How VA Innovative Partnerships and Health Care Systems Can Respond to National Needs: NOSE Trial Example

Background: At the onset of COVID-19, essential supplies were not obtainable from manufacturers. This caused patients and clinicians to have additional risk and exposure to COVID-19 in some settings and the wasting of critical materials when testing was unavailable in other settings. Observations: The Veterans Health Administration (VHA) developed and enacted contingency plans for depleted supplies under both its First Mission—to care for veterans—and its Fourth Mission— to support the American health care system in times of crisis. A partnership among the VHA, US Food and Drug Administration, the National Institutes of Health, and America Makes addressed national shortages with the curation and development of designs, testing protocols, product evaluation, and product validation. VHA leveraged digital manufacturing to produce nasopharyngeal swabs onsite—3-dimensional-printed nasal swabs—and validate them to cover the gap between stockpile depletion and ramp up of traditional product manufacturing. Conclusions: This effort involved close collaboration between innovators and researchers within the organization and alongside government, industry, and academic partners. We illustrate this collaborative concept here with a use case of nasal swabs to demonstrate successes and lessons learned that are shaping how the VHA in conjunction with government and industry partners can shepherd this new strategy for crisis preparedness.