Do we really need to manufacture ventilators locally in Pakistan?

Prime Minister Imran Khan’s Task Force for Knowledge Economy has recently sent out a call invoking all potential stakeholders/developers to come up with their respective prototypes – a one “page document” that will assist in the development of an indigenously built ventilator – in lieu of the most recent COVID-19 pandemic. The deadline for this submission was March 26 and the signatory of this call was identified to be Dr. Atta Ur Rehman and Dr. Shoab Khan – both leading the charge on PMs Knowledge economy task force. Once the prototypes are finalised it would be shared with the National Health Sciences Ministry and other relevant stakeholders after which a decision would be reached regarding the production of ventilators in Pakistan. 

Notwithstanding the outstanding credentials of both of these signatories, the timing of this call, the manner in which it was sent out and the target audience – all beg a number of important questions.  Whereas, on the one hand, this call signifies the seriousness with which the government of Pakistan is taking this pandemic, on the other hand, it also illustrates how ill prepared and shortsighted our national health and technology development strategy is. 

Not sure why our government and other agencies are always reactive and not proactive; no strategy would ever succeed if we become the nation of reactors. We have come to believe that perhaps one day – some technology will show up magically; hope as we all know, is never a good strategy. For Pakistan to be driven by a knowledge based economy, it would need to first put its house of technology development in order and then harvest that facility with innovators and creative thinkers with all necessary infrastructure in place. 

We need to ensure that fundamental research and ground work is done systematically and strategically; if nothing goes into the pipeline – nothing comes out at the other end. We have also failed to recognize that if the intent is to support the innovators and product developers then what kind of non-disclosure agreements are in place to ensure that the ideas provided will not be stolen, sold to some other manufacturers, or yet to serve the personal financial interests of individuals in the name of national benefits. Why does anyone in their right mind forward this task force their intellectual property which is yet to be secured; that is, no patent has yet been filed. 

If on the other hand, people used cut and paste strategy to steal others IP then the government of Pakistan and the affiliated agencies will all be held legally liable and sued for multi-billion dollars.  Moreover, the government must assure confidentiality and guarantees that the ideas shared in the absence of a non-disclosure agreement are protected and that the developers will be given their due credit with revenue sharing. In the absence of such measures, a credible, trustworthy hub for innovation and creativity is not possible, nor would such an exercise render fruitful outcomes.

The recent pandemic of COVID-19 caused by Severe Acute Respiratory Syndrome virus (SARS-CoV-2) is highly infectious and deadly. Most seriously infected patients die due to severe pneumonia and lung failure while undergoing respiratory distress. The requirement of a ventilator for such patients is a life saver and hence the global urgency. Similar viral pandemics in 1912 infected 500 million people of which 50 million died – including approximately 700,000 in the USA alone! During that pandemic, neither did we have antibiotics or antivirals but we still survived and ended up developing vaccines, antivirals and antibiotics. 

SARS pandemic of 2009 similarly caused havoc; its onslaught was however fast thus making it easier to identify and manage the symptoms. It did however, cause immediate pneumonia and hence the respiratory distress which meant that the patients needed to be kept on ventilators for an extended time period. Another issue with the SARS virus was that it could not survive for longer periods of time in humans and hence its impact was not as harsh as that of the most recent novel COV-2 virus. 

Whereas, SARS caused fluid based pneumonia in the infected patients, the CT scans of lungs infected with novel virus, reveal white patches which a radiologist would designate as “ground glass opacity” or partial lung filling-in of air spaces. This virus also causes lung fibrosis with large nodules in the lining of the lung. Even if these patients were to recover, their quality of life would be seriously compromised for years to come. Another issue related to this virus is that its symptoms appear slowly often taking two weeks or more and if not managed earlier these could be life threatening. 

The coronavirus symptoms are – for the most part, mild and 80% of those who are infected recover without any major respiratory distress, whereas the mortality rate for serious infections is about 4% at worst. The seriously infected patients would need to be put on ventilators and hence a sense of urgency by the government of Pakistan to acquire adequate devices in case they are needed. There is no cure nor are any vaccines available; these may require at least a year or even longer but by then this virus, which has already mutated twice from bat to snake to humans – would have moved on thus making vaccines a hit and miss. 

The best that we can do at this moment is to self-isolate ourselves physically and take all necessary hygienic measures that are invoked by WHO.  It suffices to say, that this is not the first time that we have been incapacitated by viral infections and it won’t be the last time! If this current ventilator acquisition strategy does not pan out for this particular pandemic, we might be ready for the next onslaught after having acquired these homemade devices. 

In light of the urgency that Pakistan is facing, I consider it shortsighted on part of our health and government agencies and beg the question: Why these ventilators cannot be 3-D printed as is the situation elsewhere? For instance, medically approved emergency, 3D printed ventilators have already gone into production in Spain. This is an emergency device that can help patients breath for short periods of time and is composed of 3D printed goggles, masks or shields. 

The technology was developed by Leitat Technology Center and the prototype that has gone into production is a simple version of conventional ventilators. A decent size 3-D printer could produce 50-60 ventilators per day and would suffice to meet the needs of most critically ill patients. 

Many Canadian and other technology hubs are also using similar approaches. Considering the current situation and the time cycle that Pakistan is in vis-à-vis this pandemic, it perhaps makes more sense that we seek short-term, albeit practical and realistic solutions and try not to chase the virus or its aftermath.