Supply chains for vital medical supplies have been scrambled by COVID-19 – so much so that the United States has trouble supplying its hospitals with simple face masks.

Why a nation like the United States hasn’t been able to procure necessary supplies was at the heart of a National Press Foundation online training on “Medical Trade Wars: The Search for Drugs, Devices and PPE.”

By now, readers worldwide are familiar with the scramble for face masks (The Washington Post, PolitiFact, The Seattle Times), as well as more complicated devices such as ventilators. There are also growing concerns about U.S. dependence on China for pharmaceuticals as well as other medical products.

Rosemary Gibson (bio, Twitter), author of “China Rx: Exposing the Risks of America's Dependence on China for Medicine,” said that U.S. capacity to make its own pharmaceuticals has withered. Other countries are overly dependent as well: While India is seen as a powerhouse, it still depends on China for about 70% of the active ingredients and chemicals essential for production.

China plays a disproportionate role in the manufacturing of active pharmaceutical ingredients – APIs – as well as “key starting materials,” or the chemicals and raw materials that are necessary to get production started.

“Where do those APIs come from? They don’t fall from the sky,” Gibson said. More and more, they come from China.

While drug shortages during the COVID era have been fairly sporadic, shortages in masks have been far more prevalent. Sébastien Miroudot, a senior trade policy analyst in the Trade and Agriculture Directorate of the Organization for Economic Cooperation and Development, detailed the manufacturing process that goes into making N95 respirator masks.

These are more elaborate than cloth surgical masks but are still fairly ubiquitous. They are also relatively complicated to make, with 70 parts — everything from aluminum for the nose bridge, to elastic for ear loops, to multiple layers of non-woven fabric that are assembled together with ultrasonic welding. (Miroudot explains the process here.)

Adding to supply chain bottlenecks have been export bans on finished masks; at least 30 countries have put in place such bans, Miroudot (bio, Twitter) found, although some have since been lifted. China is the dominant player in the face mask market; in 2017, it was responsible for 41% of all exports of the product.

Coronavirus has exposed the growing U.S. dependence on other nations for critical medical supplies and renewed calls for “reshoring” — bringing manufacturing back home tothe U.S. or other nations.

“We’ve been hearing … that COVID-19 is perhaps the end of globalization as we know it – that the global chains have not been able to deal with these kinds of problems, and that there are very real dependencies for critical resources,” said Gary Gereffi (bio, Twitter), who directs the Global Value Chains Center at Duke University.

He foresees shifts – but not total upheaval.

“I believe domestic production in these medical devices and personal protective equipment is definitely going to increase in the next few years,” Gereffi said. “But it’s not going to replace globalization.”