In the intricate world where healthcare delivery meets public policy, few voices carry the weight of experience like that of Faisal Zain. With a deep background in the manufacturing and innovation of medical technology, he has a unique, ground-level perspective on the vulnerabilities that ripple through our nation’s health systems. Today, we delve into the critical issues facing hospitals, from the quiet erosion of emergency preparedness funding to the stark realities of supply chain breakdowns and the looming threat of cyber warfare. Our conversation will explore the tangible consequences of these challenges and the pragmatic policy shifts needed to build a more resilient healthcare infrastructure for all Americans.
The Hospital Preparedness Program has seen its funding fall from over $500 million to $240 million since its inception. How does this funding gap impact a hospital’s day-to-day emergency readiness, and what practical steps would direct-to-hospital funding allow you to take that aren’t possible now?
It’s a staggering decline, and the impact is felt not just during a massive hurricane or pandemic, but in the constant, low-level hum of being unprepared. When you see a funding drop from a high of $520 million down to $240 million, you’re not just cutting fat; you’re cutting into bone. On a day-to-day basis, this means less training, older equipment that doesn’t get replaced, and weaker coordination with regional partners. You have brilliant, dedicated people, but they’re working with one hand tied behind their backs. If we had direct-to-hospital funding, the change would be immediate and tangible. We could finally invest in dedicated training for a multi-state disaster scenario, something that’s nearly impossible now with funds locked within state lines. We could also compete to be the HPP recipient for our area, allowing a major academic medical center, for instance, to lead preparedness efforts with the institutions that are actually on the front lines, rather than having all resources flow through a single state agency. It’s about getting the resources directly to the front lines where they can save lives.
With drug shortages remaining over 200 at the end of last year, what specific supply chain vulnerabilities do you see most often? Could you walk me through how making a manufacturer’s quality ratings public would help a hospital administrator prevent a future shortage of a critical medication?
The vulnerabilities are deeply concentrated. We see a lack of manufacturing redundancy and an over-reliance on a few sources for raw materials. The fact that we were still dealing with 216 drug shortages at the end of last year, even after the wake-up call of recent years, is telling. The problem isn’t just exotic new drugs; it’s basic, essential medications for things like ADHD, anxiety, and even local anesthetics. Imagine you’re a hospital administrator trying to secure a year’s supply of a critical drug. Right now, your decision is based almost entirely on price. You have no real insight into the manufacturer’s operational integrity. Now, picture a world where the FDA provides a public quality rating for that manufacturer. This rating wouldn’t just be about the final product’s purity; it would reflect the resilience of their supply chain and their manufacturing processes. As an administrator, I could see that Manufacturer A has a lower price but a poor quality rating, indicating a high risk of disruption. Manufacturer B might be slightly more expensive, but their high rating tells me they have diverse sourcing and robust facilities. I can now make an informed decision based on risk, not just cost, effectively buying resilience and preventing a future crisis where my doctors are forced to use less effective alternatives or delay care.
Thinking about the Baxter facility shutdown in 2024, which crippled the supply of sterile fluids, how do hospitals manage when a single manufacturing site goes down? Can you share an anecdote about the trade-offs you have to make regarding patient care during such a disruption?
The Baxter shutdown was a gut punch for the entire system. It was a stark reminder of how a single point of failure—in this case, one facility in North Carolina—can hold patient care hostage. When something like that happens, it’s an all-hands-on-deck crisis. The first thing you do is an immediate inventory, figuring out exactly how many days of supply you have left. Then, the calls start—to every alternate vendor, to other hospitals, to anyone who might have a surplus. The word you hear over and over is “exorbitant.” Prices skyrocket. I remember a colleague at a regional hospital describing the impossible choices they faced. They had to decide which procedures to delay. Do you postpone a non-urgent irrigation procedure for a wound to save sterile fluid for a critical dialysis patient? Of course. But that “non-urgent” patient is still in pain and at risk of infection. You’re constantly weighing one patient’s immediate need against another’s, a terrible ethical calculus forced upon you because a single hurricane took out a single factory hundreds of miles away. It took until May of the next year for things to normalize; that’s months of constant, stressful improvisation.
You’ve noted that device shortage notifications are currently tied to public health emergencies. How would untethering this requirement help hospitals manage supply constraints during a more routine, non-emergency period? Please provide a step-by-step example of how this early warning could change your response.
This is one of the most practical, common-sense changes we could make. Tying shortage notifications to a declared Public Health Emergency, or PHE, is like only allowing the fire department to respond if the entire city is on fire. Shortages happen all the time for reasons that have nothing to do with a pandemic. Let’s walk through a scenario. Say a key component for a diagnostic device is suddenly in short supply due to a factory fire overseas. Under the current system, the device manufacturer isn’t required to notify the FDA, because there’s no PHE. Hospitals only find out when their orders are suddenly delayed or canceled. Panic ensues. Now, imagine the requirement is untethered. Step one: The manufacturer experiences the disruption and is now required to notify the FDA immediately. Step two: The FDA analyzes the situation and alerts the healthcare community, noting that this specific device may face a meaningful disruption in the coming weeks. Step three: As a hospital, I get that early warning. I can immediately begin conserving our existing stock, I can proactively reach out to alternative suppliers before they’re overwhelmed, and I can work with clinicians to identify and validate alternative diagnostic procedures. Instead of a sudden, reactive crisis, it becomes a manageable, proactive operational adjustment. It turns a fire into a fire drill.
The Change Healthcare incident in 2024 showed how a cyberattack can disrupt care on a national scale. If a similar attack were designated an “all-hazards” incident, what immediate federal resources would become available, and how would that tangibly help a hospital facing ambulance diversions and system outages?
The Change Healthcare attack was a nightmare, and it laid bare how interconnected and vulnerable we are. Designating a high-impact cyberattack as an “all-hazards” incident would be a game-changer. It unlocks a federal response mechanism that currently doesn’t see a cyber event in the same light as a hurricane or an earthquake. The moment that designation is made, a flood of resources becomes available. For a hospital in the thick of it—with ambulances being diverted because your digital systems are down and you can’t access patient records—this would mean immediate, tangible help. We’re talking about federal agencies providing human and technical support on the ground. Think of it as a FEMA-like response for a digital disaster. Financial support would also flow to the victim organizations to help them recover and maintain operations. Furthermore, if a “cybersecurity attack” is defined as a “covered hazard,” we could use Hospital Preparedness Program funds before an attack to strengthen our defenses and conduct robust response training, making us a harder target in the first place. It fundamentally shifts the paradigm from “you’re on your own” to “we’re in this together.”
What is your forecast for the resilience of the U.S. health care supply chain over the next five years?
My forecast is one of cautious optimism, but it is entirely conditional. If we continue with the status quo—underfunding preparedness, ignoring supply chain concentration, and treating cybersecurity as an afterthought—then our resilience will continue to erode. We will lurch from one crisis to the next, with patients paying the ultimate price. However, if we seize the opportunity presented by the reauthorization of PAHPA and implement these thoughtful changes, the outlook is much brighter. By diversifying manufacturing, creating transparency through quality ratings, untethering device shortage notifications, and treating cyberattacks with the seriousness they deserve, we can build a system with the redundancy and flexibility it needs. The next five years will be a test of our political will. The blueprint for a stronger, more resilient system exists; we just need the collective courage to build it.
