Manufacturing and Value Chains

A better answer to the ventilator shortage as the pandemic rages on

A patient suffering from coronavirus disease (COVID-19) wears a full-face Easybreath snorkelling mask given by sport chain Decathlon and turned into a ventilator for coronavirus treatment at the intensive care unit at Ambroise Pare clinic in Neuilly-sur-Seine near Paris, as the spread of the coronavirus disease continues in France, April 1, 2020. REUTERS/Benoit Tessier     TPX IMAGES OF THE DAY - RC2PVF9G7LP2

'No one has a real idea of what the total demand is likely to be before the epidemic ends' Image: REUTERS/Benoit Tessier

Torbjørn Netland
Professor, Production and Operations Management, ETH Zurich
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COVID-19

  • Last year, 77,000 new ventilators were enough to meet the market demand of the entire planet. In April, New York City alone forecasts a need for 30,000 additional machines;
  • Some ventilator manufacturers have already boosted their production by 30-50% but, by themselves, can’t deliver the 500 or 1000% growth in production required;
  • The world’s top supply chains could pool resources and expertise to help ventilator-makers, focusing on six areas of support.

An epidemic is an emotional issue. With the lives of our friends and loved ones on the line, we tend to respond with the heart first, then the head.

“Close the borders! Ground the planes!” Such responses are natural and understandable, but, taken too far, may become counterproductive. Social distancing for individuals is an unfortunate necessity; for countries, the reflex threatens to turn into a terrible policy. The same hoarding impulse to take care of your own, which has led to unnecessarily empty toilet paper shelves all over the world, may exacerbate a far more serious shortage: getting ventilators to the people who need them.

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Health ministries all over the world face the same dreadful equation: last year, 77,000 new ventilators were enough to meet the market demand of the entire planet. In April, New York City alone forecasts a need for 30,000 additional machines. No one has a real idea of what the total demand is likely to be before the epidemic ends.

Where will we get all these machines? Myopic politicians everywhere see more domestic production as the solution to the ventilator shortage and for some products and some countries that may well be part of the answer. But when you look at where the ventilator companies are located and where they source the 700-plus parts that go into them, it’s easy to see that a better answer is not hoarding machines, 3D printing or cobbling together MacGyver-style contraptions. In the short-term, the only way to succeed is by getting the world’s most established ventilator manufacturers to mass-produce many more units and fast.

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Unfortunately, just at the time when we need them most, the global supply chains that could deliver all those parts and products at high velocity are being dismantled. Such systems have gotten a bad name in recent years, and are even slandered now as somehow bringing on the pandemic. However, if the goal is to save the lives of as many coronavirus victims as possible, we should be looking for ways to supercharge ventilator makers’ global production capacities, not hobble them. International trade may leave many things to be desired, but if your goal is to keep as many people breathing as possible over the next months, you need all those supply chains intact and growing.

Stay global

Scaling the ventilator-makers’ plants has several obvious advantages. First, the top ventilator manufacturers – Gelinge, Hamilton Medical, Dräger, Mindray, Medtronic, Löwenstein, Vyaire Medical, Philips, GE Heathcare, and Fisher & Paykel Healthcare, among others – don’t need to retool their whole production lines before they can deliver. They can also guarantee cost-efficient production, an absolute necessity to supply developing markets in Africa and elsewhere.

There is a catch: although some of these manufacturers have already boosted their production by 30-50%, by themselves they can’t deliver the 500 or 1000% growth needed to prevent the deaths of tens of thousands, even hundreds of thousands, later this year. Not only do their relatively small plants have limited capacity to expand, but their supply chains are likely to run into shortages and other problems as they try to meet the demand.

Unprecedented demand for respiratory medical devices in the US
Unprecedented demand for respiratory medical devices in the US Image: AdvaMed

Fortunately, meeting this challenge is not impossible, only difficult.

To help all those people, ventilator manufacturers will need the support of a larger, global supply chain. The World Health Organization doesn’t need to commandeer all the ventilation-related manufacturing capacity and transportation, but the world’s most advanced supply chains – UPS, FedEx, DHL, Kuehne + Nagel, Panalpina, Nippon Express, the national post services and even national military procurement arms – should be working together to help ventilator manufacturers and their suppliers meet this single aim. Just as pharmaceutical companies and researchers are working together to produce a vaccine, the world’s top supply chains could pool resources and expertise to make sure these companies get what they need.

Six tasks should top their agenda:

1. Map the ventilator supply chain: A precision instrument manufacturer like a ventilator-maker may require components from nine layers of subcontractors in dozens of different countries. In ordinary times, it’s enough to contract with reliable subcontractors to deliver those parts when needed, but in a crisis, demand exceeds that supply. The maker needs to know: what parts are needed and where can they be sourced? Which components are most likely to be in short supply? Is the component necessary or can something more readily available be used?

2. Trace better pathways: Consider the best ways to get those parts to the manufacturer and what it would take to expand capacity. Is there any overlap in supply chains between industries, for example, that could facilitate easier shipments? Could we establish global, fast-response logistic networks through air traffic hubs?

3. Forecast demand: Plot where demand is growing and where the next coronavirus epicentres are likely to be. Leading research centres are already contributing daily updates and their analytics could be used to manage orders fairly and efficiently. Could artificial intelligence, which may otherwise have little application during the ventilator crisis, play an important role here?

4. Recruit more help: Which expert, at each level of this supply chain, is best positioned to improve its capacity? Amazon, for example, has temporarily refocused all its delivery capacity on medical supplies. General Motors is working with Ventec, an established ventilation maker, to add capacity. In the UK, Dyson, the vacuum cleaner producer, is ramping up production of a new, internally designed device. Who else might have useful expertise?

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5. Prepare the operators: One manufacturer said recently in Der Spiegel that he believes the biggest challenge in connecting patients to ventilators will be finding enough trained people to operate them. Can the machine be made more operator-friendly by subtracting features? Does the documentation need to be improved or training simplified? Could we start training healthcare workers now to run the ventilators that will arrive in three or six months? Can we deliver real-time instruction through the web?

6. Look for alternatives: The above tasks should take priority, but during this global crisis, we must also look for substitute products. Many ambulances have respirators as part of their standard equipment. For the duration of the emergency, reserve mobile respirators could be repurposed. Could lower-tech solutions, such as hand pumps, which saved lives in Copenhagen during a 1952 polio epidemic, play a role?

Finally, this task force will need to maintain this global, strategic view all through this emergency. If we want to be as effective and efficient as we can to solve the healthcare issues caused by the COVID-19 pandemic, we need to take a broad, systemic perspective. The virus doesn’t worry about boundaries; we shouldn’t either.

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Manufacturing and Value ChainsHealth and Healthcare Systems
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