The spread of coronavirus has resulted in a worldwide shortage of essential medical supplies, especially ventilators that help critical patients breathe when their lungs are not functioning properly. Fearing a spike in such cases, even the United States has ordered ventilators from abroad. It has also asked its auto industry to manufacture ventilators in order to match the rising demand. Several countries that manufacture ventilators have banned exports in view of the growing local needs due to the pandemic.

The increasing demand for ventilators and other essential medical equipment has brought production capacities under stress. More importantly, it has raised questions about the capacity and investment in the healthcare sector globally.

A similar debate started in Pakistan when the first Covid- 19 patient was confirmed in the last week of February. The questions raised were whether the country had qualified medical workforce and equipment to tackle this challenge. There was a big question about the number of ventilators in the country and the fraction of those that were functional.

The question had already been raised a couple of times in the recent years. Former chief justice Saqib Nisar had reprimanded Dr Yasmeen Rashid, the Punjab’s health minister, back in 2018 for a shortage of ventilators in the province and had directed the government to purchase the required numbers without delay.

In a briefing to the parliamentary committee on coronavirus on April 6, Lt Gen Muhammad Afzal, the National Disaster Management Authority (NDMA) chairman said that there are more than 3,800 ventilators in the country of which 2,200 are owned by the public sector. He said around 500 more ventilators will reach the country from China during the same week and another 2,000 will arrive later.

There might be a need to manufacture essential medical equipment at home if the country wants to be better prepared for the challenge, says Dr Athar Osama, a consultant and programme chair of the Higher Education Commission‘s (HEC’s) Grand Challenge Fund.

In a research paper, Osama suggests that textile and garments plants can be easily used to produce masks, hospital gowns, and personal protection equipment warning that unprotected doctors and healthcare workers could cause a rapid collapse of the healthcare system. “Pharmaceutical and cosmetics plants can be used, at least partially, to make sanitisers and disinfectants.”

Similarly, he says, automotive parts manufacturers and light engineering industry can be repurposed to manufacture ventilators. He says these are trickier to set up and would require new investment and retrofitting in the auto parts industry in Lahore and Karachi as well as the light engineering industry in Sialkot and Gujrat.

Osama says several prototypes of ventilators have been shared with the Pakistan Engineering Council (PEC) and the Drug Regulatory Authority of Pakistan (DRAP). Once these are approved the Pakistan Association of Automotive Parts and Accessories Manufacturers (PAAPAM) has offered to manufacture ventilators to meet the projected national demand.

An informal coalition calling itself Pakistan against Covid-19-Volunteers (PAC-V) which includes professionals from health, engineering and business sectors, is focusing on medical supplies required during the pandemic. The members of the group have used 3D printing to produce splitters allow a ventilator to be used for up to four patients.

Dr Bilal A Siddiqui, a PAC-V founding member, says volunteer engineers and technicians are visiting healthcare facilities and repairing ventilators for free. “This is an extraordinary situation. It calls for an extraordinary response. I am extremely proud of Dr Zahoor Sarwar, who is leading these efforts nationwide.” He says that the group’s volunteers have already repaired more than 100 ventilators, with active support from civil as well as military authorities. He says it is estimated that around half of the ventilators in the public sector need maintenance and repair.

In a meeting called by the PEC on March 24, six research groups sought approval for their projects. These included two Pakistani inventors holding US patents. Their designs were chosen for clinical trials and production. Factories operating under the Ministry of Defence Production (MODP) will support mass production of the equipment. Since that meeting, the number of groups working on indigenous ventilator designs has increased to more than 50, says Dr Siddiqui. He says that the PEC is facilitating the research efforts by helping in sourcing the components and by making the acceptance procedure transparent.

He says the ventilators being thus approved for production would only be used in case of a shortage of professional grade ventilators. Efforts are under way to eventually develop and produce professional grade ventilators. He says they have now started mass production of ventilator splitters. “We are receiving weekly orders up to 2,000. Volunteer engineers are developing these, but doctors will have the final say on whether and when to use these.”

Dr Javed Akram, the vice chancellor of the University of Health Sciences (UHS), Punjab, tells TNS that he has issued instructions for repairing of all out-of-order ventilators in the Punjab. He says the work is in progress but he cannot give the exact number of repaired ventilators. Prof Dr Mahmood Shaukat, chairman of the Corona Expert Advisory Group, says that the number of functional ventilators would be known once a survey, currently under way, is completed. For the moment, he says there are sufficient ventilators available at the Pakistan Kidney and Liver Institute, the Services Hospital and Mayo Hospital.

“The total number of ventilators does not matter, the number of functional ones does.”