Frontier Tech 4 COVID Action: 10 things we’ve learnt about ventilators for emerging markets

We recently launched #COVIDAction.

This was a collaboration of the Frontier Technologies Hub, Global Disability Innovation Hub, and UCL Institute for Healthcare Engineering, and funded by the UK Dept. for International Development (DFID).

We set out to discover proven frugal innovation across DFID’s countries that could be rapidly manufactured around the world to meet the demands of COVID-19.

The call resulted in 50+ applications. The #COVIDaction team is now working with the teams to take the most promising technologies forward.

Meanwhile, we’ve learned a lot about the health crisis, ventilators and more, which we wanted to share with you in this post.

Here’s what we’ve learnt. As these findings inform our ongoing work, we hope they also help support health systems in the global fight against COVID-19.

Lessons from those ahead in the crisis:

We engaged with NHS colleagues, who made available insights from their counterparts in Spain and Italy, surfacing lessons around: the specific ARDS for COVID sufferers, designing with the frontline users in mind, approaches to meet demand for ventilators.

1. Most countries are employing a range of approaches to meet the high demand for ventilators: This includes repurposing existing ventilators, and enhancing the supply chain for parts and manufacturing capacity to build existing tried and tested models of ventilators. Interestingly, hospitals are increasingly validating innovations of alternative designs. Often, these innovations result in cheaper, less sophisticated ventilators that could still save lives of patients with acute respiratory distress syndrome (ARDS), who would otherwise die without access to invasive mechanical ventilation
2. Design for COVID ARDS: In general, COVID patients present with one pattern of respiratory failure — ARDS . The type of ARDS is specific to COVID (see here), allowing simplification in the function of ventilators.

Identifying the best ventilator to meet the global crisis:

1. Try to consider what is clinically validated first: Time is critical, and to spend it working with a prototype rather than a device that has proven itself for extended periods in medical settings, is a decision not to be taken lightly. Having said that, emerging evidence from Europe is showing that left-field, easy to make, untested prototypes might still have a role to play. We still have a preference for what’s been clinically validated, but less than when we started.
2. Use frontline intelligence: It is crucial that the intelligence and lived experience from front line intensivists, anaesthetists, and others managing COVID directly shapes the design and roll out of rapidly mass-produced ventilators. This means that the ventilators produced are ‘fit for purpose’. Linked to this, ventilation designs should be accompanied by visual and simple instructions that can be easily understood by all healthcare staff (see supporting data from Japan Council Quality of Health)
3. Will it be cost effective to scale?: Costs (costs of goods sold) of ventilators applying to #COVIDAction ranged from US$250 (for basic automated compression of a CPR bag) to US$7000 (for more complex ventilators). All were significantly lower than the ventilator machines in British, US and Western European hospitals today (which go into tens of thousands of US$), while meeting many of the MHRA/WHO clinical specifications and being easier to manufacture. Our preference — for meeting the needs of countries with weak health systems — remained the lower end of this price spectrum, ideally US$1000 or less to manufacture.
4. Simplicity of manufacture is important: Seek ventilators with off-the-shelf componentry, globally available in most countries, and not too many parts. Ventilators will likely have to be mass produced in low resource countries, in the context of globally fragmented supply chains. Our focus is on ventilator systems with high redundancy, and globally available parts. For example, in Barcelona, the engineers from SEAT have been on the wards co-designing a simple method for delivering ventilatory support which uses the rotational motor of a car and runs off a 12V car battery (or electrical connection).

Thinking beyond the ventilator:

1. Consider the oxygen therapy spectrum: Consider oxygen therapy on a spectrum from routine to severe to critical care. For example, oxygen masks and catheters could serve patients with mild respiratory ailments, with low-cost ventilators serving those in moderate/severe condition, and higher cost ventilators for those in a critical condition. The WHO COVID disease commodity packages outline the various equipment and commodities that could form part of the spectrum.
2. Identify and make available complementary solutions: Different countries and contexts will have different needs (supply chains, oxygen requirements, energy sources, etc). It is important to consider oxygen provision solutions that are complementary and can respond to a different patient needs and health system and societal realities.
3. Other emerging solutions could become viable options in the long-run, but require more development time: Through our global search, we have identified innovations such as scuba diving systems, that can be adapted to treat COVID19 patients with high impact potential in contexts with low oxygen supplies. We also identified older models of ventilators that worked well in the 1980s and that could be re-engineered to be brought back in hospitals. These could become an option in the near future, but will potentially require a longer time to market. They will need to be clinically tested, enhance their supply chains, and so on.

A final thought: our most important lesson learned

To end, we’d like to share a quote from 2019 Nobel Peace Prize laureate Abiy Ahmed, shared with us by one of our clinical experts. It resonates deeply with the global fight we are fighting, and global talent we are harnessing (article in full here):

Covid-19 teaches us that we are all global citizens connected by a single virus that recognises none of our natural or man-made diversity: not the colour of our skin, nor our passports, or the gods we worship. For the virus, what matters is the fact of our common humanity.

And in the words of our clinical expert:

If ever we needed a global strategy, working across traditional boundaries, innovation, amplification of limited resources, impact that lasts- now is the time.