Centre rushes to prepare for ventilator shortage, repeats mistake of protective-gear crisis

26 March 2020
A patient on a ventilator photographed at the Park Hospital, in Gurgaon, in May 2019. A ventilator helps patients who are unable to breathe properly on their own, and the COVID-19 virus, which affects the respiratory system, has led to a sharp spike in the number of hospitalised patients in need of breathing assistance.
MONEY SHARMA / AFP / Getty Images
A patient on a ventilator photographed at the Park Hospital, in Gurgaon, in May 2019. A ventilator helps patients who are unable to breathe properly on their own, and the COVID-19 virus, which affects the respiratory system, has led to a sharp spike in the number of hospitalised patients in need of breathing assistance.
MONEY SHARMA / AFP / Getty Images

The end of March witnessed a flurry of activity to deal with COVID-19 crisis, indicating that the government is finally waking up from its slumber on the rapidly progressing pandemic. With severe shortages in medical equipment already, India’s doctors will face the prospect of having to ration goods and services, especially with one lifesaving medical equipment that has become more valuable than gold dust: mechanical ventilators. In the last week, the centre issued notifications to ban its export, formed a national-level committee for its procurement and held a meeting with the civil-aviation department to prepare itself for an inevitable ventilator shortage. Yet, the centre appears not to have learnt any lessons from its failure to stockpile personal protective equipment and its raw material, because it took till 24 March to prohibit the export of all respiratory apparatuses and breathing devices.

A ventilator helps patients who cannot properly breathe on their own by pumping air into their lungs through a tube inserted into their windpipes. The COVID-19 virus affects the respiratory system, which has led to a sharp spike in the number of hospitalised patients in need of breathing assistance. Both Italy and China, which faced the worst of the pandemic, have already had to deal with this, and it is likely that India will struggle with it as well. “The decisions are coming a few weeks too late, and I hope the delay does not cost us a lot,” Malini Aisola, the co-convenor of a non-profit industry watchdog called the All India Drug Action Network, told me. “There seems to be a multi-pronged concerted effort in place now, and it gives hope that it will ensure we get ventilators in time for when cases start surging.”

Despite the international patterns of exponential rise in cases and the shortage of essential medical equipment witnessed by multiple countries, the Indian government has repeatedly failed to heed the warnings and act ahead of the spread. It took the centre till 19 March to issue its first notification during the public-health crisis to prohibit the export of ventilators. The same notification also prohibited the export of raw materials for coveralls and masks, three weeks after the World Health Organisation had issued guidelines informing countries to expect a disruption in the supply of protective equipment for medical staff. Yet, it took the government five more days before it issued an order prohibiting the export of the component parts of ventilators. On 24 March, the directorate general of foreign trade prohibited the export of “all ventilators, including any artificial respiratory apparatus or oxygen therapy apparatus or any other breathing appliance/device.”

During a press briefing on 22 March, Lav Agrawal, a joint secretary in the union health ministry, said that the centre had placed an order to procure 1,200 new ventilators, but that may still leave doctors well short of the required amount. This is particularly true for Maharashtra, where the state government has specified that ventilators made in India should be certified by the United States’ Food and Drug Administration or the European Union’s CE—a certification mark indicating that a product meets the health standards in practice within the European Economic Area. The steep standards are impossible to follow, given the dire need, shortage of time and the global lockdown of flights. The decision also suggests an inexplicable lack of urgency, considering that Maharashtra has been the worst affected so far among Indian states, recording over a hundred cases.

A ventilator manufacturer, who spoke to me on the condition of anonymity, said that he had approached the state government, urging it to rethink the impractical standards. He wrote to the government, “In these times of crisis, it is appalling that CE approval and US FDA is made mandatory.” He requested the state to devise specifications that are “practical, achievable, and possible for Indian manufacturers to meet,” adding that “only the minimum modes or specifications should be asked.”

Vidya Krishnan is a health journalist based in Goa. Her first book, on the rise of antibiotic resistance and the threat to global health security, is slated to be published in 2020.

Keywords: COVID-19 medical infrastructure
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