Supply chain headache? Hundreds of millions of syringes will be needed to vaccinate U.S.

The CEO of the world’s largest manufacturer of syringes said this week “there is no capacity” to quickly ramp up production to 1 billion syringes for an expected COVID-19 vaccine because of “extreme surge demand,” adding a potential new wrinkle to the overtaxed medical supply chain.

Becton Dickinson is in “active conversations” with the federal government on the COVID-19 response, said Troy Kirkpatrick, a spokesman for the company said. He added that CEO Thomas Polen, who made his comments in a Thursday earnings call, was concerned that governments globally think ahead.

“Waiting until a vaccine is available will be too late,” Kirkpatrick said. “There is not capacity in the global industry to manufacture hundreds of millions or billions of syringes and needles in a month or two.”

The warning reinforces that of federal government whistleblower Dr. Rick Bright, who said in his complaint that he raised the issue with his superiors at the Department of Health and Human Services earlier this year, telling them the nation’s stockpile “contains approximately 15 million needles and syringes, a mere 2% of the required amount.”

In a March 12 email to colleagues bolstering his complaint, Bright wrote: “It could take two plus years to make enough to satisfy the US vaccine needs for a pandemic. We need to hold on to all that we have and look at surging supplies now from producers.”

In a Feb. 14 memo, Peter Navarro, the White House director of trade and manufacturing policy, wrote the COVID-19 task force, saying experts estimated the country would need 850 million syringes to deliver a potential vaccine. Vaccine experts say two doses of the vaccine might be required.

Dr. Dan Hanfling, a vice president at In-Q-Tel who advised the Bush and Obama administrations on emergency preparedness, said Bright’s concern is not new.

“The issue of needle and syringe shortages as a part of the supply chain needed to ensure timely delivery of medical countermeasures has been on the radar screen for a long while,” Hanfling said. “If delivery systems are not available, how do we get medical countermeasures into the arms of those who will need them?”

NBC News has confirmed the Department of Health and Human Services signed contracts with two companies for $111 million on May 1 for “a COVID-19 Mass Vaccination Campaign,” according to federal purchase orders. The contracts were first reported by Bloomberg Law.

During a typical year the influenza vaccine requires 160 million doses for about half of the U.S. adult population, according to Kim Elmore, senior director of pharmacy contracting for Premier Inc., a group purchasing company for health care providers across the country.

To meet the demand for a possible vaccine, she said that figure would have to be doubled.

“You can’t make it all at once,” she said.

Premier estimates the syringe manufacturers could absorb an extra increase of 10 million before they would have to boost their capacity.

An HHS official told NBC News it would be premature to speculate on what might be needed because it’s too early to know what form a vaccine might take.

“For example, we don’t know if successful vaccines would be injected or oral (as a pill or liquid), or if injected, how many doses each person would need to get,” the official said. “When a safe, effective vaccine becomes available, doses will be manufactured over a period of time, so ancillary supplies will be needed over time rather than all on day one, which aids manufacturers in meeting the need.”

Hospital leaders said needle and syringe shortages were not yet an immediate issue but a known potential problem. They said if a vaccine was developed in the near future, supply chain issues could result in a lack of syringes to administer a vaccine and place “a substantial strain on the American health care system.”

The pharmaceutical trade group PhRMA says the industry is prepared either way.

“As a matter of course, innovative biopharmaceutical companies have comprehensive contingency plans as part []of their overall supply chain planning, meaning that during unforeseen events biopharmaceutical companies are able to redirect resources from other manufacturing,” a spokesperson said.

Both Becton Dickinson and Cardinal Health, the other major syringe manufacturer, say they have already ramped up production.

Becton Dickinson’s Kirkpatrick said the company is anticipating juggling multiple demands and “extreme surge demand for these products, including an expected surge for flu vaccinations next season given forecasts of a potential second wave of COVID-19 in the fall.”

Any sudden surge in demand for syringes would put even more pressure on a health care supply chain system that is already experiencing “unprecedented” pressure.

For example, in a normal year the federal government proactively places health care products on an “allocation list,” which limits how much can be purchased by a health care provider to prevent hoarding.

Currently, about 350 types of syringes are on the list.

In a typical year, upwards of 1,800 items are on the allocation list. Now, according to Premier Inc., there are more than 10,000.