The Strategic National Stockpile: identification, support, and acquisition of medical countermeasures for CBRN incidents

Abstract

The Strategic National Stockpile (SNS) serves as a repository of materiel, including medical countermeasures (MCMs), that would be used to support the national health security response to a chemical, biological, radiological, or nuclear (CBRN) incident, either natural or terrorism-related. To support and advance the SNS, the National Institutes of Health (NIH) manages targeted investigatory research portfolios, such as Countermeasures Against Chemical Terrorism (CounterACT) for chemical agents, that coordinate projects covering basic research, drug discovery, and preclinical studies. Project BioShield, managed by the Biomedical Advanced Research and Development Agency (BARDA), guides and supports academia and industry with potential MCMs through the Food & Drug Administration’s approval process and ultimately supports the acquisition of successful products into the SNS. Public health emergencies such as the COVID-19 pandemic and the ever-increasing number of MCMs in the SNS present logistical and financial challenges to its maintenance. While MCMs for biological agents have been readily adopted, those for chemical agents have required sustained investments. This paper reviews the methods by which MCMs are identified and supported for inclusion in the SNS, the current status of MCMs for CBRN threats, and challenges with SNS maintenance as well as identifies persistent obstacles for MCM development and acquisition, particularly for ones focused on chemical weapons.

Keywords:

• Strategic National Stockpile (SNS)
• medical countermeasures (MCMs)
• BARDA
• chemical weapons
• CBRN

Acknowledgements

Joshua P. Gray is a professor at the U.S. Coast Guard Academy. The opinions expressed are his own, not necessarily those of the Coast Guard or the U.S. government.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was funded in part by the National Institutes of Health CounterACT Program through the National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIH Grant number U54AR055073].