Why Domestic Supply Matters: Lessons Learned Between 2020 and Today

Over the past five years, our global supply chain endured numerous hardships including an unforeseen pandemic, geopolitical climate shifts, and catastrophic natural disasters. This turbulent ecosystem that our industry navigates is constantly presenting new risks, and the only guarantee is that unpredictable changes are never far from reach.

Without proactive planning and risk anticipation, even minor disruptions can lead to widespread shortages and delays. The healthcare sector, especially, cannot afford to operate reactively. Resilience requires more than just a backup plan; it demands a forward-thinking strategy built on a sturdy foundation of domestic capability, diversified sourcing, and continuous potential scenario monitoring. To withstand future disturbances, we must shift from simply managing our supply chains to strategically designing systems that can adapt and endure.

2020 – Pandemic Crisis and PPE Shortages

In early 2020, the COVID‑19 pandemic struck, exposing critical weaknesses in global supply systems. U.S. hospitals were scrambling for critical items like N95 respirators, gowns, and gloves. This shortage greatly impacted clinicians and everyday care. It was recorded that so many healthcare workers faced low or out-of-stock inventory, they had to reuse single-use items or resort to makeshift protection including everyday use items like garbage bags as critical personal protective equipment (PPE)¹.

As COVID-19 case numbers continued to soar, countries such as China halted PPE exports to prioritize their own domestic needs, especially crucial items like N95 masks, which were largely controlled by Chinese production at the time². This export restriction triggered a ripple effect, accelerating mask shortages everywhere.

By the middle of 2020, critical PPE was so scarce that states often had to bid against one another to obtain masks, ventilators, and other critical supplies, further intensifying the crisis³.

2021 – Tariffs, Trade Frictions, and Ongoing Supply Pressures

As panic and stockpiling due to the COVID-19 pandemic slowed, other longer-term supply chain structural issues became more apparent. Tariffs on medical goods, which began with the U.S.–China trade war in 2018, continued to impact costs and timelines for much-needed imports⁴.

Meanwhile, the temporary surge in domestic PPE manufacturing that ramped up during the pandemic began to unravel. Many of the U.S. based factories launched during the crisis have closed, as low-cost Asian imports resumed business in late 2020 and 2021⁵. As of 2024, the U.S. still imports over $75 billion in medical devices and supplies⁶.

In addition to trade wars and tariffs, hospitals were actively bracing for renewed supply chain disruptions tied to unpredictable circumstances, potentially mirroring the shortages experienced during the height of COVID‑19 .

2022–2023 – Resilience through Domestic Capacity & Strategic Shifts

In response to persistent pressures, stakeholders including private distributors and hospitals began redirecting strategy toward strengthening domestic and nearshore sourcing opportunities.

Alongside others in the industry, we advocated for building strategic inventory management tools alongside strong local manufacturing networks. According to Owens & Minor insights, creating resilient supply chains requires identifying vulnerabilities in advance and utilizing regional manufacturing to ensure fast, reliable delivery⁷.

At the same time, the global supply chain crisis, notably spanning from 2021 – 2023, continued to impact facilities and networks that relied on just-in-time (JIT) delivery models. Congested ports, labor shortages, strikes, and container scarcity all added stress to already stressed supply chains, heightening the need for redundancy and flexible sourcing⁸.

2024–2025 – Toward a Forward-Looking, Data-Driven Foundation

In 2024, the White House increased tariffs by up to 25% on Chinese-made masks and gloves in order to encourage domestic production. Though a seemingly welcome step for U.S. manufacturers, it did not fully reverse the downward trend in the customer’s desire to focus solely on domestic supply⁹. Supply Chain leaders started thinking outside the box, and outside the U.S., for nearshore opportunities.

Moving out of 2024 and into 2025, the healthcare sector began prioritizing resiliency efforts into supply chain design to bolster advantages for customers, manufacturers, and suppliers:

• Diverse Sourcing Offerings: Domestic and nearshore suppliers began serving as reliable backup suppliers for mission-critical items, reducing dependency on one long-distance, foreign source.
• Digital Risk Monitoring: Many healthcare networks adopted real-time analytics and methods of AI to detect early disruptions before they happen, like anticipated shipping delays or upcoming tariff changes. This allowed them to adjust supply strategies proactively.
• Government and Industry Coordination: The Defense Production Act was enforced initially by the U.S. Government in March 2020 for ventilator and PPE production, and again later in 2023 to expand domestic manufacturing of essential medicines and countermeasures¹⁰.
• Strategic Local Distribution: Inventory models pivoted from lean efficiency toward just-in-case readiness, with regional distribution centers prepped for emergencies.

Conclusion

The turbulent years since 2020 have taught us that supply chain security depends on preparedness, not just procurement. By weaving domestic and nearshore strategies into our supply chain frameworks, clinicians can push forward towards uninterrupted patient care. Building this robust foundation now is crucial to prepare for tomorrow’s unknown crises.