Low-cost interventions help keep India ahead in virus fight

An AgVa Healthcare employee showing how the company's ventilator works, at the research centre in Uttar Pradesh state, in March. The company came up with the toaster-sized ventilator that is priced at less than a fourth of conventional ventilators, a
An AgVa Healthcare employee showing how the company's ventilator works, at the research centre in Uttar Pradesh state, in March. The company came up with the toaster-sized ventilator that is priced at less than a fourth of conventional ventilators, and is one that families could take home and operate themselves.PHOTO: AGENCE FRANCE-PRESSE

A neurosurgeon at a top government hospital in Delhi, Dr Deepak Agrawal would often see families struggle to meet the steep expenses involved in maintaining chronic patients on ventilator support.

It was with them in mind that he and his business partner, robotics scientist Diwakar Vaish, came up with a cost-effective solution in 2017 - a toaster-sized ventilator that is priced at less than a fourth of conventional ventilators and one that families could take home and even operate themselves.

In a country of 1.3 billion people that has an estimated 48,000 ventilators, it is this low-cost product from AgVa Healthcare that is now helping to meet the surge in demand for ventilators to support Covid-19 patients with breathing difficulties.

About 1,000 units are operational in the market and production has been augmented from 100 units a month last year to 500 a day now, with manufacturing support from Maruti Suzuki India, the country's leading automobile manufacturer.

"We plan to ramp this up to 1,000 per day by May 10," said Dr Agrawal, a co-founder of AgVa Healthcare which has been swamped with orders since March.

"The only reason we could have this humongous increase in scale is because of several innovations and indigenisation of technologies that ensured we were not copying other ventilator makers and competing for the same components that are now in short supply globally," Dr Agrawal told The Straits Times earlier this week.

Key measures that have helped to lower costs include using disposable plastic valves made by the firm locally and relying on cheaper but still medical-grade sensors.

The company has also set up a factory in Shenzhen in China and expects to produce another 10,000 units per month there in another fortnight or so.

The ventilator is priced at around $2,820 and has generated interest from the United States, Europe, Africa and South-east Asian countries such as Malaysia, Indonesia and Singapore.

"We will begin exporting once we are more comfortably placed as far as our resources are concerned and have met domestic demand," Dr Agrawal said.

AgVa Healthcare is one of the many Indian entities that are stepping up to the challenge of better managing the Covid-19 pandemic, as well as hopefully eliminating the coronavirus with home-grown and affordable interventions that may have spillover benefits for the rest of the world once India begins to export these products.

Besides ventilators, the products include testing kits, personal protective equipment, mobile ultraviolet disinfection units used to sanitise hospitals, and online healthcare services, among others.

Another intervention that has generated interest is a Covid-19 test kit that is expected to bring down the cost of testing from 4,500 rupees (S$85) now to somewhere around 800 rupees.

Developed by a team of researchers from the Kusuma School of Biological Sciences at the Indian Institute of Technology (IIT) Delhi, the kit has eliminated the use of fluorescent dye probes - commonly used in other testing kits - to keep costs low.

A standard "reverse transcription polymerase chain reaction", or RT-PCR, test for Covid-19 - more reliable than cheaper and rapid antibody tests - uses fluorescent dye probes that help illuminate coronavirus samples.

The team at IIT Delhi has identified unique regions (short stretches of RNA sequences) in the coronavirus not present in other human coronaviruses. This enables the detection of Covid-19 cases with the help of a simpler technology that relies on a fluorescent dye made in India instead of probes that have to be imported at a higher cost.

This is used along with a very specific set of primers that can detect and amplify only the coronavirus. Primers are short, synthesised fragments of nucleic acid that help amplify DNA of pathogens like viruses.

"With a pandemic headed our way and the need for carrying out hundreds of thousands of tests in a highly populated country like India, we realised we could not rely simply on imported and expensive testing kits," Professor Bishwajit Kundu, part of the team at IIT Delhi that developed the kit, told The Straits Times.

"We needed an affordable and indigenous testing kit for India that could also be exported to other countries."

The kit has been approved for use by the Indian Council of Medical Research and there are around 30 companies, including foreign ones, negotiating with the technology transfer team at IIT Delhi to acquire manufacturing rights.

Prof Kundu said they should soon be able to choose the first batch of firms which will begin mass production of the testing kits.

Dr Agrawal said India is best suited to become a hub for developing low-cost technologies and launching them.

"We have the market required to be able to make a product frugal as well as test it out," he said. "This ecosystem can help India become a successful launchpad for products that are not just cost-effective but also of good quality."

A version of this article appeared in the print edition of The Straits Times on May 02, 2020, with the headline 'Low-cost interventions help keep India ahead in virus fight'. Subscribe