The United States is now four summers into a pattern it can no longer call unprecedented. Each summer from 2023 to today, we’ve had Canadian wildfire smoke cross the border and trigger air quality emergencies across a widening swath of the country.

What began as Manhattan’s skyline turning orange has expanded every year. This summer, 800-plus active Canadian wildfires have pushed hazardous smoke into 20-plus states, from the Great Lakes through the Midwest and Northeast.

Detroit, Minneapolis and Chicago have posted some of the worst air quality of any city on Earth. Ohio issued a “Code Maroon” alert, the highest level. Officials in New York warned this could be the city’s most significant smoke event since 2023.

This is now a predictable, recurring national public health emergency, and the country’s preparedness posture has not kept pace with that reality.

The health stakes are measurable and national in scope. Research shows that a modest rise in wildfire smoke particulate matter is associated with an 11 percent jump in asthma-related emergency room visits and a 14 percent increase in COPD-specific mortality in the days after exposure. Wildfire smoke exposure is linked to 40,000 deaths annually in the United States.

Behind those numbers are real families and effects. Grandparents with COPD who can’t leave the house for days at a time, parents keeping kids with asthma indoors through what should be the middle of summer, and outdoor workers who have no choice but to breathe the smoky air outside.

Here is the troubling part. When local leaders scramble to distribute masks from a state stockpile, there is often no guarantee those masks actually protect against fine wildfire particulate matter.

Many masks handed out in these emergencies are imported from China. This decision is often based on the lowest cost, with little regard for quality or for investing in domestic jobs to create the products.

China’s regulatory standard for KN95 masks is just self-certification by Chinese authorities rather than by the National Institute for Occupational Safety and Health (NIOSH), a U.S. agency. They do not meet the rigorous safety testing and auditing that the U.S. requires for its N95 respirators.

That sourcing choice now carries a second layer of risk beyond quality control.

In June 2026, the U.S. trade representative formally determined that China is among the economies that have neither banned nor effectively enforced a prohibition on goods made with forced labor. The finding was serious enough to trigger a proposed 12.5 percent tariff, the steepest tier USTR imposed in that investigation.

At best, Chinese workers are not paid a livable wage. At worst, they may be working under conditions of forced labor to make these masks.

America should not be using taxpayer funds to stockpile personal protective equipment that does not meet our national standards and fund a bad global trade actor. We deserve localized reserves of respirators that are both NIOSH-certified and entirely free of forced-labor risk, and that support livable wages and protect American workers who turn out high-quality products.

Domestic personal protective equipment manufacturers can produce 435 million NIOSH-approved N95 respirators yearly under normal conditions, about 97 percent of routine U.S. demand. These companies can surge to as many as 1.5 billion a year in a genuine emergency.

That capacity was built in plants across the United States to ensure the country would never again be caught without it. Four wildfire summers later, we have to ask whether that lesson has actually translated into how the states prepare for emergencies and distribute personal protective equipment.

The fix doesn’t require reinventing anything. It requires prioritizing U.S.-made equipment in regional and state-based stockpiles, especially those pre-positioned in states now squarely in the annual smoke path.

These stockpiles must be sourced from the existing domestic, NIOSH-approved manufacturing base. The bipartisan Make PPE in America Act already gives states, Congress, the administration and HHS the framework to do this. We need follow-through, not new legislation.

The country just got its fourth consecutive preview of what a smoke-filled July looks like now. The question is whether state leaders treat this as the fourth rehearsal of an emergency they still haven’t prepared for, or as the moment they finally build the domestically sourced personal protective equipment stockpile this pattern has already told us we need.

Eric Axel is the executive director of the American Medical Manufacturers Association. He wrote this for InsideSources.com.