As India went under lockdown on 24 March 2020, and most of us gave up on the life we had before, a determined team was taking shape at IIT Kanpur.
The objective of this multi-generational team was something that would have been dismissed by any sane thinking person — a made-in-India ICU ventilator to be produced within 90 days in the peak of the nationwide lockdown.
The Ventilator Project is a chronicle of this zealous pursuit to help India become self-reliant in making ICU ventilators, a shortage of which our healthcare system is dearly paying with. This pursuit brought together some of the best minds from various fields in India and abroad.
The IIT Kanpur Ventilator Consortium task force was formed five days after the nationwide lockdown was announced. Within two months, the Noccarc V310 ventilator went into several weeks of trial at an ICU in Pune. By 29 June the Medanta and Artemis group of hospitals issued their approval, and the first commercial batch was available in the market, two weeks after. The best bit about Nocca Robotics, the startup that made this product was that it had never produced ventilators before this.
While in the process, the two IIT-Kanpur alumni who spearheaded the Ventilator Consortium task force also managed to document everything in a book — an in-depth insight into how they managed to clear all the regulatory hurdles, bring multiple senior stakeholders to work like an agile startup and keep up with the changing requirements from the government.
Thanks to this book by Amitabha Bandyopadhyay and Srikant Sastri, the individual journey of Nocca Robotics is converted into a much-needed voice to request change in the way medtech innovation is treated in the country. As India is dealing with a deadly second wave of COVID-19 where our healthcare system is stressed beyond all capacity, the sad reality is that despite having an indigenous ICU ventilator, we don’t have enough oxygen supplies.
Reading The Ventilator Project, you will appreciate the challenges behind making a medtech product in India. It will also make you shake your head at the kind of roadblocks that an innovator faces when bringing their products to markets.
The 90-day journey
The main protagonists of the story are Nocca Robotics’ team of Nikhil Kurele, Harshit Rathore, Tushar Agarwal and Asim Thakurta. From surprising senior members with a prototype of a ventilator at their first Zoom call to adding finesse to the final product, using jugaad to get the components necessary for the circuitry to repurposing other components, the Nocca team is a stand-in for every persevering Indian startup there is. By all conservative estimates the entire process of designing, manufacturing, testing, clearing regulatory hurdles, clinical trials and clinical validation can take anywhere from 18-24 months — this team did it in three. Noccarc V310 would have taken far longer to be market-ready, if it hadn’t been for the support of mentors such as serial entrepreneur Saurabh Srivastava, co-founder of HCL Ajay Chowdhary as well as other mentors as the IIT Kanpur Incubator team. Not to forget, two doctors who helped out the team despite their daily stressful duty hours.
The book is divided into two sections: 'The Ninety-Day Saga' which focuses on building the taskforce, collaborative working and leads up to the making of the approved ICU ventilator. The second section of the book — 'Big Hopes for the Future' — takes the learnings from those 90 days and puts them in a general context that can be helpful for any startup working to make a product that can solve some of India’s critical problems. The idea is to develop a war-like innovation attitude (such as the unprecedented scenario the Covid pandemic had presented the ventilator team with) which adds a sense of urgency to getting something out within a limited time frame.
(Atma)Nirbhar Bharat
The authors raise an important point on what exactly needs for Atmanirbhar Bharat to succeed. When we talk about indigenisation, do we want every single component to be made in India from scratch, or should the focus be on getting these low-value components from outside and ensuring more value is added in the product design and manufacturing process instead?
“Out of the eighty-five Noccarc V310 components 13 were sourced from outside India and accounted for 65 percent of the bills of materials (BOM) value... Nocca import components were worth about Rs 50,000 but the final product is a lot more valuable because of superior design, local components, software, manufacturing process, quality control and customer service. This allows Nocca to sell the ventilator in India at a price of Rs 3 lakh or more,” note the authors stressing on the fact that most of the profits are retained in India.
A few chapters in the second section of the book explore the question whether innovators should just focus on making the product and then licensing it out in parts or in full; or if the entire production should also be the headache of the founders. These chapters provide a much-needed insight into why India lacks companies such as Arm or Qualcomm — electronics giants who license their chip-designs. It also answers the question as to why licensing is not the default business model for many Indian startups and companies — lack of respect for intellectual property is a major concern.
Another important point raised is the need to have a domestic market for innovative products before one can think of exporting. The Nocca Robotics team lost major distributors after they couldn’t secure big orders from government-associated hospitals and healthcare institutions. The authors note that when it comes to critical medical products, the government should be playing a key role in procurements to get things moving, else it wouldn’t take long for big players to bulldoze upcoming startups.
Frugal innovation, jugaad are great, but need to be challenged in the Indian context
This book is yet another documentation of how Indian minds have managed to produce world-class products despite the mounting challenges. While some experts quoted in the book consider lack of resources as an advantage, as it helps India excel at frugal innovations, I felt this idea needs to be challenged. Just like after every terror attack in Mumbai, the crutch of “The Spirit of Mumbai” has been used to hide administrative foresight and planning, frugal innovation in most cases in India isn’t by choice but almost always mandatory. Not holding the authorities to account and giving them a clean chit perpetuates the stereotype that Indian scientific minds will overcome everything with a little bit of jugaad and their perseverance.
Last year, a book named Nanoscale elaborately documented how Prof CV Dharmadhikari created India’s first scanning tunnelling microscope (STM microscope) at the Savitribai Phule Pune University in 1988 despite no help and funds from the administration. But after he retired, his creation was dismantled and languished in the corridors of the university halls. It’s almost like the system wants to use ingenious scientific minds to show how India is great, but at the same time do nothing to improve their situation.
In The Ventilator Project, we learn about how India has no regulations for certifications of critical medical equipment. Anyone can make a ventilator and sell it to hospitals — no certifications needed. Thankfully, Bandyopadhyay and Sastri have spoken at length about how that’s counterproductive to have any sort of manufacturing prowess in the medtech sector, where the majority of hospitals and clinics prefer buying imported certified equipment. This is a major reason the Indian medical community relies on US’ Food and Drugs Administration (FDA) and/or European Conformity (CE) certified international medical equipment which costs significantly higher over India-made critical medical equipment.
“Indian hospitals and doctors buy Rs 40,000 crore worth of medical equipment every year, but close to 80% is imported. The numbers are similar for ventilators. Close to 5,500 of these devices are imported each year,” note the authors. The average price of a ventilator is Rs 6.2 lakh per unit. Around 700 refurbished ventilators are sold every year, but the price is still a steep Rs 5.07 lakh. The Noccarc V310 has been priced around Rs 3 lakh.
No sense of priority in the administration
The Nocca Robotics team had to redo their designs three times as the ministry of health and family welfare was changing requirements on the fly. When the team went to demo their ICU ventilator in Delhi, they learned that they were supposed to carry their own oxygen cylinder when they entered the room to demo the Noccarc V310. They had to return with a cylinder the next time. It almost feels like the innovative minds in India are left to fend for themselves even when they are actively trying to solve a critical nationwide problem.
Reading these experiences in the book at a time when India is dealing with the deadly second wave, brings home the point that the administration just doesn’t give a damn. We are already seeing the effects of this kind of mentality. At a time when the country is under distress and administrative shortcomings have reached a point where citizens are seeking help on Twitter, instead of acknowledging our flaws, according to our health minister everything is hunky-dory. For a country which produces some great scientific minds, it’s a pity when political leaders make a mockery of science on important scientific forums. It's no surprise then that during a raging pandemic asking logical questions to the health ministry gets no answers, but someone who claims of 'COVID-19 cure pills’ gets national media coverage and a thumping endorsement from the health minister himself.
To that extent, the regulatory challenges mentioned in the book are a mirror to the incompetencies in our administrative systems that need immediate correction. If the status quo continues, ambitions such as Atmanirbhar Bharat will remain mere paper dreams and ‘good-to-have’ stamps on indigenous products.
Force-fitted analogies
At the end of every chapter, there are two sections ‘Key Takeaways’ and ‘Starter Kit’. While key takeaways are fine, the starter kit seemed a bit much — unless you are a startup founder or belong to the maker community. If the authors so wanted, an entire chapter dedicated to a consolidated action plan could have worked much better. A chapter-wise ‘Starter Kit’ gets a tad too preachy at times and is in complete contrast with the natural story-telling flow of each chapter.
Another aspect that comes across as a bit jarring is trying to convert anecdotes from non-scientific personalities and force-fitting them to a moral that the authors want to convey. I agree that the authors wanted to make things more relatable for the general audience, but constantly referring to Bollywood and IPL stories just seemed odd.
For instance, when the authors give an analogy of how cinematography and film making brings multiple generations together because of the inherent experience — that works perfectly as an analogy with the Ventilator Task Force set up. But another instance, when the authors talk about how film director Imtiaz Ali was obsessed with shooting on an island and convinced his crew to follow him, the moral lesson of ‘collective endeavours led by a small step’ falls flat. I was left wondering — couldn’t an anecdote from the many science and technology related fields have had a lot more impact? Moreover, having the team members themselves elaborate on their experience would have made the need for many such analogies obsolete.
In some instances, the authors do tend to get carried away while shining light on the achievements of some of the project supporters who aren’t directly related to the Ventilator Project. It is great to know about these personalities, but it could have easily been done in a more compact manner in a way that didn’t take the focus away from the ventilator story.
In conclusion
Overall, The Ventilator Project is a good mix of not just the thrilling story of making a world-class product in the midst of the pandemic, but also gives a blueprint for future medtech innovators as to how to go about setting up the team and dividing responsibilities. With the Nocca Robotics team laser-focussed on making the ventilator, external senior mentors helping out with their experience in various industries and the IIT Kanpur Incubator team doing the rest of the heavy lifting — the task force had a well-oiled three-tiered system where each team worked to the best of their areas of expertise to speed up the production of Noccarc V310. The book is a good starting point to think of organisational frameworks for young startups.
The second half of The Ventilator Project gives valuable insights into what happens after you have a ready product. It gives a set of guidelines as to where future roadblocks may arise, the nitty-gritties involved in selling commercially in a space like the healthcare industry. On second thoughts, the book is ripe for adaptation as a multi-part documentary. I really hope some streaming service is already on this.
Bandyopadhyay and Sastri paint a great picture of what can really kick-start a medtech innovation cycle in India. It’s appreciable that they not only led the task force but also documented everything and wrote this book.
I really hope someone higher up in the administration reads the book, takes a hard look at the flaws mentioned in it and adopts measures to ensure innovation in the medtech space is given all the help that can be had.
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