Medical Supply Chains and Policy Options: The Data Challenge

Medical Supply Chains and Policy Options: The Data Challenge

September 16, 2020
Medical Supply Chains and Policy Options: The Data Challenge
The Coronavirus Disease 2019 (COVID-19) pandemic has
publicly available, in part due to confidentiality
revealed some areas in which the United States relies
requirements. However, no U.S. government agency
heavily on global supply chains. U.S. shortages of critical
collects detailed statistics on the quantity and value of total
supplies of medical products have prompted congressional
U.S. production by product category.
interest in better understanding U.S. import trends and
Nonetheless, data from an annual government survey of
domestic production capacity in certain industries
U.S. manufacturers, analyzed in conjunction with official
considered essential to U.S. public health and national
U.S. trade statistics, provides some insight into domestic
security. Some Members of Congress and the Trump
production activities and a rough estimate of the share that
Administration have sought ways to increase U.S.
some imported medical products make up in total U.S.
production of medical products, such as personal protective
supply.
equipment (PPE) and pharmaceuticals, by providing
economic incentives to firms and strengthening government
Survey of Manufactures and Trade Statistics
procurement requirements to better prioritize domestically
The Census Bureau’s Annual Survey of Manufactures
produced goods.
(ASM) measures U.S. manufacturing activity, including
industry outputs, inputs, and operating status. It provides
Within this context, Congress has raised questions
sample estimates of statistics for U.S.-based manufacturing
regarding domestic consumption of PPE and other medical
according to the North American Industry Classification
products to understand the proportion of such goods that are
System (NAICS). ASM statistics include the value added
produced domestically versus imported. Some Members
by manufacturing, total value of shipments for close to
have also sought a better understanding of the costs and
1,400 classes of manufactured products, costs of materials,
feasibility of dismantling—and eventually reestablishing
and inventories. NAICS categories, however, may not
elsewhere—some global supply chains, and the extent to
capture all medical production. A data time lag also
which domestic producers might be able to meet U.S.
prevents the U.S. government from developing a current
demand going forward. However, a lack of critical official
understanding of industry trends; 2018 is the most recent
data and information has impeded U.S. policy makers’
year for which data are available.
ability to assess the size and composition of the U.S. market
for specific products, and the overall production capacity of
The Census Bureau and BEA also collect data on U.S.
U.S.-based producers to satisfy various essential national
exports and imports. By matching these datasets with the
needs. Compounding the challenge are definitional
ASM, CRS was able to roughly estimate the imported—and
differences in the categorization of domestic and imported
thereby impute the domestic—share of U.S. supply for
products that make it difficult to assess overall levels of
some NAICS categories considered to include PPE,
U.S. import dependencies.
pharmaceuticals, and other medical-related products in
Domestic Supply: U.S. vs Foreign Made
2018 (Table 1). CRS calculated the figures at the NAICS 6-
digit subheading level—the most disaggregated level for
In general, the U.S. government does not gather data on the
which the data are available. Because these are broad
domestic production of specific items (e.g., surgical masks
product categories, the data may at times underestimate or
and gloves) by quantity or value, nor does it track how
overestimate actual domestic production and imports.
much of this production is ultimately consumed in the U.S.
market. Of U.S. domestic production, the U.S. government
These estimates suggest that the United States depends
tracks categories of products that are exported to foreign
heavily on certain imports (for more than 90% of domestic
markets. It also collects statistics for broad industry sectors,
supply in some cases), but foreign source dependence
such as gross output, value added—also known as gross
varies by product category. In 2018, the United States
domestic product by industry, and intermediate inputs.
imported many low-end and labor-intensive manufactured
products from China (e.g., apparel made from fabric, such
Another complicating factor in the analysis of U.S.
as hospital gowns). Notably, some of the higher value-
production and U.S. imports of PPE, pharmaceuticals, and
added and skill-intensive imported products came mainly
other medical products is that there are no domestic or
from Europe (e.g., irradiation machines and biological
internationally agreed guidelines, standards, or definitions
products, such as vaccines) or were produced domestically
of what specific products make up these categories.
Therefore, questions such as “
(e.g., MRI equipment). The estimates likely understate the
How much PPE does the
extent to which the United States relies on China for certain
United States currently produce relative to what it
imports?” or “
products, such as pharmaceuticals, as some U.S. imports
By how much has domestic production of
may contain a high share of Chinese content but may not
pharmaceuticals increased since the COVID-19 outbreak?”
always be classified as Chinese in origin when imported
are difficult to answer. Some agencies, including the Food
into the United States.
and Drug Administration (FDA) and the Department of
Commerce’s Census Bureau and Bureau of Economic
Analysis (BEA), collect more information than they make
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Medical Supply Chains and Policy Options: The Data Challenge
Table 1. Estimate of the Imported Share of U.S.
Vulnerabilities regarding raw materials and inputs, such as
Domestic Supply: Selected Medical Products
active pharmaceutical ingredients, are not well recorded in
Share of Domestic Supply (%) in 2018
official trade and industry data. They might be particularly
U.S.
U.S.
difficult to track if they originate in one country but are
Total
Imports
Imports
then processed in another, reflecting modern supply chains.
U.S.
from the
from
NAICS Code and Description
Imports
EU28
China
Another complication is the lack of a statutory definition of
315220: Men's and Boys' Cut and Sew
what qualifies as a “U.S. product” or what is
Apparel [medical and laboratory apparel]
98
3
20
“manufactured” in the United States, which may mask and
315240: Women's, Girls', and Infants'
understate the extent to which domestically produced goods
Cut and Sew Apparel [medical and
96
3
36
laboratory apparel]
rely on foreign inputs. In response to some of these
333314: Optical Instruments and Lenses
concerns, the Coronavirus Aid, Relief, and Economic
94
14
23
[microscopes, telescopes, prisms, lenses]
Security Act (P.L. 116-136) has provisions that aim to help
325414: Biological Products [vaccines,
79
59
*
regulators and the public better understand medical supply
toxoids, blood fractions]
chains. One example is the requirement for producers
339115: Ophthalmic Goods [eyeglasses,
contact lenses, protective eyewear]
60
22
20
registered with the FDA to report annually to the agency the
313210: Broadwoven Fabrics [fabrics and
amount of drugs manufactured for domestic commercial
felts, including surgical gauzes]
55
10
17
distribution.
325411: Medicinal and Botanical Drugs
and Vitamins [uncompounded medicinal
48
34
8
chemicals and derivatives, botanicals]
Domestic production data that more readily correlates with
325413: In-Vitro Diagnostic Substances
trade data—particularly in its timeliness and harmonization
[chemical, biological, or radioactive
48
27
3
of definitions—would likely assist in analyzing the position
diagnostic substances]
of the U.S. economy and its industrial base in critical global
325199: All Other Basic Organic
Chemicals [isopropyl alcohol, glycerin]
42
14
9
supply chains. In particular, as China seeks to advance its
334517: Irradiation Apparatus [X-rays
position in the global supply chain through state-led
and other ionizing radiation apparatus]
41
25
4
industrial policies, such as Made in China 2025, it is
339113: Surgical Appliances and Supplies
targeting industries in which U.S. industry leads. Integrated
[orthopedic devices, prosthetic
39
15
6
appliances, surgical dressings, crutches]
data could help identify emerging industry and supply chain
325412: Pharmaceutical Preparations [in-
shifts in specific areas that may be occurring, at least
vivo diagnostic substances]
39
23
*
partially, in response to China’s policy incentives and
339112: Surgical and Medical Instruments
pressures. Moreover, such data could support a strategic
[syringes, needles, caterers, anesthesia
36
10
2
approach to U.S. supply chains that considers prospects and
apparatus, blood transfusion equipment,
medical thermometers]
options to sustain U.S. leadership in critical sectors, such as
Source: CRS analysis of data from the U.S. Census Bureau, U.S. Bureau of
advanced medical equipment and pharmaceutical
Economic Analysis, and the U.S. International Trade Commission.
innovation. More integrated data could better enable U.S.
Notes: (1) Rough estimates calculated at the NAICS 6-digit subheading level, which
policymakers to understand the interplay of domestic and
may cover products that are not for medical use; (2) * = Share of domestic supply is
less than 0.05%; (3) descriptions in brackets are only selected examples of products
global developments and respond to them in time frames
covered by the subheading; and (4) estimates likely understate the extent to which
closer to real time, assess overall production capabilities of
the United States relies on China for certain products.
U.S.-based producers in sectors of concern, and better
Other Sources of Data and Information
prepare for—and respond to—future crises.
Capturing the U.S. government’s reliance on foreign-made
goods faces similar data limitations. The General Services
A single legislative solution to measure and manage supply
Administration (GSA) maintains a database, the Federal
chain dependencies and risks may not exist. Congress,
Procurement Data System-Next Generation (FPDS-NG),
however, could consider—potentially as a first step—
authorizing federal agencies to collect more data on firm’s
for which federal agencies are required to report
procurement contracts whose estimated value is $10,000 or
activities in the United States and abroad and at the points
more. However, there are documented issues about the
of U.S. import and government purchase. For example, the
accuracy, completeness, and timeliness of data in FPDS-
U.S. government currently surveys U.S. and foreign firms
NG. Despite these limitations, the data may still provide
and reports on U.S. investment abroad and foreign
general information regarding the value, quantity, and types
investment in the United States. Agencies could obtain,
of domestic and foreign-made goods procured by U.S.
analyze, and report specific supply chain information about
government agencies. For example, analysts may rely on
the status of U.S. production and distribution without
FPDS-NG data to identify broad trends and produce rough
disclosing business confidential information. Congress
estimates, or to gather information about specific contracts.
could direct some agencies to collect data on federally
owned public and defense stockpiles of certain items.
Private research firms, trade associations, and media also
Congress also might require an alignment of domestic and
offer information on domestic production capacity and
trade industry data to occur on an accelerated timeline. For
production changes in response to the COVID-19 outbreak.
more information, see CRS Report R46304, COVID-19:
Nevertheless, they often base their figures on surveys,
China Medical Supply Chains and Broader Trade Issues.
firms’ press releases, or firm/industry forecasts, which may
differ significantly from actual production.
Andres B. Schwarzenberg, Analyst in International Trade
Issues and Options for Congress
and Finance
Some Members have raised concerns regarding gaps in U.S.
Karen M. Sutter, Specialist in Asian Trade and Finance
understanding of domestic manufacturing capacity and
IF11648
dependencies on China and other sources of global supply.
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Medical Supply Chains and Policy Options: The Data Challenge

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