With COVID-19, continuously spreading
within the country, India is facing a tough time to manufacture lifesaving
equipment. The pandemic outbreak, which has resulted in 216,824 positive cases
and 6088 deaths in India as of June 4, 2020, requires procurement and
distribution of personal protection equipment, ventilators, and masks to fight
against it. COVID-19 severely affects the respiratory system of the patients
who are then required to be put on a ventilator, a medical device used to
assist with breathing by blowing air and oxygen into the lungs. One out of six
cases of COVID-19 gets seriously ill or faces breathing challenges owing to
which, ventilators are required to manage respiratory distress in critical
patientsas they are capable of providing the body with oxygen through a tube to
a patient’s lungs.
Type of Ventilators
1. Transport
Ventilator: Transport
ventilators are usually powered pneumatically or via DC or AC power and are
designed to take the place of manual ventilation or “bagging” during emergency
or transport situations. Transport ventilators provide ventilatory support for
patients who cannot breathe on their own during illness, trauma, congenital
defects, or the due to effects of drugs (e.g., anesthetics).
2. Intensive
Care Ventilator: Intensive
care ventilators are usually connected to a wall gas supply and are larger in
shape. These ventilators use AC power and are microprocessor controlled. This
kind of ventilators offer greater control on a wide variety of parameters.
3. Neonatal
Ventilator: A typical
neonatal ventilator system consists of a breathing circuit, a humidification
system, gas-delivery systems, monitors and their associated alarms, and gas
sources for oxygen (O2) and compressed air. These ventilators are designed to
monitor the most accurate volume and pressure.
4. Positive Airway Pressure Ventilator: The positive pressure
allows the air to flow into the airway until breath of the patient is terminated. These are specifically
designed for non-invasive ventilation, and can be used at home.
Some other conditions when a patient needs ventilator include ALS, Unconscious,
Brain injury, Lung infection, Pneumonia, Stroke, Premature lung development,
polio, among others.
Ventilators-Need of the
Hour
Each
nation across the globe is actively surveying the available stock of working
ventilators. There's a squeezing demand of ventilators in India due to surging
positive cases and a massive disparity in their availability in various states.
Sighting trends from other severely affected countries means that an estimated
5-10% of patients will require ventilator support for their survival. Moreover,
it can be calculated that India will need 110,000 to 220,000 ventilators to
minimize the number of fatal cases. Based on the latest information shared by
Ministry of Health and Welfare, India had 19,398 ventilators available in the
country against demand of 75,000 on May 1, 2020. The country has placed orders
for 60,884 ventilators as of May 1, out of which order for 59,884 ventilators
has been placed with domestic manufacturers.
According to TechSci
Research report “Global Mechanical Ventilators Market By Mobility
(Intensive/Critical Care Ventilators Vs Portable/Transportable Ventilators), By
Interface (Invasive Ventilation Vs Non-Invasive Ventilation), By Type (Adult /
Pediatric Ventilators Vs Infant/Neonatal Ventilators), By Mode (Combined-Mode
Ventilation, Volume-Mode Ventilation, Pressure-Mode Ventilation, Other Modes),
By End Use (Hospitals & Clinics, Home Care, Ambulatory Care Centers,
Emergency Medical Services), By Region, Competition, Forecast &
Opportunities, 2025”, the global mechanical ventilators market was valued
at around $ 1.37 billion in 2019 and is expected to grow at a robust CAGR over
the next five years to reach $ 3.98 billion by 2025. Rising incidences of
respiratory disorders is one of the primary factors responsible for growth of mechanical
ventilators market across the globe. Additionally, increasing number of ICU
beds is further anticipated to bode well for the growth of mechanical
ventilators market across the globe in the coming years. Moreover, rising
preterm births is expected to bolster the market growth through 2025.
Several
orders for ventilators have already been placed by the central and state
governments, to treat patients suffering from COVID-19. Majority of ventilators
were imported from Europe or China but with the ongoing pandemic, infecting the
whole globe the country is striving for other options. To deal with the
crippling shortage of medical equipment, the Union government has prohibited
the export of ventilators, sanitizers, and other ICU equipment with immediate effect.
Automotive Makers-The Ray
of Hope
Series
of companies are preparing to step up the production of critically required
equipment. Producers are on a mission to produce desperately needed restorative
ventilators for containing the coronavirus widespread. Major Indian producers
of ventilators include Skanray Technologies, AgVa Healthcare, AB Industries,
Air Liquid Medical Systems, AVI Healthcare, Life Line Biz, and Medion
Healthcare. Above mentioned, domestic ventilator manufacturers are tie-ing up
with automakers such as Maruti Suzuki, Mahindra & Mahindra, Tata Motors,
Hyundai India, etc., to contribute to the anti-coronavirus effort. Automobile
manufacturers can not only assist them in arranging capital or joint
investments but also can quickly modify their vehicle assembly lines for the rapid
production of ventilators in India. For instance, Maruti Suzuki is working with
AgVa Healthcare, BEL with Skanray to deliver 30, 000 and 10,000 ventilators,
respectively.
Recent Developments to Push
Production of Ventilators
· The government has placed an order with SkanRay,
Mysuru-based ventilator manufacturer, in collaboration BEL, for the manufacture
of 30,000 units. Another order has been placed with NCR-based AgVa Healthcare
to scale up production from 400 units per month to 10,000 pcs per month by May.
The company will be assisted by Maruti Suzuki to assemble and manufacture parts
required for the ventilators as AgVa Healthcare sources 40% of its parts from
different suppliers for the manufacturing of portable ventilators. Portable
ventilators unlike mechanical ventilators are easy to install and transport and
require low power.
According to TechSci
Research report “Global Portable Ventilator Market, By Type (Invasive
Ventilation, Non-Invasive Ventilation), By Mode (Pressure Mode Ventilation;
Volume Mode Ventilation; Combined Mode Ventilation), By Application
(Aeromedical; Pediatrics; Domiciliary Ventilation; Non-Invasive Ventilation),
By End User (Hospital; Ambulance; Clinic; Rehabilitation Center; Others), By
Region, Forecast & Opportunities, 2025”, the global portable
ventilator market is expected to grow at a steady rate during the next five
years. Portable ventilators are used to provide oxygen to patients while
commuting. The factors that drive the market are increasing breathing issues
and respiratory problems among the growing population. Additionally, increasing
smoking population is another factor for the growth in demand for portable
ventilators. Additionally, the requirement of portable ventilators exists in
segments like homecare, clinics and hospitals. The intervention of technology
in the healthcare sector has improved the operational conduct and has provided
the patients with intensive care solutions.
However, the high cost of installation and high maintenance of the
ventilators might act as a constraint for the market.
· MG Motor India is also in
talks with three medical device makers, including GE Healthcare Systems, to
produce ventilators at its Halol facility in Gujarat to help meet demand during
the pandemic.
· IIT Kanpur-incubated
start-up Nocca Mechanical autonomy created an intrusive ventilator model that
permits ventilators to be associated to a portable phone so that specialists
can screen patients.
· Another firm, Dynamatic
Innovations aims to make up to 50,000 pneumatic or expendable ventilators which
don't need power to preserve airflow by month end.
Government Initiatives
· The Government of India
is planning to counter the shortage of ventilators with the development of 2-3
different models. While one will be a low-cost respirator model, the second
will be a high-end Intensive Care Unit (ICU) model. Another option is to develop
multi-patient ventilators that can serve to more than one patient at a single
time.
· A technical committee has
also been formed under the Directorate General of Health Services (DGHS) to
keep a watch on the high demand for ventilators and their specifications from
the ones quoted in the tender by HLL.
· To counter the supply
chain disruptions. the government wants private defense firms to consider
manufacturing medical equipment, including personal protective gear and
ventilators, to curb the impact of coronavirus. The government has also taken
steps to check shortage and black-marketing of protective gear, particularly
masks and sanitizers and asked manufacturers to improve their manufacturing
capacities for these things, in order to smoothen the supply chain.
· Recently United States
also announced to send 200 ventilators to India in the following three weeks
starting May 20, 2020.
The Way Forward
If positive cases continue rising
exponentially in India, the demand-supply gap for ventilators will surely be
very high. As pharmaceutical companies and researchers are working together to
produce a vaccine, country's top supply chains could pool resources and
expertise to make sure the ventilator manufacturing companies get what they
need. Few tasks which will boost up the manufacturing processes:
- Plotting the Supply Chain of the
Ventilator: A ventilator-maker may require components from
different subcontractors operating in dozens of different countries. In
normal days, it’s easy to procure parts with reliable subcontractors to
deliver those parts when needed but in a crisis such as the outbreak of
coronavirus, demand exceeds supply. Figuring out the supply chain will
enable the makers to understand which parts are needed and what can be
obtained. The makers also need to figure out the shortage of any
particular component and if something more readily is available, which can
be used as a replacement.
- Making Smooth Pathways:
Ventilator manufacturers should consider the best and the most seamless
path to get the parts so that they can expand the capacity as quickly as
possible. A global, fast-response logistic network can be established
through air traffic hubs to speed up the processes.
- Forecasting the Demand in Hotspot Zones: Identify
areas from where the demand is growing and the hotspots that have been identified,
to manage orders fairly and efficiently. Focus should be more on meeting
the demand in epicenters as the number of patients is on the higher side
in those areas.
- Increasing the Workforce: As the
demand for ventilators increases, the number of individuals required to
meet the surging demand must be taken into consideration, and more number
of people should be recruited to pace up the manufacturing process.
- Requirement of Trained Professionals: Simply
increasing the workforce won’t help in treating the patients, the biggest
challenge is connecting patients to ventilators which requires finding
enough qualified people, who can operate them.
Finally, the healthcare
task force will need to maintain the global, strategic view all through this
national pandemic phase. If we as a country want to be as effective and
efficient as we can to solve the healthcare issues caused by the COVID-19
pandemic, we need to take a broad, systemic perspective. The virus doesn’t seem
to limit itself within any boundaries; we shouldn’t either. The coming days
will be pivotal, and India needs, in conjunction with all that's being arranged
and done, more good fortune on its side to handle any flare-up of a bigger
extent.