Why didn't the US replenish its strategic stockpile of face masks after the 2009 pandemic?

Question

According to a March 25 NYT opinion piece:

Few in the protective equipment industry are surprised by the shortages, because they’ve been predicted for years. In 2005, the George W. Bush administration called for the coordination of domestic production and stockpiling of protective gear in preparation for pandemic influenza. In 2006, Congress approved funds to add protective gear to a national strategic stockpile — among other things, the stockpile collected 52 million surgical face masks and 104 million N95 respirator masks.

But about 100 million masks in the stockpile were deployed in 2009 in the fight against the H1N1 flu pandemic, and the government never bothered to replace them. This month, Alex Azar, secretary of health and human services, testified that there are only about 40 million masks in the stockpile — around 1 percent of the projected national need.

Assuming that info is correct (if not feel free to post a frame-challenge answer), why did the US not replenish its national strategic stockpile of masks after the 2009 pandemic? (E.g., would that have required the introduction of new legislation? Was such legislation introduced but defeated? Or was it not just introduced for some stated reason(s)?)

Answer 1

For a detailed analysis of the dynamics in Congress see ProPublica's piece, "How Tea Party Budget Battles Left the National Emergency Medical Stockpile Unprepared for Coronavirus".

Dire shortages of vital medical equipment in the Strategic National Stockpile that are now hampering the coronavirus response trace back to the budget wars of the Obama years, when congressional Republicans elected on the Tea Party wave forced the White House to accept sweeping cuts to federal spending.

Among the victims of those partisan fights was the effort to keep adequate supplies of masks, ventilators, pharmaceuticals and other medical equipment on hand to respond to a public health crisis. Lawmakers in both parties raised the specter of shortchanging future disaster response even as they voted to approve the cuts.

Another piece in the Atlantic also frames the issue in terms of the types of threats that were being prioritized.

After 9/11, the people in charge of the stockpile were concerned about bioterrorism—threats like anthrax—and sudden, mass-casualty events like, say, a bombing at the Super Bowl. This made some sense, but in the process officials took their foot off the pandemic-preparedness gas pedal. The response to the 2009 swine-flu pandemic was seen as a success, and the stockpile-minders moved on to the next item on their disaster checklist. “I think as human beings, we sometimes, not that we get complacent, but it’s like, Oh, we’ve got this. And we did. We had it,” says Deborah Levy, who oversaw the stockpile as acting division director for the Centers for Disease Control and Prevention in 2013 and 2014, while Burel was in another role.

Because officials weren’t as worried about pandemic flu, they stocked fewer basic medical supplies, like masks, that would come in handy during an infectious-disease outbreak. Officials thought the stockpile should have bioweapon antidotes and other drugs that aren’t easily available on store shelves, rather than common items you can buy at CVS. “The Strategic National Stockpile was built to respond primarily to chemical, biological, radiological, and nuclear events, whether by a terrorist, or a state actor, or something that might happen along those same lines that was accidental,” Burel told me.

Answer 2

So, there are a couple of things at play here.

First note that the "National Stockpile" isn't specifically for masks but rather for emergency supplies in general. It was originally designed for counter-terrorism but was extended for other things later, such as masks.

All of these things seem to be lumped together as the "National Stockpile," and is budgeted as such.

As you mentioned, the stockpile of masks was depleted in the 2009 H1N1 outbreak.

So, why wasn't it replenished? Well the consensus seems to be budget cuts (and by "consensus" I mostly mean a lot of people citing this article from ProPublic). It seems these budget cuts put the Obama Administration into a position where it had to make a choice: masks, or other important things which aren't masks--such as "lifesaving drugs:"

"We had to trade off those funds that we had, and we chose to invest in those lifesaving drugs that would not be available from any other source, in the quantity needed, and in time," he said. "I definitely want to see my health care workers protected; that's very important. But if I'm thinking, 'Do I buy this many masks to protect this many workers, or do I buy this many medicines to keep people safe that we can't get elsewhere?' There's no easy answer here."

In hind-sight, we seemed to have had need of the masks before these drugs, but how exactly do you know that back in 2012?

Also worth noting is that since this is a general stockpile, other disasters can deplete it as well, not just outbreaks. For instance, hurricane response can use the stockpile too:

Again according to NIH, the stockpile's resources were also used during hurricanes Alex, Irene, Isaac and Sandy. Flooding in 2010 in North Dakota also called for stockpile funds to be deployed. The 2014 outbreaks of the ebola virus and botulism, as well as the 2016 outbreak of the zika virus, continued to significantly tax the stockpile with no serious effort from the Obama administration to replenish the fund.

So there were other strains on the stockpile during that time as well.

Between the cuts and other disasters that required using its supplies, the stockpile was just never able to regain headway against its growing need.