New Delhi: As the novel coronavirus wreaks havoc across the globe, infecting more than 600 people in India, the Narendra Modi government has asked medical device manufacturers to assess the availability of ventilators in India and boost their production, ThePrint has learnt.
Covid-19 is known to affect the respiratory system of the patients who are then required to be put on ventilator, which is a medical device used to assist with breathing.
At a meeting Tuesday, the government asked device makers in India to collate all information about the available stock of ventilators by 1 April, as well as their scope to manufacture additional machines.
The meeting was chaired by Ravinder, Joint Secretary, Technical Committee for Ventilators, Department for Promotion of Industry and Internal Trade (DPITT), under the Ministry of Commerce.
The government has informed the manufacturers that the Andhra Pradesh MedTech Zone (AMTZ), an Andhra government initiative, will provide financial assistance to the tune of Rs 40 crore for large-scale manufacturing of ventilators. “AMTZ, under technical supervision of the Principal Scientific Advisor to the Government of India and assisted by the World Bank, invites proposals from leading med tech champions,” said the proposal letter, a copy of which was accessed by ThePrint.
The AMTZ will also provide a team of 25 medical technology experts and biomedical engineers free of cost to each manufacturing partner for the first three months for starting operations at the earliest.
India’s capacity to produce ventilators
“Every country across the globe is busy assessing the available stock of working ventilators. It is like assessing the military equipment before starting a war. We can produce around 5,500 units locally every month with the present set of manufacturers,” said Rajiv Nath, who heads the Association of Indian Medical Device Industry (AIMED), the lobby of medical device makers in India.
Nath, also the managing director of Hindustan Syringes and Medical Devices, represented the industry at the meeting Tuesday.
AIMED has contacted seven of the nine major manufacturers, who have confirmed that the current production capacity is 5,500-5,750 pieces per month. The production last month was approximately 2,700 pieces.
What is a ventilator and why do Covid-19 patients need it?
A ventilator is used when the breathing centre of the brain is unable to control respiration. The machine resembles an octopus, with several pipes coming out of the main equipment.
“In case of Covid-19, reports confirm that one-third of patients develop acute respiratory distress syndrome,” said Judish Raj, an industry veteran and founder of Hyderabad-based Sithara Adept Technologies, which manufactures medical devices.
“A ventilator is used when lungs are filled with fluid. Such patients find it very difficult to be oxygenated in a normal way. The only way to manage is to put the patient on ventilator assistance,” Raj said.
The additional pressure from the ventilator pumps oxygen into the bloodstream, and takes out carbon dioxide from the lungs.
The ventilator market in India
According to the estimates shared by Medikabazaar, a B2B online platform for medical supplies and equipment, the total ventilator market in India is valued at around Rs 500 crore.
“Of the total market, 75 per cent is imported equipment, with the market leaders being GE Maquet and Draeger. The remaining 25 per cent machines are Indian-manufactured,” said Jitesh Mathur, senior vice-president, Medikabazaar.
The Union health ministry’s data shows there are only 8,432 ventilators in the public sector in India. Chennai-based medical device maker Trivitron Healthcare adds that there are about 40,000 ventilators across the country — mostly in the private sector.
“There is a pressing need of ventilators in India and a huge disparity in their availability in various states. For instance, Mumbai alone has 800 to 1,000 ventilators, while states such as Tamil Nadu and Madhya Pradesh have 1,500 and 1,800 respectively. The city of Bengaluru, has approximately 400 ventilators, whereas Kerala has 5,000,” said Sudip Bagchi, president, Trivitron Healthcare.
Other industry players gave similar estimates. Vineet Acharya, managing director of Life Line Biz, said: “Even if I share extremely conservative estimates, our industry has supplied more than 50,000 ventilators to hospitals in the last five years. We can safely assume that they are working ventilators.”
According to Acharya, ventilators manufactured in India costs Rs 5-7 lakh, while a foreign machine with same features will cost between Rs 11 lakh and Rs 18 lakh.
While the Indian Council for Medical Research, the country’s apex body in this field, predicts that India may need thousands of ventilators if the coronavirus scenario worsens, experts say the number may run into several lakhs.
“Considering the phenomenal requirement of ventilators in developed nations such as Italy, India would need 80-100 times the available number of ventilators to prepare for a worst case scenario,” said Raj, who is also a medical device consultant at the Karnataka-based Kaynes Technology, a contract manufacturing firm.
“If there are 40,000 ventilators in the country, India needs to prepare for 40 lakh, considering the worst case scenario,” he added, based on an average stay of 21 days for a coronavirus patient on ventilator, as against an average patient’s stay of two days.
Govt to airlift imported components
The ventilator industry might be confident of producing over 5,000 pieces per month, but it is dependent on imports, mainly from Europe, for some raw materials and components. And that is a problem at present.
For instance, the essential electronic parts coming from China and the European Union are taking over 10 days to reach due to poor air-freight connectivity.
“The entire process of development of ventilators depends on the availability of various raw materials, tools and parts that are manufactured in different parts of the world. Any disruption to the supply chain, or the unavailability of any part would bring the entire procedure to a halt,” Bagchi said.
The manufacturers raised the issue at the meeting with government officials.
“We have asked the industry to prepare a list of components which need to be imported. We will send a cargo plane to airlift the raw material and components from these countries as an emergency requirement,” said a government official who was part of the meeting, which was also attended by representatives of the Ministry of Civil Aviation.
Nath from AIMED confirmed this. “We will soon submit the list of components,” he said.
Industry starts building capability to increase production
Meanwhile, several manufacturers have started diverting resources towards the production of ventilators from other components such as X-Ray machines and infusion pumps.
“The companies which are already involved in making health technology products might find it a bit easier to manufacture ventilators, owing to the fact that they have required equipment, trained staff, protocols, skills and expertise,” said Bagchi.
However, for companies in a different business domain, it might be difficult to churn out sophisticated breathing equipment like a ventilator, as it would mean major factory upgrades, and re-fitting assembly lines.
“If the government is ready to help us in importing the components, we can immediately jack up the production,” Life Line Biz’s Acharya said.
Speaking to ThePrint, an official from a multinational electronics company said every order for an ICU ventilator is being imported as the demand of them is very less in India. “While the government has reached out to us to understand the stock availability, it is a lockdown situation across the globe and our supplies are also significantly disrupted.”
The official added: “Moreover, our manufacturing cities are also struggling to source several components from other parts of the world so they are not operating fully. Several products are stuck for custom clearances.”