As the race for a vaccine against the coronavirus heats up, the US faces another potential crisis: a shortage of syringes. The US federal government has already spent hundreds of millions of dollars in hopes of warding off a syringe shortage, if and when a Covid-19 vaccine is approved. It comes as shortages of personal protective equipment continue to hamper the response to the pandemic. A potential vaccine could receive emergency approval as early as winter 2020. But industry leaders and experts are warning the US has only a short window of time to scale up syringe supplies in order to deal with the vast number of inoculations required to control the pandemic. The biggest danger for shortage will not come in the first wave of any potential vaccination program, but in the second and third waves in 2021. Then, manufacturers will need to roughly double capacity to meet demand in the US alone. That situation narrows the window for syringe manufacturing to just a few months, with the early arrival of a vaccine holding the potential to disrupt the supply chain. “What we’ve been telling governments around the world is, if you are planning to do an immunization program for Covid-19, you need to order those now and not wait until a vaccine is ready,” said Troy Kirkpatrick, spokesman for Becton, Dickinson & Co, better known as BD. BD is the world’s largest manufacturer of syringes, and makes more than half of those used in the US. It has already committed to produce 470m syringes for the US, UK and Canadian governments. “Our baseline is already in the multiple billions, and even at that scale it’s not like we can, say, produce another 100 million this month,” said Kirkpatrick. “That’s why we’re being very proactive in educating governments that you need to place your orders now.” Not all experts in the field are worried. “The syringes are the easy part, and I think we as a country are in a very good position to deal with it,” said Chaun Powell, group vice-president of disaster response for Premier Inc, a medical supply chain management company. But others have been warning of a potential syringe shortage for some time. In May the whistleblower and former Biomedical Advanced Research and Development Authority (Barda) director Rick Bright filed a complaint alleging the US national stockpile had only 15m syringes. Five companies make up most of the US syringe market, manufacturing roughly 663m syringes a year, all of which are already allocated for other programs such as flu shots. The Trump administration has estimated the US could need an additional 850m syringes to deliver a Covid-19 vaccine en masse. Researchers at the left-leaning Center for American Progress found an estimated 462m doses of a Covid-19 vaccine would be needed for the US to reach herd immunity, with accompanying syringes needed to deliver the vaccine. In part, the huge numbers of syringes needed is a function of Covid-19. Coronaviruses produce a short-lived immune response in people. Most experts believe people will need to receive a second shot, or “booster”, if and when a vaccine is rolled out. “The very first phase, we’ll have enough because we aren’t going to vaccinate billions of people, we’re still going to get vaccines to hundreds of millions of people,” said Prashant Yadav, a senior fellow at Center for Global Development and professor and an expert in supply chains. “In the second and third phase is when things get tricky.” Analysts at McKinsey believe vaccine manufacturers have the cumulative capacity to manufacture up to 1bn vaccines by the end of 2020, and 9bn by 2021 – if a vaccine is approved. And that later time frame is when global syringe capacity looks shakiest. “If we have 7 or 8 billion doses in 2021 and 2022, do we have an additional 7 or 8 billion syringes in capacity? No,” said Yadav. Some companies, such as Pfizer, are turning to outside contractors because they face an internal shortage of syringes and vials, according to the trade publication Biopharma Reporter. The hope is to make room for production capacity for the company’s vaccine candidate. The US government has turned to companies such as BD, which makes 58% of America’s syringes, along with a number of smaller companies. The federal government effectively doubled the annual revenue of Texas-based Retractable Technologies when it gave the company $137m to deliver syringes and expand production. In 2019, Retractable’s revenue was $41.8m, according to the Dallas Morning News. Another $143m contract for unproven plastic vials lined with a microscopic layer of glass have gone to Alabama-based SiO2, which received a Barda contract to ramp up production of vials to 120m vials by November. SiO2 produced 14m vials per year, as of March. BD is producing 190m syringes for the US government, and is expanding its production lines in Nebraska with $42m in taxpayer cash (part of a $70m investment). The new capacity will allow the company to produce hundreds of millions more syringes a year beginning in 2021. What’s more, some distributors worry that regardless of capacity, panic buying and stockpiling are undermining the supply chain. “People are so afraid of what happened with N95s that it’s just going to continue from product to product,” said Michael Einhorn, president of Dealmed, the largest medical equipment distributor in New York, New Jersey, Pennsylvania and Connecticut. “We’ve seen requests come in from one particular governmental agency that wanted to stockpile syringes, and the governmental agency does not provide healthcare services directly,” said Einhorn. “When people are panicked … people don’t act rational.”