different Companies to make those ventilators. Narrator the final contract in 2014 went to a Company Called philips respironics. The plan at the time washey cou0 machines to the stockpile by mid 2019. Ultimately, that ventilator t approved for use by the fda. It was small. It was nimble. It was notve. And there was a contract to procure those for the strategic nation stockpile. Linderman so philips delivered on their contract . No. Narrator hhs didnt actually order the ventilators until september 2019, and thenave philips more time to deliver. The delays have sparked questions in light of the coronavirus pandemic. When we spoke to congressman Raja Krishnamoorthi this past summer, he was leading an investigation into the philips deal. Although philips had been contracted to deliver them by this time, theyre nowhere to be seen. Linderman is that surprising . It is surprising, given how much money that the federal government and the taxpayers have put into this project of developing these ventilators. The fact that i dont believe we have even one of these is not only surprising, its shocking. Thats all the more an indication of failure on the part of the government. Narrator philips would not agree to an interview, but in aners to our written questions, said it had recently delivered 1,700 ventilators. The company said the delays were due to Software Development issues discovered during testing, and fda cleance. Which took longer than anticipated. As a result of the delays, at the end of the Obama Administration, there were only about 18,000 ventilators in the tional stockpile, a fraction of what Health Officials said would be needed in a fullblown pandemic. And when it came to n95 masks, the reserves were thin, too. So in all of this, you say, well, whats likely to happen . People are going to get sick. Healthcare workers are going to need to take care of them. You need to protect healthcare workers almost as a First Priority population, because you need to keep the Healthcare System running, right, to take care of people who are sick. Narrator with these shortages in mind, nicole lurie and other outgoing Health Officials tried to warn the Incoming Trump administratio about the dangers that might lie ahead. There was a brief afternoon with the incoming team that played through a pandemic scenario and walked through with the incongabinet what roles and responsibilities were, and the things that they needed to have on their radar screen. Linderman did they mention specifally, like, shortages . We always talked about shortages. Linderman do you remember the, kind of the big takeaways from that . The big takeaways from that were that there was not a lot of traction on the part of most people who were participating. One didnt have the sense coming in that this was going to be high on the priority list. The World Health Organization declaring the outbreak of covid19 a Global Pandemic. New delopments in the coronavirus emergency. Much of america shutting down. Every day, you hear about a new shortage. Narrator in the spring of 2020, it was impossible to ignore the warnings any longer. All kinds of companies producing things they dont normally produce. Narrator furniture makers switched to making masks. Were seeing a lot of handsondeck approach. Narrator factories retooled to make face shields. Distilleries were producing hand sanitizer. We went to one Hospital Group on long island. Hello linderman hi narrator that was trying to make its own swabs for coronavirus tests. By no means are we going into the swab business forever. This is a way to keep us operating at00 as more and more people came into the hospital. Narrator they were using 3d printing technology. This is the final swab here. We need these swabs from everyone. Like, producing it by manufacturing capacity is not there, so we need everyone firing on all cylinders in order to combat this, so we can get ourselves back to normal, and we wanted to ensure that the testing supplies were not limited by something as simple as a nasal swab. Narrator with such widespread srtages, the Trump Administration had to look abroad for help. We did not make any significant volume of supplies in the United States. I realized that i was going to have to fly material here, accelerating volume from overseas to the u. S. Narrator rear admiral John Polowczyk was put in charge of a program called project airbridge that attempted to procure supplies from china and elsewhere and distribute them in the u. S. But from the start, it didnt go well. States continued to struggle to get supplies. Some governors took matters into their own hands, cutting their own foreign deals. In New Hampshire today, an airplane carrying over 91,000 pounds of personal protective equipment landed in the granite state. Marylands governor brokered a deal to buy half a million coronavirus tests. Governors were forced to find private Business People who had connections around the world to tryo somehow get ahold of just basic things like masks. This is the first of several flights to the frontlines in illinois, an effort the governors office, frankly, calls comparable to the wild, wild west. Theres 50 states, and so it was everybody against everybody else. It was just a freeforall. The single largest shipment the states received of personal protective equipment, or ppe, is being delivered today. Linderman do you have a sense of where and how supplies are distributed . Well, thats one of the questions weve asked them in our manletters,s, what are the standards and what are the protocols . Project airbridge is, li many of these pjects with the federal government, its a little unclear how much thats actually worked to bring equipment here. And, i mean, the original idea, i think, was to get equipment here, but i havent seen much of a response. Linderman why hasnt there been better coordination . I think theres been, theres been a lot of coordination. Ive had several series of sit downs with every state emergency manager, every state health officer, what theyre buying, how theyre trying to buy, where theyre going. So from where i sit, i see lots of coordination. Linderman both houses of congress have investigated project airbridge, and among the issues theyve raised is concerns about secrecy, lack of transparency. Whats your response to those criticisms . Unfounded. Linderman unfounded. The governors have as much visibility as i do to where supplies are going. So the secrecy and the lack of transparency is absoluty unfounded. The volumes of masks, gowns, thermometers, face shields, those supplies went to, first, frontline healthcare workers. Narrator in fort worth, dan reese was watching from the sidelines, dismayed once again by the shortes, and the continued reliance on products from china. The minute i heard that this was the coronavirus in china, we started reaching out to the government to try to get help, because were thinking that this could be the big one that weve been talking about. Narrator reeseffered to ramp up mask production, but the company wanted a guarantee that the government would commit to buying from them even after the emergency was over. Its the same catch22 we had on h1n1. When they would come back to us and say, well, yeah, and well give you a contract for the next nine months. From a business stanoint, we said, we cant do that, when we dont know that theres going to be a tomorrow. Narrator at the time, there were mounting calls to tap into u. S. Companies like reeses. Associations representing hospitals, physicians, and nurses appealed directly to the president to increase Domestic Production of ppe and other supplies. Linderman you had a chance to go to the oval office and actually talk to the president. What did you tell him . We did have a brief discussion about the, you know, the ppes. When you look at the job weve done on everything on supplies, on eve gowns, the gloves, the. The masks. A lot of nurses theyre seeing death probably three to four times the average than what they normally would. A lot of death. Yes. No question about it. And by the way, while were at it, can you pass these pens around, okay . You know, he was insisting that anyone who needed to get the equipment, you know, it was there. Ive heard that they are loadedp with, with gowns now. Ive heard we have tremendous supply to almost all places. Tremendous supply. I dont believe that thats the case. Linderman do you think that this administration has done what it needs to do to protect healthcare workers . I think a lot more could be done. Linderman what should have happened . Well, a. N. A. Advocated for the president to open up the defense production act so that, you know, companies within the United States could begin to quickly manufacture the equipment that we needed not only the masks, but even ventilators and, etc. Narrator trump had been resisting such calls to use the defense production act, the dpa, which compels private American Companies to produce needed supplies. Defense production act is a wonderful thing, but i just havent had to use it. But remember, were really a second line of attack. The first line of attack is supposed to be the hospitals, and the local gornment, and the states, the states themselves. Were a country not based on nationalizing our business. Call a person over in venezuela, ask him how did nationalization of their businesses work out. Not too well. Narrator eventually, as the pandemic worsened, he relented, tweeting at automakers start making ventilators, now this afternoon i invoked the defense production act to compel General Motors to accept, perform, and prioritize federal contracts for ventilators. Narrator we spoke to the head of the ventilator company that was working with gm about the president s order. We were doing everything we could to move as fast as possible with General Motors. I think trump was expressing what so Many Americans were feeling we need ventilators now. We need to solve this problem now. Mendoza President Trump said the defense production act, he was invoking it in order to get this going. Is that what got you and your Company Working with gm in kokomo to start making ventilators, or were you already making ventilators at that point . We were already in the process of making ventilators, and the defense production act didnt get us to move faster and itidnt create the partnership. The dpa did help in terms of supplyines and getting parts here on time. You can get a tweet from the president , or you can have a phone call with a frontline spital worker and hear their voice shaking, talking about trying to make a decision of who gets a ventilator and who doesnt. Its those phone calls from, from the real heroes that. That you, youll never forget. Narrator in august, we met with President Trumps trade adviser, peter navarro, who oversees the defense production act. Linderman a common refrain from critics has been that the dpa hasnt been used enough and that it wasnt used soon enough. So, on the soon enough, thats, thats counterfactual. If you look at the executive orders, they begin in march quite aggressively. So we had six executive orders and four president ial memorandum where we were using it, so thats when that began. And in terms of aggressive enough, this, this again is counterfactual, and i think it reflects a misunderstanding of what the dpa actually can and should do. Our strategy has been basically to go innd use it forcefully when weve had to, and then let the rest of Corporate America understand that if they dont do what they should do, were coming after em, and thats been very effective. Narrator navarro was one of the earliest officials to warn President Trump about the pandemic and has long expressed concerns about critical supplies, like ppe, being manufactured overseas. Were dangerously dependent on the Chinese Communist party for all sorts masks, equipment, and we know that they, in terms of, times of crisis, will hoard that stuff. Linderman you haveeen talking out the potential dangers of u. S. Manufacturing moving offshore for a very long time. Is this the ty of scenario you were worried about . No, this is what i was worried about on steroids. This panmic has shone a bright light on the dangers, because Something Like over 80 countries during this pandemic has put some form of export restrictions on what we need as a country to protect our public health. Narrator using the defense production act was supposed to help address this problem and invigorate u. S. Manufacturing. But when wlooked at the white houses report on dpa contracts it showed that the largest ones had been earmarked not for ppe, but for ventilators which the u. S. Produces a lot of already. And one contract stood out 646 million to philips respironics, the same Company Whose earlier deal to deliver ventilators to the National Stockpile has been plagued by delays. Linderman if this company didnt deliver on their first contract, how do you get a second contract . That is something were trying to figure out. For philips to essentially fail on its first contract, and then to be awarded a more lucrative contract, is puzzling, to say the least. Narrator the new contract would pay philips nearly five times as much per ventilator as the previous contract. The company told us the original machines had been priced exceptionally low and that the new ones had functional differences and a higher cost for expedited delivery. We showed the specs for both models to experts in respiratory care and medical device engineering. They said the two devices appeared to be similar and found nothing to account for the price difference. A congressional investigation came to the same conclusion and laid some of the blame on the man who negotiated the contract, peter navarro. Linderman the criticism has been that this administration is allowing taxpayers to pay five times more for what is functionally the same ventilator as the previous. See, thats. Linderman no, no, and this is coming from a congressional report. Of course, its a democratic congressionareport. Let me tell you about ventilators. All ventilators are not created equal. You cant compe the price of this ventilator with that ventilator withoutontrolling for their functionality, okay . Linderman so youre saying theyre very different. Theyre very different. Youre dwelling on something thats tiny in the scheme of things, and thats why i always worry about these kind of interviews, because if the American People really want to know whats happening, its not what may or may not beappening with a single contract with philips, okay . Because thats just pure political bs, okay . Thats all youre doing here. If you want to play that game and put it on the air, fine, but put this on the air thats just bs. Narrator shortly after we spoke to navarro, the department of health and Human Services terminated the contract with philips. Hhs declined to comment on why but canceled other ventilator deals, too, saying the National Stockpile ha our months of reporting on the supply chain problems led not just to china or the white house but to the way hospitals themselves operate in the unit states. To places like this, a procurement warehouse for northwell health, the new york Hospital Group that had scrambled for swabs in the early days of the pandemic. Linderman so, paul, whats going on the truck . These two car are ppe supplies for a covid unit. Narrator paul spodek oversees medical supply distribution here. He explained to us that the way the business works is based on a concept known as just in time, which is designed to keep costs low. A hospital will submit an order today, get their delivery tomorrow just for that dayand they receive it in just in time instead of stockpiling material on site and using up valuable space and also labor. Linderman so its a space issue, not wanting to order a lot more product than you think youll need in the immediate short term. Correct. Its a space issue, but its also making sure you get the right product. If youre not utilizing a justintime system, you will order too much product that you do not need and not enough product that you really do need. Narrator but when the pandemic first hit, most hospitals didnt have enough on hand or a way to stockpi because of the justintime system. Even a chain as big as northwell, with its 85,000 squarefoot warehouse, struggled. Lindean how close did you geto running out . Isolation gowns was very close. This building looks large, but as we found out in this pandemic, large wat enough. Linderman did you experience any shoages that were surprising to you . Well, you know, wed never thought wed run out of mortuary kits, also called body bags. It was something that youd never think of, um, that wed alwayhave enough. I mean, it still gives me goose bumps thinking about it. Narrator some of northwells supplies come by way of a Company Called premier. A Group Purchasing organization, or gpo, which works with more than 4,000 hospitals around the country to get medical supplies. Its another way of keeping costlow. Wdont distribute products, so we contract for products. There are Health Care Systems that, you know, said, were going to go dos on our own. Well, youre going to be spending a lot of money on holding costs, carrying costs. Mendoza if you have a lower cost, does that mean you have less Surge Capacity . No, well, its interesting. Um, if you have a lower cost. I think what we did and again, not we, premier, but we, the industry, did by creating this, you know, narrow supply chain of products, i think we didnt keep sort of redundancies along the way. I think that there are ways that we can still create products at reasonable prices. It may not be the lowest price, but reasonable prices. Narrator but we found studies and reports going back years raising concerns that gpos could be anticompetitive and disrupt the supply chain. Mendoza is there some risk that gpos slowed down that procurement . Slowed down the procurement . You know, its interesting, i dont think so. I would actually argue its the exact other way, were sort of this independent arbiter that helps sort of grease the skids and tries to always try to create healthier markets. Their role is to obviously be able to buy more in bulk at a cheaper, cheaper rate. And as a result of that, you know, youre saving money down, down the line. But in this case, when theres the increased demand, the system seemedo have failed somewhere along the way. Narrator that is exactly what happened to premier when the pandemicit and oic hit and s overseas factories shut off supplies. The factory in taiwan said, were no longer going to be able to ship to the u. S. , were going to ship all this product to mainland china. Lesson learned on behalf of the industry is weve got to create more resiliency, and we dont ever want to find ourselves in this situation again. Narrator so, in may, premier bought a Minority Stake in one of the only domestic mask makers, dan reeses company, prestige ameritech. So, its a huge thing for our company, it was very good. The key thing, its not so much just the dollar infusion in cash, its the commitment of these members. The members are stepping in, saying, hey, were going to buy 500,000 respirators a month for the nexthree years. See, thats what we need. Narrator while reeses masks cost more than ones from china, premier was willing to pay the extra at least for now. Mendoza this is e of your prestige ameritech n95 masks for under a dollar. Heres a n95 mask made in china for 30 cents. How do you compete with that . Well, thatsthats really the issue. The bottom line is china can sell masks into the u. S. Market in my territory for cheaper than my raw material costs are. And so youre not gonna be able to successfully compete there. Narrator thats the same thing we heard talking to people who do business in china. speaking chinese dialect Cameron Johnson helps u. S. Hospitals buy ppe from china and has been based in shanghai for 20 years. Mendoza one thing that i keep hearing here in the United States is, we are gonna have to shift manufacturing here. Were gonna have to be producing a domestic supply of n95s and gowns and gloves and test kits. Is that realistic . The challenge really is that china has 50 of the worlds productionapacity, particularly for masks. So are we gonna move an entire supply chain over . Its just not gonna happen. Manufacturing, as we know it, is never gonna return. speaking chinese dialect narrator thousands of compies in china are dedicated to making ppe. And many others, like this plastics manufacturejohnson took our camera crew to see, quickly pivoted during the pandemic under governmt orders. The factory we visited, historically, that company produced plastics and then had to shift to producing ppes. Part of this change for them was required by the local government at the time in march. So this is why they shifted so quickly into producing these products. In china, you have an ecosystem of various companies, whether they provide ingredients, raw materials, production capacity. And that currently doesnt exist in the u. S. Narrator to the Trump Administration, this all speaks to what they say is an unfair Playing Field that china continues to exploit. The n95 face masks. Um, china put export restrictions on those masks and then nationalized. Narrator for peter navarro, a case in point is what happened in late february at the shanghai subsidiary of american mask maker 3m. Next thing they did was nationalize, effectively, 3m, our company, uh, in china to prevent them from sending us any stuff. The masks that we produce in china are sold in china, for the most part. Um, that is a Large Industrial country now. Mendoza the white house trade advisor, peter navarro, at one point, said china had nationalized 3ms manufacturing there. Did that is that accurate . When the demand increased in china we produce respirators in Shanghai Area um, and what did happen is the Shanghai Municipal government came to 3m and requested preference and, uh, a higher degree engagement in, uh, addressing the orders that we were. For everything that we were shippi out of the shanghai facility. They were prioritizing thethe shipping locations, because they understood evebetter than we did or even our own distributors where the needs were greatest in china. Mendoza so that doesnt really sound like the government nationalized it. Right. We ctinue to run the plant, the operations, our workers, um, but theythey were there with us, uh, you know, every day, um, as we produced respirators, and they were very closely involved inin deciding where those shipments were going. Linderman we spoke to 3m and they completely disagree that it was nationalization. They said that the Chinese Government requested preference and a higher degree of engagement in addressing the orders for everything we were shipping out of the shanghai facility. Memo to frontline here. This is why we had to do the dpa order on them. Theythey are the slipperiest people that i that i dealt with in this white house, in terms of getting to yes on things. So if theyre spinning it that way, they can go ahead and spin it, but im telling you flatout that the Chinese Communist party, both at the federal level and at the local level i think it was in shanghai was prohibiting those masks from leaving china. Linderman but. And we had no. We had to deal with that diplomatically and we had to deal with it with the dpa. And im telling you, i dont care what 3m says thats what happened. Linderman but is that different than the functions of the dpa that sayhat we can block exports of masks from our country . What that does is it underscores, with an exclamation point, why we have to have this prodtion here, why we have to have it here. Narrator in recent weeks, President Trump and former Vice President joe biden have both made returning medical supply manufacturing to the u. S. Part of their camigns. Were taking our business out of china. We are bringing it home. Well make the medical supplies that our country needs. Bring home our medical supply chains. Its easy to, as a politician, to stand at the podium and say, america is the most competitive country in the world. We have the best workers. The truth is, we are not that competitive. Well never again be at the mercy of china or other Foreign Countries in order. Oftentimes we hear anywhere but china abc. Anywhere but chi. Okay, but whats your plan . Manufacturing is not gonna come back to the u. S. Either, becae the ecosystems dont exist or the Technology Basis doesnt exist or Government Support doesnt ex i mean, take your pick. Here we are again. Its harder to get anything. Nurses worry there wont be enough personal protective equipment to go around. Narrator seven months into the pandemic, the medical supply chain remains fragile. Linderman were months into this pandemic and we are looking around the country and nurses and doctors still dont have enough personal protective equipment. So, i want to ask you, i mean, why do you think that is . I, uh. Nna have to disagree with you. Um, uh, as i, uh, look across the nation and the data that i have from, uh, supply chain, from the commercial supply chain, from hospital reporting, nursinhome repting, theres a lot of supplies in the nation. Uh, i cant, uh i cant answer your question why, uh why nurses are still saying that, um, they dont have supplies, because thats not the picture i have. Narrator but a recent survey of nurses around the country found that twothirds of them were still reusing n95 masks, more than half of them for five days or more. It didnt need to be this way. This is an administration that had policies, procedures, tools, plans, checklists, advance warning, all of those things. And it appears to have used almost none of it. Former hhs official nicole lurie, who recently began advising the biden campaign, has watched with alarm. Im sure that there are people working very, very hard. And i know there are, and i know there are a lot of people who are really frustrated. Um, but for. His is such a historical failure on so many levels. Theres new vaccine hope this morning. Narrator and now there are new concerns about the supply chain. This morning, a major milestone in the battle against covid19. Narrator as the country races for a vaccine. Covid19 vaccine contenders are now producing their vaccines. Narrator . Will there be enough syringes . Has asked states to prepare for covid19. Given the abject failure, frankly, of the administration to provide materials for testing and ppe, we do worry if ll have enough of the vials and enough of the syringes and so on. Narrator the Trump Administration says its been ramping up and has given contracts to seral u. S. Companies to boost the supply of syringes. Linderman in june, you meioned thatthat we were on the path to have 400 million needles and syringes. Can you just tell me if you think were gonna meet it . Weve used the defense production act with, um, a few u. S. Producers. I believe theyre on track. I think some of these vaccines might be a, um. A double dose, so well need, you know, twice the number of 300someodd million, uh, americans, and ii believe the i believe they have, uh, syringes on thatthat order of magnitude uh, vials, syringes onon order. Narrator hhs would not discuss its syringe deals or tell us how many have been delivered to date. Buwe found some troubling signs the largest contract is with a company that says it doesnt yet have fda clearance. Another company has experienced supply chain delays. And e ceo one supplier told us he has doubts about t countrys ability to ramp up. Back in fresno, california, nurses like rachel spray, still reeling from the death of her colleague Sandy Oldfield, are worried. Were still reusing masks, shields. Weve been short on gloves, short on gowns. We feel disposable. If theyre saying that theres enough, why cant we get it . It costs money. It costs money to bring it here and make it here. Its cheaper to just import it. You know . All that capitalism and rporate greed. Mendoza at wt cost . The cost of human life. Nurses. Patients. Health care workers. Sandy. Go to pbs. Org frontline for more reporting from our partners the Global Reporting Centre and the ap on medical supply shortages. That could be a life and death situation right . Heres a n95 mask made in china for 30 cents. And read the extended interview with peter navarro. You want to play that game and put it on the air fine, but put this on the air. Thats just bs. Connect with frontline on facebook and twitter, and watch anytime on the pbs video app or pbs. Org frontline. Well we are going to have to see what happens. You know that, ive been complaining very strongly about the ballots. Narrator is america headed for a constitutional crisis . Im being facetious, i said what country are we in . Narrator jelani cobb investigates the early warnings. Theres a dispute over which votes might count. Republicans control some really key levers of power. Narrator and allegations of voter suppression. Were setting the ground rules for how voteare going to be cast and counted come november. Frontline is made possible by contributions to your pbs station from viewers like you. Thank you. And by the corporation for public broadcasting. Major support is provided by the john d. And catherine t. Macarthur foundation, committed to building a more just, verdant and peaceful world. More information at macfound. Org. The Ford Foundation working with visionaries on the frontlines of social change worldwide. At fordfoundation. Org. Additional support is provided by the abrams foundation, committed to excellence in journalism. The park foundation, dedicated to heightening Public Awareness of critical issues. And by the frontline journalism fund, with major support from jon and jo ann hagler. Captioned by Media Access Group at wgbh access. Wgbh. Org for more on this and other frontline programs, visit our website at pbs. Org frontline. Frontlines, americas medical supply crisis is available on amazon prime video. Youre watching pbs. Continues to grapple with the impact of the ongoing pandemic. Narrator the truth is rare black and white. Protesters versus frontline workers. Filled with so much uncertainty. Narrator but if we ask the hard questions. Death toll in the u. S. Tops 200 thoand. Narrator check the facts. The internet is disrupting. Is amazon taking over the worla good thing . Narrator ig a little deeper. Boom narrator and take a breath. The truth is closer than you think. Major funding for voces on pbs was provided by the National Endowment for the arts and by acton family giving. Funding for adios amor was provided by. The National Endowment for the humanities bringing you the stories that define us. The corporation for public broadcasting a private corporation funded by the American People. And others. A complete list is available from pbs. O0 c1