The landscape of shortages changed dramatically over the course of the COVID-19 pandemic. Initially, extreme shortages emerged in the equipment needed to protect healthcare workers, diagnostic testing, equipment and staffing to provide care to seriously ill patients, and basic consumer goods disrupted by panic buying. Many commercial and governmental operations curtailed or suspended operations, leading to shortages across "non-essential" services. For example, many health care providers stopped providing some surgeries, screenings, and oncology treatments. In some cases, governmental decision making created shortages, such as when the CDC prohibited the use of any diagnostic test other than the one it created. One response was to improvise around shortages, producing supplies ranging from cloth masks to diagnostic tests to ventilators in home workshops, university laboratories, and rapidly repurposed factories.

As these initial shortages were gradually remedied throughout 2020/2021, a second group of shortages emerged, afflicting industries dependent on global supply chains, affecting everything from automobiles to semiconductors to home appliances, in part due to China's determination to eliminate COVID-19 from its population by enforcing stringent quarantines and shutdowns, in part by disruptions to goods distribution, and in part by forecasting errors.

Shortages were concentrated in America, Europe, Latin America, and China, while other jurisdictions were much less affected, for a variety of reasons.

Background

Historically, governments were the primary source of supplies for pandemics. Their willingness to maintain large stocks has tended to vary with the severity of the most recent pandemic. For example, in the early 2000s, President George W. Bush increased US pandemic stockpiles. These were depleted in the 2009 swine flu pandemic. The pandemic was seen by the public as mild, which led to a backlash over preparedness spending. National stockpiles of medical equipment were not systematically renewed, in the US or in jurisdictions such as France, which in 2013 moved responsibility for personal protective equipment (PPE) stockpiles to public and private enterprises. The French strategic stockpile dropped from one billion surgical masks and 600 million FFP2 masks in 2010 to 150 million and zero, respectively, in early 2020.

Manufacturing for many types of health-related equipment had moved offshore, seeking lower costs. American mask manufacturer Prestige Ameritech warned for years that the USA mask supply chain was too dependent on China.

Public (World Health Organization (WHO), World Bank, Global Preparedness Monitoring Board) and private initiatives emphasized pandemic threats and preparation. In 2015, Bill Gates began warning about a possible pandemic. This had little impact: WHO's pandemic influenza preparedness project had a  million two-year budget, out of WHO's 2020–2021 budget of  billion.

In 2018, China experienced a shortage of emergency drugs. In 2019, the Global Preparedness Monitoring Board reported the WHO's remaining pandemic emergency fund was depleted by the 2018–19 Kivu Ebola pandemics.

As COVID-19 spread in January 2020, China began blocking exports of various medical supplies, including N95 masks, booties, and gloves produced by factories on its territory. Organisations close to the Chinese government began foreign markets for supplies. This limited other countries' access.

Tests

Initial testing shortages were a key factor limiting authorities' ability to measure disease spread. Because the virus was new, tests had to be designed, manufactured, distributed, administered, and evaluated from a standing start. The ability to do this varied dramatically across jurisdictions. Germany started producing and stockpiling COVID-19 tests in January 2020.

The United States Centers for Disease Control and Prevention (CDC) initially demanded that universities and other researchers abandon their attempts to make diagnostic PCR tests in favor of waiting for the CDC to release its own tests. The CDC then distributed 160,000 defective tests, leaving the US with no testing capacity in the early weeks of the pandemic. By February 27, fewer than 4,000 tests had been conducted in the U.S. CDC released a corrected test in March 2020. By then the pandemic had spread across the country. The Associated Press reported that "the system has been marked by inconsistencies, delays, and shortages", forcing many people with symptoms to wait hours or days to get tested and then days longer to receive the results.

Many countries did not have the ability to implement large-scale testing, lacking both tests and the health care infrastructure to administer and evaluate them.

Reagents In Ireland and the United Kingdom (UK), reagent shortages limited the number of tests evaluated through March and April. Reagent shortages became a bottleneck for mass testing in the European Union (EU).

On 1 April, the UK government confirmed that 2,000 NHS staff had been tested for coronavirus since the outbreak began, but Cabinet Office Minister Michael Gove said a shortage of reagents meant it was not possible to screen the NHS's 1.2 million workforce. Gove's statement was contradicted by the Chemical Industries Association, which denied any shortage.

Some US hospitals manufactured their own reagents from publicly-available recipes.

Swabs The US Strategic National Stockpile held no swabs, forcing reliance on commercial supplies, which were soon exhausted by the explosive growth in testing. The US had shortages, despite the fact that one domestic manufacturer increased production to 1 million swabs per day in March, and the government funded it to build a new factory in May. Shortages arose in the UK, but were resolved by 2 April.

In May 2020, the US FDA licensed a swab-free saliva test and new swab designs, including 3-D printed swabs that labs, hospitals, and other medical facilities could make themselves. The development process took as little as two weeks.

Personal protective equipment Personal protective equipment (PPE) stocks ran out around the world in the winter of 2020. People from 86 countries engaged in the voluntary production of PPE to supplement disrupted supply chains. By summer 2021, shortages had turned to glut, as many manufacturers reduced production.

China

Before the pandemic, most PPE was made in China. The Chinese government took control of stocks from foreign enterprises whose factories produced these goods. At the outset, China imported some 2.46 billion pieces of PPE between 24 January and 29 February, including 2.02 billion masks and 25.38 million items of protective clothing.

In February 2020 WHO minimised the need for PPE, recommending telemedicine; physical barriers such as clear windows; isolating patients; using only PPE necessary for each specific task; reusing respirators without removing them while caring for multiple patients with the same diagnosis; monitoring and coordinating supply chains; and discouraging masking for asymptomatic individuals.

China later sent supplies to Spain, Turkey, and the Netherlands that were of poor quality. The Dutch health ministry recalled 600,000 face masks on 21 March for poor fit and dysfunctional filters despite them having a quality certificate. The Spanish government discovered that 60,000 out of 340,000 test kits from a Chinese manufacturer produced inaccurate results. The Chinese Ministry of Foreign Affairs responded that the customer should "double-check the instructions to make sure that you ordered, paid for and distributed the right ones. Do not use non-surgical masks for surgical purposes". In mid-May, the European Commission suspended an order of 10 million Chinese masks after two countries reported receiving sub-standard products. After a batch of 1.5 million masks was distributed, Poland said the 600,000 items they received had no European certificates nor did they comply with the necessary standard.

Hand sanitiser

Hand sanitiser went out of stock in many areas, causing high prices. In response, brewers and distillers began to produce hand sanitizer.

Protective gear Initial shortages were such that some nurses at one New York City hospital resorted to wearing garbage bags as an alternative to unavailable protective clothing. Small businesses throughout the United States retooled to produce makeshift protective devices, often through open source initiatives. Many manufacturers donated gear. An example is the COVID-19 Intubation Safety Box, which is an acrylic cube placed over an infected patient's torso, with openings that allow ventilator intubation and extubation while minimising risk to healthcare workers.

Amazon banned sales of N95 face masks to prevent price gouging.

In March 2020, Doctors' Association UK alleged that shortages were covered up through intimidating emails, threats of disciplinary action and work suspensions. Some doctors were disciplined by managers annoyed by online postings online regarding shortages. On 18 April, communities secretary Robert Jenrick reported that 400,000 protective gowns and other PPE were on their way to the U.K. from Turkey. One day later, these were delayed, leading hospital leaders to criticise the government for the first time. Only 32,000 items arrived (less than one-tenth). Eventually, all were returned to Turkey for failure to meet NHS standards.

Most of the world's glove supply comes from Malaysia; Large orders with trusted companies were typically made "years in advance". Malaysia-based Top Glove and its subsidiary TG Medical were accused of violations of workers' rights, leading U.S. Customs and Border Protection (CBP) to ban their products in July 2020. Thai company Paddy the Room repackaged used gloves and sold tens of millions to U.S. buyers in 2021.

Masks

China

As the pandemic accelerated, the mainland market saw a shortage of face masks. Hoarding and price gouging drove up prices, leading the market regulator to crack down. In January 2020, price controls were imposed on face masks on Taobao, Tmall JD.com, Suning.com, and Pinduoduo; third-party vendors were subject to price caps, and violators to sanctions.

United States In 2006, 156 million masks were added to the U.S. Strategic National Stockpile in anticipation of a flu pandemic. After they were used against the 2009 flu pandemic, neither the Obama administration nor the Trump administration replenished the stocks. By 1 April, the US stockpile was nearly empty.

National Nurses United, the largest organization of registered nurses in the United States, filed over 125 complaints with Occupational Safety and Health Administration (OSHA) offices charging hospitals with failing to comply with laws mandating safe workplaces.

France In 2010, France's stock included 1 billion surgical masks and 600 million FFP2 masks; in early 2020 it had fallen 150 million and zero, respectively. As the pandemic consumed supplies, stocks ran low and caused national outrage. France instructed its remaining mask-producing factories to work 24/7 shifts, and to expand national production to 40 million masks per month.

Competition for supplies Countries such as the United Kingdom, France, Germany, South Korea, Taiwan, China, India, and others initially responded to the outbreak by limiting or banning exports of medical supplies, including rescinding existing orders. Germany blocked exports of 240,000 masks bound for Switzerland and stopped other shipments to Czechia. Turkey blocked a shipment of ventilators to Spain; 116 were later released.