Establish respirator stockpiles and competent emergency distribution systems that persist indefinitely in preparation for the next pandemic.

## Stakes
In a worst-case scenario pandemic, where one or multiple pathogens spread faster than vaccines or therapeutics can be developed, respirators for critical workers are essential for keeping society running.

Critical workers include people like scientists developing countermeasures, hospital staff, police, warfighters, and personnel who maintain infrastructure for the production and transportation of necessary goods like food.

If critical workers are unable to go to work, we could lose trillions of dollars and millions of lives to war, famine, and disease.

## Context
There are more critical workers than most people think. By some estimates, it includes more than 104 million US workers, ~71% of the workforce. They are also the population hit first and sometimes hardest: healthcare workers were 21% of all SARS cases in 2003.

The US entered COVID-19 with roughly [12 million N95s in the Strategic National Stockpile](https://www.seattletimes.com/nation-world/face-masks-in-national-stockpile-have-not-been-substantially-replenished-since-2009/), ~1% of the HHS-projected severe-pandemic need of [up to 3.5 billion.](https://www.cnbc.com/2020/03/04/hhs-clarifies-us-has-about-1percent-of-face-masks-needed-for-full-blown-pandemic.html) The resulting shortages contributed to [at least 3,607 documented US healthcare-worker deaths](https://kffhealthnews.org/health-industry/us-health-workers-deaths-covid-lost-on-the-frontline/) in the pandemic's first year.

Stockpiling enough respirators for a severe pandemic is an achievable goal, even at the scale enabled by private philanthropic funding. [Blueprint Biosecurity](https://blueprintbiosecurity.org/) believes the cost for a global 20-year reusable respirator stockpile is $19B-100B. The disposable N95 equivalent is $360B-1,700B. For the United States alone, the 20-year cost is in the low single-digit billions (reusables) to low tens of billions (disposable). On the lower end, this is $1B per year for the entire world. The US military spends [$1B every 10 hours](https://appropriations.house.gov/sites/evo-subsites/republicans-appropriations.house.gov/files/evo-media-document/final-fy26-defense-minibus-4-summary.pdf). There is soon to be an [estimated $37–100B/year](https://nanransohoff.substack.com/p/the-third-wave-of-american-philanthropy) additional philanthropic dollars from frontier AI labs. [Hadrian](https://hadrian.org/), funded by Coefficient Giving, is already working toward stockpiling in the United States.

In a globally interdependent world, scaling this work to other countries is necessary to protect global supply chains, especially those most well positioned to develop and export countermeasures. For instance, most US pharmaceutical ingredients come from overseas, particularly from China and India. Keeping the global supply chain safe in a pandemic is one of the most critical aspects of keeping society running through a crisis, and this is currently the cheapest and most scalable way to do it.

However, just building stockpiles is not enough. We must build credible distribution systems and plans to make sure that respirators are accessible to those they were stockpiled for. This was a significant problem during COVID. An HHS Inspector General review found the Strategic National Stockpile [was not positioned to respond effectively](https://oig.hhs.gov/reports/all/2023/the-strategic-national-stockpile-was-not-positioned-to-respond-effectively-to-the-covid-19-pandemic/), and states were left [bidding against one another](https://www.markey.senate.gov/news/press-releases/senator-markey-and-congresswoman-pressley-lead-massachusetts-congressional-delegation-in-demanding-answers-from-fema-white-house-coronavirus-task-force-about-lack-of-transparency-equity-regarding-ppe-distribution). Massachusetts received only about 10% of the respirators and other PPE it requested in its first shipment. A major component of any effort in this area therefore has to include building the distribution system alongside the stockpile.

## **Target End-State**
Within ~2–3 years of a founder starting, at least three countries besides the US maintain stockpiles of enough respirators to cover all critical workers for ≥6 months alongside a credible emergency distribution system. This can be broken down by country if needed, especially for larger countries, with different owners for each.

## **Owner Profile**
This can be led by a driven generalist with the ability to hire out expertise.
The ideal owner profile:
- Operations or supply-chain background.
- Ability to fundraise significant capital or experience doing so.
- Comfort engaging both government and philanthropic funders, with an existing network a plus.
- Ability to navigate the regulatory landscape.

## **Initial Scoping**
**First 3 Months**
- Read: [BlueDot Field Strategy: protecting critical workers during a pandemic (respirator stockpiles)](https://docs.google.com/document/d/1XAfw9XHltgjDEIjVkKpyStaGdGbZbL6ss3PO6G6EGY4/edit?tab=t.gphxdsc7qzoc).
- Call the team at Hadrian.
- Identify the most promising target countries, then landscape country specifics like critical workforce size and government funding vs. philanthropic funding feasibility.

**Key Questions**
- Which respirators make the most sense for a given country?
- How is a distribution system sustained in peacetime well?

## **Funders and Partners**
**How much money is behind this?**
A [wave of philanthropic capital](https://nanransohoff.substack.com/p/the-third-wave-of-american-philanthropy) is soon to be available for founders looking to work on important problems like biosecurity. The OpenAI Foundation, for instance, is part of an estimated $37–100B/year in new AI-lab-driven giving. Existing philanthropic capital is also significant. Coefficient Giving alone deploys over $100M per year to biosecurity.

**Potential Funders**
[Coefficient Giving](http://coefficientgiving.org)
[BlueDot Impact](http://bluedot.org)

**Potential Partners and Stakeholders**
[Hadrian](https://hadrian.org/)
[Blueprint Biosecurity](https://blueprintbiosecurity.org/)

## Learn More
[BlueDot Field Strategy: protecting critical workers during a pandemic (respirator stockpiles)](https://docs.google.com/document/d/1XAfw9XHltgjDEIjVkKpyStaGdGbZbL6ss3PO6G6EGY4/edit?tab=t.gphxdsc7qzoc)
[Coefficient Giving — "Defenses in Depth" project list](https://defensesindepth.bio/10-big-projects-for-reducing-bio-x-risk/)

## Interested in building this?
Contact: Olivia Scharfman, [olivia@bluedot.org](mailto:olivia@bluedot.org).


Respirator Stockpiles and Emergency Distribution Systems