India has less than 50% of the ventilators than needed for Covid-19 treatment: Ashok Patel, Max Ventilators

Every city is running short of Ventilators, as this new strain has a typical behavior that it starts damaging the lungs within 4 to 5 days of time.

Covid-19 pandemic exposed many shortcomings in the healthcare systems of various countries. In India and elsewhere, Covid-19 pandemic brought the need for ventilators to focus. According to industry data India had eight ventilator manufacturers with an yearly capacity to supply 3,360 ventilators before the pandemic. During the Covid crisis, nine more players entered the field and it raised India’s manufacturing capacity to 396,260 annually. Gujarat-based Max Ventilator ramped up its production and also upgraded its in-house R&D centre. Max Ventilator has designed, manufactured and marketed a wide range of ICU, Anesthesia, Emergency & Transport, and Homecare Ventilators, of both invasive and non-invasive variants. Over the years, the company has installed in excess of 13,000 ventilators across the whole country. In an exclusive interview with Financial Express Online Ashok Patel, Founder & CEO, Max Ventilators talked about the situation on ventilator manufacturing in India, its fluctuating demand and the support the industry is looking for from the government. Excerpt:

As a ventilator manufacturer, how do you think we have performed in terms of handling the pandemic so far and how do we go about in terms of addressing the second wave that has hit us?

Given the dire predictions of ventilator shortage in the country during the onset of the first wave of the pandemic, I think until the arrival of the second wave, we had managed to overcome the shortage fairly well. Mounting a nation-wide effort led by the government itself with other private players pitching in, our country as a whole had aggressively scaled up the production of these lifesaving breathing machines. However, as the second wave hits us with more force and ferocity, the initial impulse was again that we might need more ventilators in order to meet the expected surge as well as to stave off any eventual shortage. But a very recent analysis, just days ago, by the health ministry based on patient data across hospitals in the country indicates that the need for ventilators in the second wave may well be lower than in the first wave. Yet, this is just one analysis and we may need more of such studies to conclusively establish that the demand for ventilators will be lower this time. My personal instinct tells me that the demand for ventilators will remain steady and almost at the same levels as the first wave if not extraordinarily higher.

As an individual manufacturer, how did you manage to deal with the fluctuations or the volatility in demand in the last few months?

Sticking to the basics of inventory management doubled with keeping a tight leash on the entire value chain of ventilator production is what has helped us navigate through this volatility in demand in the last few months. As such, we have been able to keep our production lines adaptable responding to the ebb and flow of the demand suitably – cranking up production or lowering it depending on the situation. Maintaining excellent relations with our vendors and suppliers has also stood us in good stead in this regard. Even during the second wave, we have a ready-to-deliver inventory of about 300 to 350 ventilators. Over-all, we have experienced a 100% jump in demand in the last one month or so with our monthly capacity being about 1000 ventilators per month. At the same time, expecting a demand for alternative devices, we have also been working on other machines such as an HFOT device which has a far lower operating cost and could ensure nearly 100% chances of survival of a patient.

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And if there is shortage, can you quantify that shortage? And why are we facing this shortage in the first place?

Every city is running short of Ventilators, as this new strain has a typical behavior that it starts damaging the lungs within 4 to 5 days of time. The only way to treat the patients in this case is either through pressurized oxygen and later ventilator, there is no other way than these two. Due to shortage of oxygen, people are put on ventilators as last resort. So patients on ventilators are increasing and we don’t have sufficient ventilators. India has less than 50% of the ventilators than needed for the treatment. From your experience, which states or regions are likely to face a more severe shortage of ventilators and which are likely to face less?

Although the second wave has swept many more states and regions, we have seen maximum demand coming from states such as Maharashtra, Gujarat and West Bengal so far. In fact, we have started receiving demand from Delhi as well lately.

Although, during the first wave of the pandemic we were receiving huge demand from states like Kerala, Punjab and Karnataka, the demand has declined there as they seem to be more equipped now.

As against the first wave, in your estimate, how many more ventilators would India require to meet the needs of our people during the second wave?

This would depend on the number of severe cases that we eventually have in a few weeks or even months. But I think we have enough ventilators in the country, or we have sufficiently developed the capability to make more if required.

While the government has encouraged domestic production of ventilators through PLI schemes, etc., what more can the government do to further incentivize and propel this indigenization? What are the regulatory steps that the government has taken so far to improve both the quality and quantity of medical devices – particularly ventilators – that you appreciate? What more do you expect from the government?

Yes, the government has indeed attempted to impart a push to domestic manufacturing of ventilators through programmes such as the PLI scheme within the larger drive for achieving self-reliance. And it is indeed welcome. What the government could do more in this context is to lower the entry barriers in terms of annual turnover criterion, etc., and expanding the device segment hitherto covered to more products under the scheme. This would help smaller but efficient players also participate effectively.

As regards regulatory steps to improve quality and quantity, the classification of ventilators as regulated devices under BIS and CDSCO under Medical Devices Rules 2017 and 2020 must be acknowledged. That acquisition of ISO 13485 certification for products has been made mandatory is again welcome.

The government could also step in by way of restriction of imported ventilators into the country which would also catalyze the ongoing Atmanirbhar Bharat drive.

What are some of the common components of a ventilator that you source from abroad and how dependent are you on imports for making a ventilator? 

High end critical accessories were the only component which we used to import from other countries.

While before COVID-19 took place 60% of our raw materials were sourced from outside India, but post lockdown when other countries refused to give us the material, we are now down to 10%. We encouraged our own vendors to manufacture the components in India itself, we ensured them that we are here to help them and guide them through it all so that in future god forbid if again any such situation arises, we do not have to depend on other countries for our material.

In terms of quality, what more can we do to compete with the world-class ventilator manufacturers from Europe and the US?

Again, while the imperative to reduce input costs in terms of utility and infrastructure expenses is certainly critical to make our products cost-competitive, we would need to align the technical specifications and standards of our products with European and American product standards. In the long run, sufficient investment in related technologies backed by a continuously flourishing R&D ecosystem would help us emerge as a world-class manufacturer of ventilators.