A large section of India’s population is under considerable stress due to COVID-19; however, for a few others, it is an opportunity to act decisively so as to mitigate the human suffering and prevailing negativity. Various reports that regularly appear, highlight the incredible achievements of our healthcare providers, scientists, technocrats, industrial companies, research organisations, entrepreneurs and others, in the fight against the pandemic. For certain, it is the healthcare providers who deserve our utmost praise for their contributions; they entered the battlefield with very little ammunition and since then, are fighting ceaselessly. “When the crisis began, not a single Personal Protective Equipment (PPE) was being manufactured in India. N95 masks were being manufactured in negligible quantity. Today, the situation is such that India is manufacturing two lakh PPE kits and N95 masks each per day. We are able to do so because India has turned a crisis into an opportunity. India’s vision to convert this crisis into an opportunity is going to prove influential as we become more self-reliant,” mentioned Prime Minister Narendra Modi about India turning the crisis into an opportunity on May 12, 2020. Every dark cloud has a silver lining.
The way some people of this country have responded innovatively with positivity in the face of the crisis is indeed remarkable. Their contributions will go a long way, not only in fighting the pandemic but also in providing impetus for the ‘Make in India’ initiative, which until now has not taken off the ground with the required thrust. At a time when the global supply chain is going through stress, India’s manufacturing industry’s significant achievements in the last couple of months should be drawing the attention of the global companies looking for new supply chain partners.
India’s ill prepared start
When the highly infectious pandemic COVID-19 began to spread in India, the country’s healthcare infrastructure was totally inadequate. While for many countries the challenge was to discover the medicine and vaccine to treat the disease, for India, the issues were many. India has one government doctor for every 10,189 people, whereas the World Health Organization (WHO) recommends a ratio of 1:1000, and this means, a deficit of 600,000 doctors; with regards to nurses, the shortage is about 2,000,000. Earlier, India was importing PPEs and N95 masks; regarding ventilators, the country’s production capacity was 3000 pieces a year; at the time of the lockdown it probably had less than 40,000 ventilators in all, whereas the requirement may be 80-100 times that number. Between the lockdown imposition and now, the picture has changed dramatically. Not the number of doctors & nurses, but our healthcare infrastructure and associated manufacturing; that is very encouraging.
Many companies — large, small, start-ups and research & development establishments — have taken up the challenge of manufacturing ventilators, Remote Patient Monitoring (RPM) systems, PPEs, sanitisers, medicines & vaccines, test kits and such others that are essential for successfully fighting the disease. While the manufacturing of ventilators, RPMs and such others involves design and engineering, in addition to establishing sophisticated manufacturing facility and employing trained workers, making sanitisers and the PPE kits is fairly simple and involves ensuring the availability of the required raw materials, skilling people and ramping up production capacity, while ensuring quality and conformance to relevant standards. As for drug discovery, it is knowledge intensive and the discovery process is long.
Design and engineering intensive devices
It is in the ventilator manufacturing space that we are witnessing numerous designs, engineering, manufacturing and collaborative initiatives. Among the automotive majors, Mahindra & Mahindra (M&M) and Maruti Suzuki have announced their entry into manufacturing of ventilators in India. While M&M, working on an indigenous, low-cost device, has tied up with Skanray, Maruti Suzuki announced a partnership with AgVa Healthcare. Skanray is a healthcare technology company, specialising in high frequency X-ray imaging systems, healthcare & telemedicine devices, etc. According to Maruti Suzuki’s statement, AgVa, a Delhi-based healthcare company, will be responsible for the ‘technology, performance and related matters’ of the ventilators, while Maruti Suzuki will produce the required components as well as ‘upgrade their systems’ for quality control and production of higher volumes. In fact, M&M has announced that it will be manufacturing ventilators in their plants in the US as well.
National Aerospace Laboratories (NAL) has developed a portable, non-invasive ventilator, which can be used to treat moderately ill patients, who do not require insertion of a tube through the mouth into the airway. NAL has already initiated dialogues with public/private industries for mass production. The ventilator has undergone biomedical tests & clinical trials and has obtained the safety and performance certificate.
Dynamatic Technologies, a supply chain partner to Airbus and Boeing, has developed, using locally available components, what it claims as the world’s most affordable ventilator. Even start-ups have started developing ventilators with unique features. A Bengaluru tech start-up, Ethereal Machines, is working in collaboration with Aster Hospital on 3D printed ventilator splitters which can treat two or more patients with a single machine. IIT Kanpur-incubated start-up, Nocca Robotics,developed an invasive ventilator prototype that allows ventilators to be connected to a mobile phone so that doctors can monitor patients’ health from remote. Even hospitals are making technology contributions in the fight against COVID-19; Max Healthcare has modified some of its ventilators so that one ventilator can support four patients.
RPM systems have been developed by Electronic Corporation of India and Bharat Electronics, in partnership with the All India Institute of Medical Sciences, Rishikesh. RPM helps to gather patients’ physiological information, and thereby, helps treat them with mild infection at their homes or at locations outside hospitals and thus, lessen the burden on patient & hospital-centric healthcare services. This significantly reduces the risk of exposure to healthcare workers. The device has non-invasive sensors to measure the main parameters of a patient, such as temperature, pulse rate, saturated oxygen level and respiration rate. When the monitored parameters exceed pre-set thresholds, the system software sends out alert messages to the healthcare workers and the geographical location of the patient is also generated. RPMs work in conjunction with sensors and the Indian Institute of Science, Bangalore, has developed an oxygen sensor for the electro-mechanical ventilator that they are developing.
Mass produce while adhering to quality and standards
PPE kits, which consist of goggles, face-shields, masks, gloves, coveralls/gowns and head covers & shoe covers, are required to protect healthcare workers from the deadly infection. India, a previous importer of PPE kits during the start of the lockdown, has now emerged as the world’s second largest manufacturer of body coveralls, next only to China, and this was achieved within a very short span of two months. Earlier, when India was importing the coveralls, it faced numerous problems – incessant delays as also the challenge of ever increasing prices by the exporters. The Indian Navy has developed PPEs and has obtained the necessary patent for the same. These PPEs are made of a special fabric, which affords high level of protection. Since it has high ‘breathability’ in comparison to other PPEs available in the market, it is more suitable to use in hot and humid weather conditions, as is the case in India. The technology has been tested and validated by ICMR approved testing lab.
Sanitisers, which destroy the virus, are yet another highly sought-after item. Immediately after the announcement of the lockdown, the demand spiked, and the item disappeared from shops. However, the production capacity of firms making alcohol-based sanitisers was ramped up and new entrants came into the market, and thus, created additional production capacity. Nivea India has started manufacturing alcohol-based hand sanitisers in response to the unprecedented demand. Its plant, which manufactures skincare products, has begun the production of alcohol-based hand sanitisers. ITC also converted its perfume-making plant to make hand sanitisers. Asian Paints, a leading paint company, has started making a range of hand and surface sanitisers at the company’s existing plant. Industrial Training Institute, Berhampur, has developed an ultraviolet-C (UV-C) based sanitiser for sanitising devices. UV-C is mounted inside ‘unserviceable’ microwaves so as to prevent any radiation from exiting the chamber. Any infected item, such as face masks and PPEs, can be disinfected by keeping the item to be sanitised inside the microwave for 15 minutes. It automatically switches off the supply when the action is complete. Defense Institute of Physiology & Allied Sciences, Institute of Nuclear Medicine & Allied Sciences and DRDO laboratories in Delhi have designed and developed a UV-C light-based sanitisation box and hand-held device. UV-C light is a short-wavelength ultraviolet light that is germicidal and can even neutralise ‘superbugs’ that have developed a resistance to antibiotics.
Vital to emerge a winner in the marathon race
In the drug discovery domain, Indian companies, such as Zydus Cadila, Serum Institute, Biological E, Bharat Biotech, Indian Immunologicals and Mynvax, are reported to be working. Some of the Indian pharmaceutical companies are also collaborating with other companies that are in the race to find a cure. Serum Institute is partnering with Oxford University to manufacture the vaccine for COVID-19, should Oxford University’s developing efforts prove successful. Some Indian firms are also in discussion with Gilead Sciences for licensing its prospective candidate, Remdesivir, for COVID-19 treatment. The Indian Council for Medical Research has announced that it would partner with the WHO on the Global Solidarity Trial for treatment of the COVID-19 disease and fast track trials to help in finding an effective treatment. WHO lists Zydus Cadila and Serum Institute as the firms from India that are in the race to find a cure. Experts say that the discovery race may last over 12 to 18 months before a vaccine is finally found. Thus, it will take a while for the big news to come and we have to wait to see if any Indian pharmaceutical company finds a place among the winners.
Kudos to all our healthcare providers as well as our scientists, technocrats, research organisations, entrepreneurs and others, who through their innovative spirit, are contributing to make India a centre of manufacturing excellence. They seem to believe in what John F Kennedy said, “The Chinese use two brush strokes to write the word ‘crisis’. One brush stroke stands for danger, the other for opportunity. In a crisis, be aware of the danger but recognise the opportunity.” The way India is responding to the challenges is encouraging and shows a bright future for the country’s manufacturing.