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How a homegrown Indian ventilator won over sceptics

The V110 had a simple design. A month later, we learnt that NASA was introducing a ventilator on similar lines for their VITAL model. NASA announced on 1 May 2020 that it had received emergency use authorization from the Food and Drug Administration (FDA) for its new ventilator called VITAL (Ventilator Intervention Technology Accessible Locally).But when the Ministry of Health and Family Welfare issued a series of guidelines about ventilator specifications in India, the designs had to be updated. Two more design iterations –V210 and V310 –followed soon after to meet the requirements. The V310 design, suitable for use by critical-care patients as well, was ready on 16 May.

But these significant design enhancements – which included a flow meter, a tablet and electronic control of oxygen flows – raised the price of the product. During its short-lived existence, the V210 was pegged at 150,000, while the final product, the V310, was expected to be priced at 350,000 (plus taxes). Although this would make it cheaper than most imported ventilators, the task force debated whether the prices could be driven even lower. But the higher cost of input components and the desire to stay away from the‘Nano trap’ convinced us to stick with it. We remembered Tata’s ambitious Nano project, which had failed because the low price of the vehicle made potential buyers suspicious about its quality.

Now that we had the answer to the ‘reliable product – affordable price’ equation, it was time to look at the logistics of making the ventilator available nationally once it was finally manufactured.

The question before us was similar to a talented batsman asking themselves at the early stages of their career whether they wanted to be a flashy T20 star like Chris Gayle or a seemingly boring but enduring cricketer like Rahul Dravid. Should we chase big Covid-specific government orders, or should we remain content as a steady long-term player with a sales presence across small and big cities across the country? Or should we do both?

After a massive government tender for ventilators was announced by HLL Lifecare Limited on 27 March 2020, Nocca filed a bid on 5 April. Winning even part of it would have been a big bounty for the team, but Nocca chose to play steady. The tender was opaque and confusing, and Nocca would find it hard to meet its deadlines if it wanted to deliver a high-quality product. It proved to be a good decision as we later found that some of our competitors had taken a shot at the tender and ended up with eggs on their faces!

With this in mind, the team had also started working on a sales and distribution strategy, with the medtech CEOs in the task force coming together to hire Vineet Kumar, the first full-time salesperson for the company. Vineet was tasked with appointing distributors and starting the process of building a potential market in smaller Indian cities. The task force ambitiously estimated that even without a big government order Nocca could use this distribution network to sell a large number of ventilators. When Vineet quickly appointed seventeen distributors in north and west India, and initial orders started coming in from places like Pune, Mumbai, Jalna (Maharashtra), Bijapur (Karnataka), Dahej (Gujarat) and Gurgaon (Haryana), these assumptions seemed to be holding true. The task force also began exploring a partnership with Aforeserve, a specialist service and repairs company with 4,000 employees across 350 Indian locations, to ensure that Nocca’s ventilators could be installed and serviced as well.

There was another challenge. Nocca also needed a plan to convince doctors that their product was of high quality, affordable and easily available and serviceable if hospitals were to move away from imported ventilators. To do so, Nocca needed to build strong relationships with the medical community within a short period of time. Task force members began leveraging their experience to provide introductions to top doctors in Pune, Mumbai, Delhi and Gurgaon, whose responses were thankfully encouraging. There was also the hope that once the DGHS had tested the V310, and certified that it had all the features as laid out in government guidelines, this would boost the confidence in their ventilator in the medical community at large.

We now needed a catchy name for the V310 which would resonate with doctors. Hundreds of names were tossed around in our daily noon calls before we finally arrived at ‘Noccarc’ – a name that rhymed with ‘Noah’s Arc’ which was instrumental in the continuation of life on earth after a devastating worldwide flood. It was planned that Nocca Robotics would remain the name of the company, while Noccarc would serve as the brand name for ventilators. It was important to make this distinction as the company still runs its original business of manufacturing robots for waterless cleaning of solar panels.

Although we had come up with a reliable product at an affordable price, and the medical community seemed be responding positively, there was a nagging feeling that a lot more was needed to be done for Nocca to be considered a serious player as a medical device manufacturer. There was also the ingrained belief among the medical community that foreign-made products are inevitably better. V. Raja, former President and CEO of GE Healthcare India, agrees. ‘Most doctors are biased in favour of imported products. They see domestic equipment as inferior. At radiology clinics, I have seen doctors opt for latest imported equipment purely as a marketing gimmick.’

So, we asked one of our medtech mentors Sanjay Banerjee, former managing director of Zimmer Biomet India, a global firm specializing in treating injuries to bones, joints and supporting soft tissues, how this could be resolved. He had three basic prescriptions: train doctors, train technicians and arrange for financing to purchase the equipment. Sanjay’s former firm offered virtual training sessions to orthopaedic surgeons across India, and he believed a similar initiative would help Nocca overcome the roadblock of a paucity of trained ‘intensivists’ (physicians who provide special care for critically ill patients) and technicians. Mint