What strategies are countries using to find new Personal Protective Equipment (PPE)?

Cross-Country Analysis

What strategies are countries using to find new Personal Protective Equipment (PPE)?

The COVID-19 pandemic has led to many countries facing shortages of sufficient personal protective equipment (PPE). The combination of increased demand for PPE and large disruptions in the global marketplace has made it difficult for virtually all countries to obtain PPE for their own needs. 

We have examined how 24 countries are finding new PPE — this includes face masks, goggles, and other protective clothing that aim to protect the wearer from infection and prevent the further spread of the coronavirus. The data have been collected from the COVID-19 Health Systems Response Monitor (HSRM) for a selection of countries based on information available online as of 15th April 2020. Nearly all countries have reported shortages of PPE. The table below indicates the strategies that countries are using to increase their supply of PPE, and is followed by a description of country examples providing more details. The strategies included in the table were observed in at least three of the countries included in the initial sample.

Table 1. Strategies for increasing supply of personal protective equipment (PPE)

Most countries are heavily reliant on PPE imports, mainly from China

Virtually all countries are importing PPE from other countries to supplement their existing stock, mainly from China. This shows a high reliance on PPE supply from one country. The means for procuring PPE varies widely. Some countries with very limited financial resources have received international donations or support from the WHO and/or the European Commission. Twenty-five European Union Member States participate in the EU’s Joint Procurement initiative for PPE. Several countries have changed their procurement process as a result of the coronavirus. CyprusGermany and Spain have centralized their procurement process. Latvia has enabled state-owned companies, some emergency and security agencies, and several ministries to procure goods and services to control the spread of the coronavirus without a procurement procedure. 

Countries have reported difficulties in competing in the international marketplace, including Malta and SpainGermany (except for aid campaigns), the Russian FederationUkraine, and the UK (outside the European Union) have implemented export restrictions of PPE. The Netherlands and Ireland for instance, have reported quality issues of PPE, e.g. examples of imported equipment which was unusable. In the Netherlands, a large order of face masks appeared to be of insufficient quality and had to be recalled from hospitals. Ireland’s Health Service Executive acknowledged at a press briefing on April 5th that around 20% of the equipment that arrived was not fit for use.  

Some countries have relaxed guidelines for the use of PPE

A few countries, including CanadaFinlandthe Netherlands, and the UK, have relaxed certain standards for equipment or guidelines for its use in order to have a higher availability of PPE. Since March 18th, Canada allows for certain products, such as hand sanitizer, masks, gowns, and swabs, to be authorized for sale if they are not fully compliant with Health Canada requirements, but are authorized in other jurisdictions outside Canada with similar regulations. In the Netherlands, guidelines for mask use were adjusted on both March 9th and 18th. As of mid-April, FFP2 masks are now only used when treatment may cause a lot of aerosols (e.g. intubation), otherwise, surgical masks are considered sufficient.

Over half of the countries surveyed are repurposing factories to produce PPE or increasing production volumes at existing PPE factories.

Twelve countries (CanadaCroatiaEstoniaFinlandFranceGermanyIsraelItalyLithuaniathe NetherlandsSpainthe UK) have ramped up production of PPE, both by increasing capacity in existing factories and repurposing factories to produce PPE. Several European brewers are producing sanitizers with the alcohol taken out from alcohol free beer. Additionally, pharmacists are allowed to produce certain hand sanitizers. In Estonia, the one producer of masks in the country has doubled its production to produce up to 100,000 masks per week for the country. Canada passed a “Call to Action” on March 20th to support businesses to scale production and re-tool manufacturing lines to develop products, and has signed new procurement agreements with Canadian companies. The Canadian government has also received donations of PPE from companies.

Some countries operate emergency stockpiles while in other countries this is primarily the responsibility of individual providers

Four countries have indicated that they have withdrawn PPE from their emergency stockpiles (EstoniaFinlandIsrael, the UK), although in the case of Israel some of the equipment was damaged and could not be used. In Finland, emergency stockpiles are stored at both national and regional levels. France had a change in state policy since 2011 to reduce the national reserve of masks, and instead have individual facilities, health care centres, or physicians stock masks. 

Several countries are setting up new monitoring systems for PPE

Monitoring systems on the allocation and utilisation of COVID-19-relevant equipment were established as a result of shortages (e.g. on gloves, masks, protective gear for medical personnel). For example Greece implemented a Digital Registry; Ukraine organised an analytical dashboard in reporting on hospital’s capacity and essential supplies stock; Canada partnered with Amazon to provide health care workers with PPE, also allowing the federal government to manage the distribution of PPE and supplies to support the COVID-19 response; the NHS in the United Kingdom will roll out an automated data-driven PPE distribution service that will calculate the amount of PPE required in each setting and deliver it automatically, with a helpline for further support.

Policy lessons 

Summing this up, virtually all countries have experienced or are still experiencing significant shortages of PPE and struggling to meet demand. Countries are employing a variety of measures to overcome shortages in PPE. At the same time, a large majority of countries are relying primarily on PPE imports from one country. The main lesson is that countries are well advised to improve the planning and monitoring of their supply system of PPE in case of a future pandemic. Future approaches should reduce the reliance on imports and scale up national production but also put stockpiles and more reliable monitoring systems in place that can meet surge demand.  

Erin Webb, Giada Scarpetti, Claudia Maier