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.