When the Covid-19 pandemic exposes our dependence on foreign production of essential medical supplies, supply chain resiliency is clearly a matter of national security. At the height of the crisis, nearly 80% of medical gloves and 70% of masks in the United States were imported, according to the U.S. International Trade Commission. Hospitals have been forced to engage in global bidding wars for ventilators, ventilators and essential personal protective equipment (PPE). For many of us in public health, that moment marked a turning point: the recognition that the nation must rebuild its domestic manufacturing base for medical supplies.
This goal is both necessary and urgent. But the current approach—imposing national security tariffs on imported medical equipment under Section 232—risks repeating the same mistake that has long plagued U.S. health policy: relying on blunt measures to solve complex problems.
The Department of Commerce's ongoing Section 232 investigation covers a broad list of products ranging from personal protective equipment and syringes to imaging equipment and infusion pumps. The rationale is to protect domestic industries critical to national security. However, imposing tariffs on such a broad range of goods could increase costs across the health care system, disrupt supply chains, and reduce hospitals’ access to the technology needed for timely, high-quality care.
The American Hospital Association reports that by 2023, more than half of U.S. hospitals will have negative operating margins. Supplies and equipment costs increased by more than 30% between 2019 and 2023, primarily due to inflation and pandemic-related disruptions. Imposing tiered tariffs on top of this pressure will almost certainly result in higher prices for patients, slower adoption of new technologies, and reduced resources for community health programs.
For public health, the stakes are broader than hospital budgets. Tariffs could undermine emergency preparedness—the ability to quickly respond to emerging threats. During Covid-19, response delays have been caused not by a lack of scientific expertise but by logistical bottlenecks. The Strategic National Stockpile (SNS) inventory is insufficient and global routes are paralyzed. The new tariff regime could make it more difficult to affordably replenish stocks, especially for critical items like ventilators, needles and testing supplies.
A smarter strategy is to build domestic capacity through investment rather than restrictions. The Biomedical Advanced Research and Development Authority (BARDA), part of the U.S. Department of Health and Human Services (HHS), already has a strong track record of working with private industry to scale production of vaccines, diagnostics and medical countermeasures. Its flexible contract model can be expanded to include medical equipment and hospital consumables critical to disaster preparedness. BARDA's NextGen program provides a template for how targeted public and private investments can strengthen domestic supply without increasing costs for health care providers.
Likewise, the Administration for Strategic Preparedness and Response (ASPR) has the authority to coordinate the procurement and logistics of emergency medical supplies. ASPR’s industrial base expansion program was launched in the wake of the pandemic to bring critical manufacturing back home through grants, pre-order commitments and technology partnerships. These mechanisms can be scaled up to ensure domestic production of high-priority equipment while maintaining global flexibility.
Such public-private partnership models address the same national security concerns that Section 232 investigations are designed to address, but they do so without compromising access or affordability. They are also consistent with lessons learned from Defense Production Act (DPA) investments during the pandemic, which helped expand U.S. capacity to produce masks and testing kits in 2021. These efforts suggest that targeted, time-limited incentives may be more effective than permanent trade barriers.
The push for onshore production is right and necessary. But Section 232 tariffs are a blunt tool for solving problems that require precision. Rather than increasing costs for hospitals and patients, the federal government should use existing powers to incentivize domestic manufacturing, strengthen public-private partnerships, and diversify global procurement.
National security starts with health security. We shouldn't have to choose between the two. Our goal should be to simultaneously make care more reliable, more affordable, and more resilient. The right mix of investment, coordination and policy foresight can help us achieve this. Tariffs alone will not do.
Photo: mohd izzuan, Getty Images
Peter J. Pitts is President of the Center for Medicine in the Public Interest and Visiting Professor at the Faculty of Medicine at the University of Paris. He is a former Deputy Administrator of the U.S. Food and Drug Administration and a member of the U.S. Senior Executive Service.
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