Existing law establishes the State Department of Public Health to implement various programs throughout the state relating to public health.

This bill would require the State Department of Public Health, in coordination with the Office of Emergency Services, medical health operational area coordinators, regional disaster and medical health coordinators and specialists, medical and health coordinators, and other state agencies, to establish a statewide strategic stockpile. The bill would require the department, in coordination with the Office of Emergency Services, to establish guidelines for the procurement, management, and distribution of medicine, vaccines, and dental and medical supplies, taking into account, among other things, the amount of each type of item required for a sustained health emergency. The bill would authorize the department to enter into contracts with private entities for the procurement or reservation of supplies and for management and distribution of the stockpile. The bill would require the department to report annually to the Legislature, and others, the amount of items in the stockpile, the amount of items from the stockpile that have been used, the amount of anticipated future usage, the status of existing contracts with private entities that fulfill the procurement guidelines, and information regarding items reserved through those private entities. By creating new duties for medical health operational area coordinators and regional disaster and medical health coordinators and specialists, medical and health coordinators, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law establishes the State Department of Public Health to implement various programs throughout the state relating to public health.

This bill would require the State Department of Public Health, in coordination with the Office of Emergency Services, medical health operational area coordinators, regional disaster and medical health coordinators and specialists, and other state agencies, to establish a statewide strategic stockpile. The bill would require the department department, in coordination with the Office of Emergency Services, to establish guidelines for the procurement, management, and distribution of medicine, vaccines, and dental and medical supplies, taking into account, among other things, the amount of each type of item required for a sustained health emergency. The bill would authorize the department to enter into contracts with private entities for the procurement or reservation of supplies and for management and distribution of the stockpile. The bill would require the department to report annually to the Legislature, and others, the amount of items in the stockpile, the amount of items from the stockpile that have been used, the amount of anticipated future usage, the status of existing contracts with private entities that fulfill the procurement guidelines, and information regarding items reserved through those private entities. By creating new duties for medical health operational area coordinators, coordinators and regional disaster and medical health coordinators and specialists, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law establishes the State Department of Public Health to implement various programs throughout the state relating to public health.

This bill would require the State Department of Public Health, in coordination with the Office of Emergency Services Services, medical health operational area coordinators, and other state agencies, to establish a statewide strategic stockpile. The bill would require the department to establish guidelines for the procurement, management, and distribution of medicine, vaccines, and medical supplies, taking into account, among other things, the amount of each type of item required for a sustained health emergency. The bill would authorize the department to enter into contracts with private entities for the procurement or reservation of supplies and for management and distribution of the stockpile. The bill would require the department to report annually to the Legislature, and others, the amount of items in the stockpile, the amount of items from the stockpile that have been used, and the amount of anticipated future usage. usage, the status of existing contracts with private entities that fulfill the procurement guidelines, and information regarding items reserved through those private entities. By creating new duties for medical health operational area coordinators, the bill would impose a state-mandated local program.

Existing law establishes the State Department of Public Health to implement various programs throughout the state relating to public health.

This bill would require the State Department of Public Health, in coordination with the Office of Emergency Services and other state agencies, to establish a statewide strategic stockpile. The bill would require the department to establish guidelines for the procurement, management, and distribution of medicine, vaccines, and medical supplies, taking into account, among other things, the amount of each type of item required for a sustained health emergency. The bill would require the department to report annually to the Legislature, and others, the amount of items in the stockpile, the amount of items from the stockpile that have been used, and the amount of anticipated future usage.

Date of Hearing: May 8, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2101

Author:(Rodriguez) – As Amended Ver:April 25, 2024

Urgency: No State Mandated Local Program: Yes Reimbursable: Yes

SUMMARY:

This bill requires the Department of Public Health (CDPH) to establish a statewide strategic stockpile.

Specifically, this bill:

1. Requires CDPH to coordinate with the Office of Emergency Services (OES); medical health operational area coordinators; regional disaster, medical, and health coordinators; and other state agencies to establish the stockpile. CDPH must coordinate with OES to establish guidelines for the procurement, management, and distribution of medicine, vaccines, and dental and medical supplies. The guidelines must take certain considerations into account, such as the policies and funding required to establish the stockpile and how distribution should be prioritized in the event there are insufficient resources to meet identified needs.
2. Authorizes CDPH to enter into contracts with private entities for the procurement or reservation of supplies and for the management and distribution of the stockpile.
3. Requires CDPH to annually report to the Legislature specified information about the stockpile, including the amount of items from the stockpile that have been used and the status of existing contracts with private entities.

FISCAL EFFECT:

1. Costs in the mid-to-high tens of millions of dollars to CDPH to establish the statewide strategic stockpile, including establishing the guidelines; procuring, storing, and distributing the materials; and reporting specified information to the Legislature (General Fund (GF)).
2. Minor and absorbable costs to OES to coordinate with CDPH to establish the stockpile and related guidelines.
3. By requiring medical health operational area coordinators and regional disaster, medical, and health coordinators to coordinate with CDPH to establish the stockpile, this bill may create a state-mandated local program. If the Commission on State Mandates determines the provisions of this bill create a new program or impose a higher level of service for which the state must reimburse local costs, the local agencies associated with the coordinators could seek reimbursement from the state (GF).

According to the Legislative Analyst’s Office, the GF faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

COMMENTS:

1. Purpose. The author states that “as the legislature considers potentially defunding the state’s early pandemic detection efforts, having a robust stockpile is even more critical for ensuring our readiness to tackle crises head-on.” According to the author:

By codifying the state strategic stockpile and enabling CDPH to develop clear guidelines for procuring, managing, and distributing these essential supplies, we demonstrate our clear commitment to preparation. Stockpiles are like emergency toolkits, giving us what we need right away when trouble hits.

This bill is supported by the State Long-Term Care Ombudsman, medical associations, and labor organizations.

1. State Stockpile. The Strategic National Stockpile is part of the federal medical response infrastructure to supplement medical countermeasures needed by states, tribal nations, and territories during public health emergencies. California also maintains its own stockpile, reflective of the state’s needs and priorities. The state’s stockpile inventory includes various types of personal protective equipment (PPE), such as face masks, N-95 respirators, and gloves, COVID-19 testing supplies and pharmaceuticals, and, in the past, Misoprostol, a commonly used abortion pill. CDPH and OES are jointly responsible for adding, dispersing, and rotating items through their warehouses, with CDPH historically responsible for distribution to public health entities and OES distributing items to other organizations.

SB 275 (Pan), Chapter 301, Statutes of 2020, required, upon appropriation, CDPH to establish a PPE stockpile to ensure adequate supply for all health care workers and essential workers in the state. The stockpile must be sufficient to weather a 90-day pandemic or other health emergency. However, an appropriation has not been made through the budget process. This bill requires CDPH to establish a statewide strategic stockpile that encompasses all of the state’s potential public health emergency needs.

1. Related Legislation. AB 228 (Wilson) requires, upon appropriation, CDPH and OES to establish an infant formula stockpile. AB 228 was held on this committee’s suspense file.
2. Prior Legislation. AB 1217 (Rodriguez), of the 2021-22 Legislative Session, would have authorized CDPH to rotate PPE in the state’s stockpile by selling the PPE to a non-profit agency, local government, or provider, and by contracting to purchase PPE on behalf of a local government or provider. AB 1217 was referred to this committee’s suspense file without further subsequent action.

AB 2537 (Rodriguez), Chapter 313, Statutes of 2020, required employers to supply workers providing direct patient care in a hospital setting with access to a six-month stockpile of unexpired PPE.

Analysis Prepared by: Irene Ho / APPR. / (916) 319-2081

Date of Hearing: April 23, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2101

Author:(Rodriguez) – As Amended Ver:April 15, 2024

SUBJECT: Statewide strategic stockpile.

SUMMARY: Requires the State Department of Public Health (DPH), in coordination with the Office of Emergency Services (Cal OES), medical health operational area coordinators (MHOACs), regional disaster and medical health coordinators and specialists, and other state agencies, to establish a statewide strategic stockpile. Specifically, this bill:

1. Requires DPH, in coordination with Cal OES to establish guidelines for procurement, management, and distribution of medicine, vaccines, and dental and medical supply items in the stockpile from DPH.
   
2. Authorizes DPH to contract with private entities for the procurement of supplies for, and management and distribution of, the stockpile. Authorizes DPH to contract for the reservation of supplies stored by a private entity for the stockpile, and the distribution of those supplies, consistent with this bill and policies established by the DPH.
   
3. Requires the guidelines to take into account all of the following:
   
   1. The various types of items that may be required during a pandemic or other health emergency, including, but not limited to, natural disasters, man-made disasters, and mass casualty events;
   2. The shelf life of each item that may be obtained from DPH and how to restock a portion of each item to ensure the procurements are unexpired;
   3. The amount of each type of item required for a sustained health emergency;
   4. Lessons learned from previous pandemics and state emergencies, including, but not limited to, supply procurement, management, provider eligibility, distribution, and restock;
   5. Geographical distribution of stockpile storage or the location of any contracted entity’s storage facilities responsible for management and distribution of items determined to be necessary for the stockpile;
   6. Guidance on the timely restocking of items distributed from the stockpile;
   7. Guidance on how to establish policies and standards for stockpile surge capacity to ensure that hospitals and emergency providers have access to an adequate supply of any relevant item during a pandemic or other health emergency; and,
   8. The policies and funding that would be required for the state to establish the stockpile.
      1. Requires the guidelines established in this bill to include guidance on distribution from any procurement is to be prioritized in the event that there is insufficient resources to meet the needs of providers or employers of providers, including consideration of all of the following:
         The provider or employer is in a location with a high share of low-income residents;
      2. The provider or employer is in a medically underserved area, as designated by the United States Department of Health and Human Services, Health Resources and Services Administration (HRSA);
      3. The provider or employer disproportionately serves a medically underserved population, as designated by HRSA;
      4. The provider or employer is in a county with a high infection rate or high hospitalization rate related to the declared emergency;
      5. Requires DPH to annually report to the Legislature, the Assembly Committee on Emergency Management and the Senate Committee on Governmental Organization the amount of items in the stockpile, the amount of items from the stockpile that have been used, the amount of anticipated future usage, the status of existing contracts with private entities that fulfill the procurement guidelines, the types and amount of items reserved through private entities, and plans to access items reserved by private entities for an emergency; and,
      6. Requires the report to be submitted in compliance with existing law.

EXISTING LAW:

1. Requires DPH and Cal OES to procure, maintain, and deploy a personal protective equipment (PPE) specific stockpile for use during an emergency, upon appropriation. [Health and Safety Code (HSC) § 131021]
   
2. Requires the establishment of guidelines for the PPE stockpile, as specified, upon appropriation. [HSC § 131021]
3. Establishes a Personal Protective Equipment Advisory Committee for the PPE stockpile, as specified, upon appropriation. [HSC § 131021]
4. Requires DPH to develop a plan with recommendations and guidelines for counties to use in the case of a significant air quality event, such as a wildfire, which must include policies on whether counties should have stockpiles of respiratory protection and other protective equipment and devices available for distribution. [HSC § 107250]
5. Requires the Department of Industrial Relations and DPH to adopt regulations setting requirements for determining 45-day surge capacity levels for health care employer inventories [Labor Code (LAB) § 6403.1]
6. Requires employers with workers in the public or private sector that provide direct patient care in a general acute care hospital to supply PPE and maintain a stockpile, as specified, comprised of three months’ worth of their normal consumption of PPE. [LAB § 6403.3]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California is a disaster prone state, and as we continue to face these emergencies, ensuring we have the necessary supplies to support our residents is imperative. The author contends by codifying the state strategic stockpile and enabling DPH to develop clear guidelines for procuring, managing, and distributing these essential supplies, we demonstrate our clear commitment to preparation. Stockpiles are like emergency toolkits, giving us what we need right away when trouble hits. The author continues with COVID-19, catastrophic wildfires, and other emergencies reminding us why readiness matters, this stockpile isn't just a good idea; it's essential for keeping everyone in California safe. The author states that as the Legislature considers potentially defunding the state’s early pandemic detection efforts, having a robust stockpile is even more critical for ensuring our readiness to tackle crises head-on.
2. BACKGROUND.
   1. Strategic National Stockpile. The Strategic National Stockpile (SNS) is part of the federal medical response infrastructure and can supplement medical countermeasures needed by states, tribal nations, and territories during public health emergencies. The supplies, medicines, and devices for lifesaving care contained in the stockpile can be used as a short-term, stopgap buffer when the immediate supply of these materials may not be available or sufficient. The SNS is separate from California’s stockpile. Items may be requested from the SNS by the Governor or their designee.
   2. The State Stockpile. DPH refers to the items stockpiled as their inventory, which is maintained by DPH and Cal OES. According to DPH, the state inventory “includes various types of PPE such as face masks, N-95 respirators, gowns, and gloves as well as COVID-19 testing supplies and a small quantity of COVID-19 pharmaceuticals.” Depending on decisions made by the Governor (noted in the court rulings section), Misoprostol may be stockpiled once again. Due to the lack of appropriation for SB 275 (discussed in the history section), DPH points to the interactions through resource requests from the COVID-19 pandemic as what directed policy decisions. This includes interactions with MHOACs, Regional Disaster Medical Health Coordinators and Specialists (RDMHSs), and other non-public health and medical sectors which required PPE. They also based guidelines on priorities from the SNS. Cal OES oversees the Logistics and Commodity Taskforce, which is comprised of DPH, the Department of General Services, and CalOES. In lieu of the unfunded Personal Protective Equipment Advisory Committee, this taskforce makes recommendations and provides operational support for acquiring and disbursing the stockpiled items.

Cal OES and DPH are jointly responsible for adding, dispersing, and rotating items through their own warehouses. Historically, DPH is responsible for distributing to public health entities while Cal OES distributes items to all other relevant organizations. Cal OES houses the majority of the PPE while DPH largely manages testing supplies, pharmaceuticals, and over the counter products. Requests are made through MHOAC, RDMHS and forwarded to DPH’s Medical Health Coordination Center, who tasks the appropriate office for fulfilment. There is also communication with the Administration for Strategic Preparedness and Response and SNS staff at the federal level regarding the contents. According to DPH, “Public Health leadership may request medical countermeasures, to include PPE from the SNS, however these resources are prioritized nationwide and may not sufficiently offset state needs.”

When asked to provide a recommendation for what types, and the amount, of items are needed for the stockpile, DPH responded with their March 3, 2020 to April 3, 2020 emergency outbreak situation response data. During this period early in the pandemic, the following resources were distributed from the state stockpile:

1. 24,700,020 N95 respirators;
2. 2,713,500 procedure masks;
3. 1,996,500 gloves;
4. 398,492 surgical/isolation gowns;
5. 408,192 face shields;
6. 116,400 goggles; and,
7. 637,068 bottles of hand sanitizer.
   1. Stockpiling in Response to Court Rulings. The state’s stockpile not only supplements the SNS but also reflects California’s priorities. In 2023, California secured an emergency stockpile of 250,000 pills of Misoprostol, a commonly used abortion pill, in response to an extremist Texas Court ruling which aimed to block access nationwide. California also negotiated an option to purchase up to an additional 1.75 million pills for the same base price of roughly 43 cents per pill. All of the purchased pills were distributed as of March, 2024. With the Supreme Court placing a hold on the Texas Court ruling while they heard arguments and draft their decision, the pressure to make a decision on stockpiling the drug further was relieved. However, the Supreme Court decision is expected in June so California will need to decide whether to resupply this stockpile.
      
   2. PPE issues. As of late 2023, the Associated Press reports at least 15 states (not including California) were forced to dispose of significant amounts of PPE because they failed to properly manage their stockpiles after the height of the pandemic. For example, Ohio trashed nearly $29 million worth of expired gowns, masks, gloves, and other materials; Rhode Island shredded 829 tons of PPE for recycling; Wisconsin trashed 1.7 million masks and 1 million gowns, and Maryland trashed $93 million worth of PPE. Even states that made an extensive effort to distribute their expiring PPE, such as Washington, Nevada, and Pennsylvania, were unable to find enough beneficiaries prior to the expiration dates and sent the PPE to landfills.

While California is not listed in this report, the issues these states have with expired PPE is similar to what our state experienced at the beginning of the pandemic with 21 million, expired N95 masks stockpiled.

1. SUPPORT. The California Nurses Association (CNA) states in support of this bill that California’s medical supply stockpile is critical to ensure the health of it’s population, as well as ensuring that the states values are protected. CNA notes for example that maintaining adequate medical stockpiles will guarantee that nurses and all health care workers have the proper PPE should the country experience another pandemic, natural or human-caused disaster. CNA further states that as other states ban reproductive rights, California maintains common medications that protect a woman’s right to make decisions over her own body. As a statewide strategic stockpile is critical, management of these supplies is equally important to ensure that equipment is ready for use in emergencies. CNA further notes that when the Covid-19 pandemic spread throughout California, the state found the majority of it’s stockpile of PPE to be expired, California scrambled to replace critical equipment that were now in high demand with low inventory available forcing the state to pay premium prices for ventilator masks, gowns and other medical supplies. CNA cites a 2020 study by the Berkeley Labor Center which found California can save millions in maintained statewide stockpile. CNA concludes that as California faces budget deficits, it would be sound economic investment to maintain a statewide strategic stockpile in the event of a major disaster to avoid a situation of low availability of medical supplies.
   
2. PREVIOUS LEGISLATION.
   1. AB 228 (Wilson) of 2023 would have required DPH and Cal OES to establish an infant formula stockpile, upon appropriation. AB 228 was held in the Assembly Committee on Appropriations.
      
   2. AB 2537 (Rodriguez), Chapter 313, Statutes of 2020, requires employers, as defined, to maintain a stockpile of specified PPE for specified workers in an amount equal to three months of normal consumption.
      
   3. SB 275 (Pan), Chapter 301, Statutes of 2020, requires DPH and Cal OES to procure, maintain, and deploy a PPE stockpile for use during an emergency.
3. DOUBLE REFERRAL. This bill is double referred; it passed the Assembly Committee on Emergency Management with a vote of 7-0 on April 8, 2024.
4. SUGGESTED AMENDMENTS. The author may wish to consider amending this bill to clarify that if DPH authorizes a contracted private entity to distribute items from the stockpile, DPH is to specify the distribution of the supplies and not the private entity.

REGISTERED SUPPORT / OPPOSITION:

Support

California Association of Medical Product Suppliers
California Nurses Association
California Teachers Association
Healthcare Distribution Alliance (HDA)

Opposition

None on file.

Analysis Prepared by: Eliza Brooks / HEALTH / (916) 319-2097

Date of Hearing: April 8, 2024

ASSEMBLY COMMITTEE ON EMERGENCY MANAGEMENT

Freddie Rodriguez, Chair

ABPCA Bill Id:AB 2101 (

Author:Rodriguez) – As Amended Ver:April 1, 2024

SUBJECT: Statewide strategic stockpile

SUMMARY: This bill codifies the Statewide Strategic Stockpile and directs the Department of Public Health (CDPH) to establish guidelines, as specified. Specifically, this bill:

1. Requires CDPH, in coordination with the California Office of Emergency Services (Cal OES) and other entities, as specified, to establish a statewide strategic stockpile.
2. Requires CDPH to establish guidelines for procurement, management, distribution, and restocking of medicine, vaccines, and medical supplies items in the stockpile from the department.
3. Requires guidelines to consider:
   1. Types of items required, their shelf life, and the amount of items needed for a sustained health emergency
   2. Lessons learned from previous incidents,
   3. The geographical distribution of stockpile storage or location of items stored through a contract with a private entity,
   4. Guidance on stockpile surge capacity policies,
   5. Funding needs, and
   6. How distributions from the stockpile will be prioritized.
4. Authorizes CDPH to contract with private entities to procure or reserve supplies and for managing and distributing stockpiled items.
5. Requires CDPH to report to the legislature on the status of the stockpile, as specified.

EXISTING LAW:

1. Requires CDPH and Cal OES to procure, maintain, and deploy a personal protective equipment (PPE) specific stockpile for use during an emergency, upon appropriation. (Health and Safety Code (HSC) § 131021)
2. Requires the establishment of guideline for the PPE stockpile, as specified, upon appropriation. (HSC § 131021)
3. Establishes a Personal Protective Equipment Advisory Committee for the PPE stockpile, as specified, upon appropriation. (HSC § 131021)
4. Requires CDPH to develop a plan with recommendations and guidelines for counties to use in the case of a significant air quality event, such as a wildfire, which must include policies on whether counties should have stockpiles of respiratory protection and other protective equipment and devices available for distribution. (HSC § 107250)
5. Requires the Department of Industrial Relations (DIR) and CDPH to adopt regulations setting requirements for determining 45-day surge capacity levels for health care employer inventories (Labor Code (LAB) § 6403.1)
6. Requires employers with workers in the public or private sector that provide direct patient care in a general acute care hospital to supply PPE and maintain a stockpile, as specified, comprised of three months’ worth of their normal consumption of PPE. (LAB § 6403.3)

FISCAL EFFECT: Unknown.

COMMENTS:

According to the Author: “California is a disaster prone state, and as we continue to face these emergencies, ensuring we have the necessary supplies to support our residents is imperative. By codifying the state strategic stockpile and enabling CDPH to develop clear guidelines for procuring, managing, and distributing these essential supplies, we demonstrate our clear commitment to preparation. Stockpiles are like emergency toolkits, giving us what we need right away when trouble hits. With COVID-19, catastrophic wildfires, and other emergencies reminding us why readiness matters, this stockpile isn't just a good idea; it's essential for keeping everyone in California safe. Especially now, as the legislature considers potentially defunding the state’s early pandemic detection efforts, having a robust stockpile is even more critical for ensuring our readiness to tackle crises head-on.”

Equity Impact: According to the author’s staff, “Vulnerable communities are often hit the hardest during disasters, facing disproportionate impacts and struggling to access essential resources. This bill specifically directs CDPH, when determining how to prioritize distributions from the stockpile to providers, to first consider factors such as locations with a high share of low-income residents, those situated in medically underserved areas, and those serving disproportionately medically underserved populations. By establishing clear guidelines for procurement and distribution, this bill aims to bridge the gap in access to lifesaving resources and ensure that marginalized populations have equitable access to critical supplies during emergencies.”

The Strategic National Stockpile: The Strategic National Stockpile (SNS) is part of the federal medical response infrastructure and can supplement medical countermeasures needed by states, tribal nations, and territories during public health emergencies. The supplies, medicines, and devices for lifesaving care contained in the stockpile can be used as a short-term, stopgap buffer when the immediate supply of these materials may not be available or sufficient. The SNS is separate from California’s stockpile. Items may be requested from the SNS by the Governor or their designee.

The State Stockpile Today: CDPH refers to the items stockpiled as their inventory, which is maintained by CDPH and Cal OES. According to CDPH, the state inventory “includes various types of PPE such as face masks, N-95 respirators, gowns, and gloves as well as COVID-19 testing supplies and a small quantity of COVID-19 pharmaceuticals.” Depending on decisions made by the Governor (noted in the court rulings section), Misoprostol may be stockpiled once again. Due to the lack of appropriation for SB 275 (discussed in the history section), CDPH points to the interactions through resource requests from the COVID-19 pandemic as what directed policy decisions. This includes interactions with the Medical Health Operational Area Coordinators (MHOACs), Regional Disaster Medical Health Coordinators and Specialists (RDMHSs), and other non-public health and medical sectors which required PPE. They also based guidelines on priorities from the SNS. CalOES oversees the Logistics and Commodity Taskforce, which is comprised of CDPH, the Department of General Services (DGS), and CalOES. In lieu of the unfunded Personal Protective Equipment Advisory Committee, this taskforce makes recommendations and provides operational support for acquiring and disbursing the stockpiled items.

Cal OES and CDPH are jointly responsible for adding, dispersing, and rotating items through their own warehouses. Historically, CDPH is responsible for distributing to public health entities while Cal OES distributes items to all other relevant organizations. Cal OES houses the majority of the PPE while CDPH largely manages testing supplies, pharmaceuticals, and over the counter products. Requests are made through MHOAC, RDMHS and forwarded to CDPH’s Medical Health Coordination Center (MHCC), who tasks the appropriate office for fulfilment. There is also communication with the Administration for Strategic Preparedness and Response (ASPR) and SNS staff at the federal level regarding the contents. According to CDPH, “Public Health leadership may request medical countermeasures (MCM), to include PPE from the SNS, however these resources are prioritized nationwide and may not sufficiently offset state needs.”

When asked to provide a recommendation for what types, and the amount, of items are needed for the stockpile, CDPH responded with their March 3,2020 to April 3, 2020 emergency outbreak situation response data. During this period early in the pandemic, the following resources were distributed from the state stockpile:

·         24,700,020 N95 Respirators

·         2,713,500 Procedure Masks

·         1,996,500 Gloves

·         398,492 Surgical/Isolation Gowns

·         408,192 Face Shields

·         116,400 Goggles

·         637,068 Bottles of Hand Sanitizer

The Committee interprets this as a ballpark number of items the stockpile should be prepared to distribute in an emergency, but notes this list only includes PPE and not other items also relevant to a strategic stockpile.

California’s History with the State Stockpile: In 2006, a robust state strategic stockpile was developed in response to the avian flu. Over $200 million was invested into a mobile field hospital program and to stockpile medication and medical gear in preparation of infectious disease outbreaks. The mobile field hospital was comprised of three mobile hospitals, built with fully insulated and HVAC-equipped semi-permanent tents capable of delivering advanced medical care. These hospitals were capable of deployment via flatbed trucks within 72 hours of activation. Each of the mobile hospitals possessed 200 beds, a surgery ward, intensive care unit, x-ray equipment, and sleeping quarters for staff. The stockpile was also filled with 50 million N95 masks, 2,400 portable ventilators, and kits for deploying an additional 21,000 patient beds.

In 2011, the anticipated, annual cost to maintain the mobile field hospital program and stockpiled materials was $5.8 million: $1.7 million for the mobile field hospitals and $4.1 million for the medication, masks, and other materials in the stockpile. However, the mobile field hospital program and stockpile were largely defunded in 2011 as the state faced a $26 billion deficit. When the state rebounded from the deficit, there were no additional investments to reinvigorate these programs. The majority of its contents were sold off or given to local or federal entities. A significant number of masks and less than half of the ventilators were left in storage. Masks were accessed for dispersal to areas impacted by catastrophic wildfire events, but not replaced.

When the COVID-19 pandemic struck in 2020, the state still had 21 million N95 masks stockpiled, but all were expired. While Governor Newsom quickly acted to replenish the state’s stockpile by coordinating with CDPH and Cal OES to develop a stockpile goal, the gap in immediate preparedness cost lives. Ultimately, they established a reliable supply chain and created strategies to acquire PPE, including acquiring 200 million masks a month at the worst points of the outbreak. At the height of pandemic response, the state managed a comprehensive distribution system consisting of all facets of procurement from production to ordering and delivery, warehousing, and direct shipments from vendors.

In 2020, the Governor signed SB 275 (Pan, Chapter 301, Statutes of 2020) which required CDPH and Cal OES to procure, maintain, and deploy a PPE specific stockpile for use during an emergency, upon appropriation. However, according to CDPH, “SB 275 never received appropriations through the Budget for implementation purposes, which would have included the formation of the Personal Protective Equipment Advisory Committee by CalOES to inform the establishment of guidelines for the procurement, management, and distribution of PPE.” While related, this bill takes a broader approach to encompass all the needs of a state’s stockpile in addition to PPE.

In 2022, the Governor announced the SMARTER plan, which was marketed both as a plan to guide California’s evolving pandemic response and as strategies and systems to be used for future emergencies and continuously improved as California faces new challenges. Through this plan, the Governor committed to maintaining an up-to-date, strategic stockpile that allows California to independently respond to local needs, to work with local public health departments to develop, support, and implement these strategies to be ready for the next surge and the next infectious disease emergency, allocate state appropriated resources to further accelerate the building of a 21st Century public health system, and enable health care facilities preparing for or responding to surges so, at any time, to bring up to 3,000 additional staff to facilities across the state within 2-3 weeks of the requested need.

Each of these commitments are essential to not only preserving a useful stockpile, but also effectively maintaining the infrastructure to distribute the stockpile’s contents to those in need. Additionally, these commitments demonstrate the intention to maintain readiness, which, according to the author’s staff, this bill seeks to ensure through codifying the state strategic stockpile and ensuring guidelines are effectively implemented.

Stockpiling in Response to Court Rulings: The state’s stockpile not only supplements the SNS but also reflects California’s priorities. In 2023, California secured an emergency stockpile of 250,000 pills of Misoprostol, a commonly used abortion pill, in response to an extremist Texas Court ruling which aimed to block access nationwide. California also negotiated an option to purchase up to an additional 1.75 million pills for the same base price of roughly 43 cents per pill. All of the purchased pills were distributed as of March, 2024. With the Supreme Court placing a hold on the Texas Court ruling while they heard arguments and draft their decision, the pressure to make a decision on stockpiling the drug further was relieved. However, the Supreme Court decision is expected in June so California will need to decide whether to resupply its stockpile.

Other States’ Management Failures: As of late 2023, the Associated Press reports at least 15 states (not including California) were forced to dispose of significant amounts of PPE because they failed to properly manage their stockpiles after the height of the pandemic. For example, Ohio trashed nearly $29 million worth of expired gowns, masks, gloves, and other materials; Rhode Island shredded 829 tons of PPE for recycling; Wisconsin trashed 1.7 million masks and 1 million gowns, and Maryland trashed $93 million worth of PPE. Even states that made an extensive effort to distribute their expiring PPE, such as Washington, Nevada, and Pennsylvania, were unable to find enough beneficiaries prior to the expiration dates and sent the PPE to landfills.

While California is not listed in this report, the issues these states have with expired PPE is similar to what our state experienced at the beginning of the pandemic with 21 million, expired N95 masks stockpiled. The mismanagement of stockpiles in other states serves as an additional warning for ensuring the maintenance of our stockpile.

Double Referral: Should this bill be approved, it will be referred to the Assembly Committee on Health.

Prior and Related Legislation:

SB 275 (Pan) Chapter 301, Statutes of 2020. Requires CDPH and Cal OES to procure, maintain, and deploy a PPE stockpile for use during an emergency, upon appropriation.

AB 228 (Wilson, 2023). This bill would have required CDPH and Cal OES establish an infant formula stockpile, upon appropriation. (This bill was held in the Assembly Committee on Appropriations.)

AB 2537 (Rodriguez) Chapter 313, Statutes of 2020. Requires employers, as defined, to maintain a stockpile of specified PPE for specified workers in an amount equal to three months of normal consumption.

REGISTERED SUPPORT / OPPOSITION:

Support:

None on file.

Opposition

None on file.

Analysis Prepared by: Ryan Fleming / E.M. / (916) 319-3802