When the Covid-19 pandemic exposed our dependence on foreign production for essential medical goods, it became clear that supply chain resilience is a matter of national security. At the height of the crisis, the United States imported nearly 80 percent of its medical gloves and 70 percent of its masks, according to the U.S. International Trade Commission. Hospitals were forced into global bidding wars for respirators, ventilators, and basic personal protective equipment (PPE). For many of us in public health, that moment marked a turning point: a recognition that the nation must rebuild its domestic manufacturing base for medical supplies.
That goal is both necessary and urgent. But the current approach — using Section 232 national-security tariffs on imported medical equipment — risks repeating the same mistakes that have long plagued U.S. health policy: relying on blunt instruments for complex problems.
The Commerce Department’s ongoing Section 232 investigation covers a sweeping list of products, from PPE and syringes to imaging devices and infusion pumps. The rationale is to protect domestic industries deemed vital to national security. Yet tariffs on such a wide range of goods could raise costs across the healthcare system, disrupt supply chains, and reduce access to the very technologies hospitals need to provide timely, high-quality care.
The American Hospital Association reports that more than half of U.S. hospitals finished 2023 with negative operating margins. Costs for supplies and equipment rose by more than 30 percent between 2019 and 2023, driven largely by inflation and pandemic-related disruptions. Layering tariffs on top of that pressure would almost certainly result in higher prices for patients, slower adoption of new technologies, and fewer resources for community health programs.
For public health, the stakes are broader than hospital budgets. Tariffs risk weakening emergency preparedness — the capacity to respond quickly to emerging threats. During Covid-19, response delays were not caused by a lack of scientific expertise but by logistical bottlenecks. The Strategic National Stockpile (SNS) was understocked, and global shipping routes were paralyzed. A new tariff regime could make it harder to replenish that stockpile affordably, especially for critical items like ventilators, needles, and testing supplies.
A smarter strategy would build domestic capacity through investment, not restriction. The Biomedical Advanced Research and Development Authority (BARDA), within the Department of Health and Human Services (HHS), already has a proven record of partnering with private industry to scale up production of vaccines, diagnostics, and medical countermeasures. Its flexible contracting model could be expanded to include medical devices and hospital consumables critical to preparedness. BARDA’s Project NextGen offers a template for how targeted, public-private investment can strengthen domestic supply without imposing higher costs on healthcare providers.
Similarly, the Administration for Strategic Preparedness and Response (ASPR) has the authority to coordinate procurement and logistics for emergency medical supplies. ASPR’s industrial base expansion program, launched after the pandemic, is designed to bring key manufacturing back onshore through grants, advance-purchase commitments, and technology partnerships. These mechanisms can be scaled up to secure domestic production of high-priority equipment while maintaining global flexibility.
Public-private models like these address the same national security concerns the Section 232 investigation is meant to solve, but they do so without compromising access or affordability. They also align with the lessons learned from the Defense Production Act (DPA) investments during the pandemic, which helped expand U.S. manufacturing capacity for masks and testing kits in 2021. Those efforts demonstrated that targeted, time-bound incentives can be far more effective than permanent trade barriers.
The drive to onshore production is right and necessary. But tariffs under Section 232 are a blunt tool for a problem that requires precision. Instead of raising costs on hospitals and patients, the federal government should use its existing authorities to incentivize domestic manufacturing, strengthen public-private collaboration, and diversify global sourcing.
National security begins with health security. We should not have to choose between the two. Our goal should be to make care more reliable, more affordable, and more resilient — all at the same time. The right mix of investment, coordination, and policy foresight can get us there. Tariffs alone cannot.
Photo: mohd izzuan, Getty Images
Peter J. Pitts is President of the Center for Medicine in the Public Interest and a Visiting Professor at the University of Paris School of Medicine. He is a former Associate Commissioner of the US Food and Drug Administration and member of the United States Senior Executive Service.
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