Large catastrophic events, or rare acute events, may cause situations in which a local jurisdiction's medicines and medical supplies are not sufficient to provide care to the population it serves. In these cases of natural or engineered disasters, such as a terrorist attack, influenza pandemic, or earthquake, state or local authorities can request that the federal government provide assets from the Strategic National Stockpile to augment the state and local jurisdictions' resources. The Centers for Disease Control and Prevention's (CDC's) Strategic National Stockpile (SNS) is the nation's repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other medical materiel designed to supplement and resupply state and local public health agencies in the event of an emergency. The materiel is intended to support national health security and is managed by the Office of Public Health Preparedness and Response's (OPHPR's) Division of Strategic National Stockpile (DSNS). The stated mission of the SNS is to prepare and support partners and provide the right resources at the right time to secure the nation's health. The National Academies of Sciences, Engineering, and Medicine organized a two-day public workshop to explore opportunities to improve the efficiency, effectiveness, and sustainable methods used by the CDC's SNS to distribute medical countermeasures and other supplies during disasters and other public health emergencies, especially those which result in disruption of physical infrastructure such as the electrical grid, central roadways, bridges, and tunnels within the impacted community. Participants explored relevant distribution lessons learned from other federal agency stockpiles and the private sector as well as opportunities to develop public-private collaborations in the purchase, warehousing, management, and distribution of medical countermeasures. This report summarizes the presentations and discussions from the workshop.

Since 1939, the U.S. government, using the National Defense Stockpile (NDS), has been stockpiling critical strategic materials for national defense. The economic and national security environments, however, have changed significantly from the time the NDS was created. Current threats are more varied, production and processing of key materials is more globally dispersed, the global competition for raw materials is increasing, the U.S. military is more dependent on civilian industry, and industry depends far more on just-in-time inventory control. To help determine the significance of these changes for the strategic materials stockpile, the Department of Defense asked the NRC to assess the continuing need for and value of the NDS. This report begins with the historical context of the NDS. It then presents a discussion of raw-materials and minerals supply, an examination of changing defense planning and materials needs, an analysis of modern tools used to manage materials supply chains, and an assessment of current operational practices of the NDS.