Wednesday, April 15, 2020

Half of ventilators in world's acute hospitals made in Ireland?

Racks of ventilators at Hamilton AG's factory in Switzerland

World medical ventilator demand during the Covid-19 emergency is about 10 times what's available and there's a scramble by countries to get supplies but sophisticated machines require 650 to 700 components and manufacturers around the world, including in China, are struggling to get supplies from about 100 companies, mainly in Asia.

IDA Ireland, the inward direct investment agency, has been using the dubious claim since at least 2014 that half of the ventilators in the world's acute hospitals are made in Ireland. It has been repeated many times by the agency and others since but the unsourced claim is an odd one as no manufacturer of ventilators in Ireland has a dominant position in world markets.

Ventilators can cost up to $50,000 each and there are invasive (where tubes are inserted into the lungs), non-invasive, portable and devices for infants.

In 2017 the Irish Health Services Executive noted that 50% of ventilators in use in the public system, were more than 10 years old.

In response to the Covid-19 emergency, there has been concerns about the overuse of ventilators, in particular the invasive ones where the patient is sedated.

There is currently a race to ramp-up production.

The following were the production levels of the principal companies before the current medical emergency:

Royal Philips NV of the Netherlands produced about 25,000 units in 2 factories in the US in 2019.

Medtronic, the American medical devices firm that became Irish for tax purposes in 2016, is the main manufacturer of ventilators in Ireland, based in Galway, and it produced about 15,000 units in 2019.

Hamilton Medical AG produced 15,000 units in Bonaduz, Switzerland, in 2019.

Drägerwerk AG produced about 10,000 units in Lübeck, Germany, in 2019.

Getinge AB produced about 10,000 ventilators in Solna, Sweden, in 2019.

ResMed Inc. of San Diego, USA, which is mainly known for its apnea sleeping disorder devices, is coy about its ventilators as they are produced in Singapore and Sydney.

Becton Dickinson (BD), a US company, used to be prominent in producing ventilators but it finally sold its struggling respiratory unit to a private equity group in 2018 and the business is now called Vyaire Medical.

A company spokesperson at Vyaire Medical's Palm Springs, California plant said it relies on components from China and Malaysia.

According to Bloomberg, the US had more than 2,000 printed circuit board shops in the early 2000s, but so much production has moved to Asia that now there are fewer than 200, and only a fraction of those are able to create boards for medical devices.

Caixin, the Chinese business magazine, says "China has more than 20 mechanical ventilator manufacturers, and 8 have received CE certification on their products, which allows them to be sold in the European Economic Area. Those 8 firms combined make 2,200 machines each week — one-fifth of the world’s total output — according to the Ministry of Industry and Information Technology (MIIT)."

However, Torbjørn Netland, chair of production and operations management, ETH Zurich (Europe's top technology university), put 2019 production at 77,000 units.

Caixin adds that Chinese ventilator-makers are facing coronavirus-related obstacles including difficulty sourcing key foreign components, and mass flight cancellations are frustrating distribution. They are also turning to government charter flights out of fear their products will be seized for use in transfer countries.

Aeonmed Co. Ltd., of Beijing and Mindray Bio-Medical Electronics Co. Ltd. of Shenzhen, are the biggest manufacturers.