The COVID-19 pandemic revealed significant gaps in global access to personal protective equipment (PPE), particularly for vulnerable populations in developing countries and mobile groups like refugees. Existing national stockpiles often proved insufficient during sudden demand spikes, leaving frontline workers unprotected. This proposal suggests creating an internationally distributed, rotating stockpile of basic PPE designed to address these systemic weaknesses.

How the System Would Work

One approach could involve strategically positioning long-shelf-life PPE (masks, gloves, basic gowns) across multiple global locations, managed through a "first-expire, first-out" rotation system. The equipment would be pathogen-agnostic - usable across various outbreaks - and stored under conditions allowing easy access during emergencies. A key innovation might be pre-positioning portions in developing regions while maintaining central coordination for quality control and distribution.

The system could prioritize:

• Frontline health workers in resource-limited settings
• Mobile populations often excluded from national health systems
• Rapid response teams deploying to outbreak zones

Implementation Strategy

An initial phase might focus on establishing governance frameworks with international health organizations and securing storage locations in 5-7 strategic regions. A minimal viable product could test the concept in a single area like Sub-Saharan Africa with limited PPE types. Subsequent phases would expand capacity while developing:

• Manufacturer agreements for stable production
• Rotation protocols to minimize waste
• Distribution networks with local health partners

Comparison With Existing Solutions

Unlike WHO's disease-specific stockpiles or national reserves, this distributed approach could offer broader protection by being pre-positioned near potential need zones. It wouldn't replace existing systems but rather complement them by focusing specifically on current gaps - particularly for populations that national stockpiles often miss. The rotation system might also reduce waste compared to traditional stockpiling methods.

Potential challenges like political interference in distribution could be addressed through independent governance structures with transparent allocation rules, while sustainability might come from combining donor funding with rotation system sales of near-expiry equipment to non-crisis markets.