For critically ill Covid-19 patients, a ventilator can offer the best chance of survival. In the wake of criticisms over the medical equipment scarcity in Bangladesh, Walton announced one and a half months ago that they will produce ventilators locally.
However, not much has progressed in this regard, though Covid-19 cases have surpassed the 20,000-milestone with around 300 confirmed deaths.
Meanwhile, the government may be able to procure 250 ventilators in the next month from different companies in the United States (US) and the United Kingdom (UK).
It is attempting to buy the devices directly from foreign manufacturers as there is little chance it will be able to purchase them through the World Bank any time soon.
Authorities concerned said patients are unlikely to get locally manufactured ventilators before June. Moreover, the cost of making ventilators has thrown manufacturers into confusion, casting doubt about whether those can be made available for all.
Health directorate officials said the country is yet to have the standards for testing, standardising, quality control and validation for local ventilators. The directorate cannot allow any local company to supply the medical equipment without testing.
A senior official of the Directorate General of Health Services (DGHS), preferring anonymity, told The Business Standard they have received four ventilator prototypes developed by local brands Walton and Minister.
According to the official, the testing standards will have to be set first. Then the prototypes will be tested at the Military Institute of Science and Technology. The third step is the validation from the Directorate General of Drug Administration (DGDA). Then the ventilators will go for clinical trials – the fourth and last step.
This entire process is unlikely to be completed before June, added the health directorate official.
When contacted, Additional Secretary of the health ministry Habibur Rahman said the testing should be solid and flawless as the equipment will be used for critical patients.
Simply put, a ventilator takes over the body's breathing process when disease has caused the lungs to fail. This gives the patient time to fight off the infection and recover.
Officials said the DGHS and the DGDA are now jointly working to set the testing standards.
The ICT Division is supervising ventilator production locally. Walton on April 28 submitted three different protypes to the ICT division. The local brand says the US-based Medtronic model prototype is more reliable, but its raw materials are scarce.
State Minister for the ICT Division Zunaid Ahmed Palak said they have submitted Walton and Minister's prototypes to the health directorate.
"Demand for the Medtronic ventilator raw materials is very high due to the pandemic. Specially, 14 components of the model are quite scarce. However, the country is able to locally produce 100 such ventilators per month if the health directorate approves."
The state minister said that raw materials for other two Walton models come from local resources. Therefore, any amount of the two models can be supplied within a short period.
Apart from Walton and Minister, Palak said other 14 organisations including MyOne, RFL, the Military Institute of Science and Technology (MIST), the armed forces, a2i (Access to Information) Innovation Lab and Buet are developing ventilators.
In the meantime, Walton says it will be able to meet demand of the country's medical sector for ventilators if their two models get approval. The company alleged that the DGHS is dilly-dallying for test.
"We really do not know how long this will take," Walton's Executive Director Uday Hakim told The Business Standard.
The government's main technical associating partner for the ventilator project a2i also said the process will take time.
"Walton's prototypes must pass some steps like testing, standardisation, quality control and validation. It certainly will take some time," said Lutfor Rahman, a2i Innovation Lab coordinator.
Lutfor also talked about a model being developed by the a2i. He said the model is at the final stage of development.
"We will have to face the final testing at the Military Institute of Science and Technology," said Lutfor.
How much would it cost and where would it be available?
An imported ventilator from China now costs at least Tk7 lakh, while those from Europe range between Tk18-20 lakh. Import from neighbouring India costs Tk6-7 lakh. But the coronavirus pandemic has squeezed ventilator export of the country as their internal demand for the equipment has skyrocketed.
Therefore, initiatives were taken to manufacture ventilators locally. However, the price remains quite costly.
Lutfor Rahman said that it was not possible to bring local ventilator prices below Tk5-6 lakh. "One of our teams plan to make mechanical ventilator, which will also cost Tk1.5 lakh minimum. The process will also be time consuming," he added.
Asked where these local ventilators would be available, Lutfor said, "We are not considering that someone will just buy it for personal use. However, those who have that capacity are exceptions."
According to the World Health Organization (WHO), some 80 percent people with Covid-19 recover without needing hospital treatment.
But one in six people becomes seriously ill. In these severe cases, the virus causes damage to the lungs, causing the body's oxygen levels to drop and making it harder to breathe.
To alleviate this, a ventilator is used to push air with increased levels of oxygen into the lungs.
"We will supply those to Covid-19 dedicated hospitals. The private hospitals will also be able to purchase these for treating Covid-19 and other critical patients," he further said.
Hasty production may invite trouble
Lutfor Rahman said quality of the medical equipment must not be compromised.
"We do not want anything to get approved in a hurry and fail to recover the patient from the critical stage. There should be enough testing and verification," he commented.
The standard protocols for testing are being developed by the drug directorate and the health directorate in association with Buet, MIST and ilab.
Now the protocol is at the health directorate to be assessed by the director general. Next, it will go to the DGDA and then it will be finalised. The entire process will not take too long, he added.
Govt to buy 250 ventilators soon
The World Bank took an initiative to procure 370 ventilators for Bangladesh on an emergency basis under the Covid-19 Emergency Response and Pandemic Preparedness Project.
In this respect, the global lender, with the help of Unicef, contacted various US and UK companies which said they would not be able to supply ventilators before August. However, Bangladesh needs them urgently. So, the government is now trying to buy the devices directly.
Habibur Rahman Khan, focal point and additional secretary of the health ministry media cell, told The Business Standard on Thursday, "We can get about 250 ventilators from the UK in the next month. However, this depends on the cargo transport situation of Biman."
He also said that the issues of price and company names, however, have not been finalised yet and that the government is working on it.
Habibur Rahman also said the country presently has more than 300 ventilators but not all of them are being used, "because in many cases, those who are given ventilator support do not recover."
Therefore, European countries are now thinking about the use of ventilators, he said, adding that, in the case of UK Prime Minister Boris Johnson, doctors there finally reached a decision about not providing ventilator support to him.
"We, too, are trying to ensure medical care for patients by increasing the oxygen supply to them."
Health ministry officials said the government took up the Covid-19 Emergency Response and Pandemic Preparedness Project after the novel coronavirus outbreak began in the country.
The World Bank agreed to provide Tk850 crore in loans for the Tk1,127-crore project to buy medical equipment to combat the novel coronavirus. The government will bear the rest of the costs.
However, the World Bank will not directly provide the money to the government but will pay for the equipment to supplying companies.
Under the project, 1,000 ventilators will be purchased. On April 20, Prime Minister Sheikh Hasina approved the project.
However, Bangladesh is facing difficulties in implementing the project as all countries now need medical equipment. In a highly competitive market, it has become very hard for Bangladesh to get novel coronavirus-related health equipment.
Health ministry officials said the World Bank's headquarters in Washington would spend the money directly on this project. However, the equipment will not be available at the desired time.
When contacted, Unicef said it would take three months to provide ventilators, masks, kits, and other medical equipment, the officials also said. This is because the countries that communicated beforehand are being given the items first. As a result, the government has moved back from the plan of buying medical equipment from Unicef.
After the World Bank informed the government about Unicef's inability to supply products immediately, the government started trying to import ventilators at its own initiative. The World Bank proposed the government finance the project.
Health ministry officials said, even though manufacturing companies have stocks, they are reluctant to supply ventilators on an emergency basis without additional money.
Habibur Rahman Khan said, "As the need increases after the outbreak of the novel coronavirus, so does our capacity. Initially we had the ability to test less than a hundred samples, daily, in a laboratory. It is now possible to test more than 7,000 samples in 41 laboratories."
He further said the decision as to which facilities in the capital would be declared Covid-19 hospitals comes from the government high-ups. At present, 110 hospitals across the country, including the capital, have been converted into Covid-19 hospitals, bringing the number of beds to about 20,000.