COVID-19 has stressed out the limitation of our healthcare system, across the globe. Inadequate availability of ventilator to push oxygen-rich air to the severely ailing lungs of Covid infected patents has drawn quite exceptional attention. State-of-the-art ventilators produced by reputed medical equipment companies cost tens of thousands of dollars. Such a high cost is one of the reasons for its inadequate availability, particularly in the hospitals of developing countries. For example, in March of 2020, Bangladesh had roughly 500 functioning ventilators for 160 million people. India had around 25,000 of them to take care of more than 1 billion population. The situation in African countries was quite poorer. Even rich countries did not have an adequate number of ventilators to take care of a likely number of infected people. According to reported numbers published by Brookings, we need roughly 110,000 to 220,000 ventilators to offer healthcare services in a situation that faces approximately 2.2 million Covid-19 infected cases. To overcome massive shortage of this device, there has been progress across the world to make ventilators. Particularly, success in developing countries is quite encouraging. How to sustain this success appears is vital for addressing medical equipment shortage in developing countries. What it takes to scale up the success of making a ventilator into a profitable business is worth investigating.
In the race of increasing the supply of ventilator, governments across the world have been increasing the purchasing budget. In addition to increasing the production, globally reputed medical equipment makers are also collaborating with firms in developing countries to scale up the production, particularly to meet local demand. To take it further, the academic community of MIT has also extended the hand. Upon consultation with physicians, students, and faculty members of MIT have designed a simple ventilator device that could be built at the cost of $400 to $500 in materials. Most importantly, the design has been made open source. The key to the design of this low-cost ventilator is mechanisation of a hand-operated plastic pouch called a bag-valve resuscitator, or Ambu bag. It is designed to be operated by hand by a medical professional or emergency technician to provide oxygen to a patient in situations like cardiac arrest until the patent is taken to the intensive care unit to offer support from the ventilator. To operate Ambu bag, the pumping of air into the lung is done by squeezing and releasing the flexible pouch by high skilled personnel. For safe operation, trained healthcare professionals should have the capability of evaluating the patient and adjusting the timing and pressure of the pumping. MIT's team has basically devised a mechanised method for squeezing and releasing the flexible pouch for an extended period. This simplicity of design has made it quite easy to turn Ambu bags, which most of the hospitals have in large numbers, into the mechanised ventilator. In addition to it, some electronics firms have also succeeded in manufacturing components and assemble state-of-the-arts ones. Once the COVID crisis is over, what it takes to apply this success profitably to produce a ventilator and other medical devices to equip hospitals, particularity in developing countries?
The journey of breathing for the person in need started in the 18th century without any role of the machine. The adventure of developing a machine to provide artificial help to the lung in difficult times was started by a Scottish doctor in the 1830s, into which air could be rhythmically pumped to rescue a "drowned seaman". In comparison to the modern one, it was a primitive product. Like ventilator, no technological product shows up in matured form, and it does not remain static either. They keep evolving through a series of redesigns by leveraging one after another emerging technology core. And ventilator is no exception. Through these redesigns, they keep getting better, lighter, and also cheaper-- a key competence needed to succeed in the industrial economy.
A firm or innovator focuses on redesign opportunities by leveraging technologies to keep pursuing the journey of profiting from ideas. In addition to the capability of making components and assembling them together, there is a need for flow of knowledge and applying that flow into a series of ideas of the redesign. For example, manual punching in controlling the flow of oxygenated air is neither precise nor could be sustained for a prolonged period. The initial redesign of a positive pressure ventilator was based on machine control technology, giving birth to pulmotor in 1935. The emergence of electronics technology was leveraged by the innovators to redesign pulmotor to replace mechanical control with electronics, making the redesigned version lighter, more effective, and also further compact. The precision of pumping in adaptation to patient's situation, which keeps changing dynamically, was improved further by redesigning the control with sensor and software-intensive algorithms. But the journey does not end here. It will keep progressing in pursuit of offering higher quality at a lower price, while sustaining profit.
Often ideas of a redesign around emerging technology core are patented to make them excludable so that profitably those ideas could be traded. To support the continued flow of such ideas, there is a need for institutional R&D capacity and partnership with suitable institutions to provide ideas. Once the flow of ideas for redesign starts drying up, the profitability of making products like lifesaving ventilators even starts evaporating. To make the designed product cost competitive, there is a need for selling the newly released version to a large number of customers, so that rising R&D cost could be divided among many customers. In the absence of this capability, the competence of just making does not lead to a sustained journey.
It's good to see the aspiration of making a ventilator during this difficult time. But this making success alone is not sufficient to sustain the journey for profitably making ventilators and other medical devices. There could be a proposition of offering tax differential for making locally made products profitable. But this is not a solution for sustainable growth. The challenge is not limited to having the capability to make. Rather the success hinges on attaining the capability of managing the technology, generating ideas of the redesign, making those ideas excludable (patented), and redesigning ventilator as well as other target products so that successive versions keep getting better as well as less costly. In the absence of this capability, this success of making in fighting the COIVID-19 crisis is not going to create sustainable capability. In this globally connected competitive industrial economy, success does not originate from attaining the capacity of making and expecting to profit from by selling at the same or higher price and demanding tax deferential as well as other incentives from the government. The effort should shift to focus on redesigning for making better versions at a lower cost for developing the sustained capacity of making. This is a key competence required to succeed in building industrial capacity in this globally connected competitive economy. Such competence is also vital for developing countries to sustain growth. South Korea has been experiencing for attaining development milestones without facing the threat of getting caught in the middle-income trap.
Rokonuzzaman, PhD is academic and researcher on technology, innovation and policy.