Learning from Apollo 13: a ventilator grand challenge

Australian hospitals are running short of medical gear and those shortages will worsen. Masks, gloves, gowns, cleaning equipment and ventilators are just the obvious ones. We need to get creative urgently, and we can.

In this pandemic crisis, we can’t expect global supply chains to ramp up fast and meet our needs, especially when they can’t meet even their home countries’ demands.

The New York Times reports that the global ventilator shortage is acute and ‘some European governments are deploying wartime-mobilization tactics to get factories churning out more ventilators—and to stop domestic companies from exporting them.’

We know there’s enormous international cooperation to develop vaccines for SARS-CoV-2, the official name for the coronavirus that causes Covid-19.

It’s a different story with ventilators. Individual governments have been working with companies inside their countries on ventilator production, but there seems to be little international cooperation.

That needs to change urgently so that we create what we need fast—open-source designs for easily producible ventilators, using parts and supplies that are likely to be available in most nations.

Hospital ventilators are complicated electro-mechanical devices that go through years of testing and certification in each jurisdiction.

But we’re in a public health crisis where the risks of not having more ventilators outweigh the risks of introducing some that may not meet standards established for normal times.

Some US hospitals appear to be using one ventilator to support more than one patient at a time.

Another solution is to have manufacturers repurpose facilities to produce ventilators. The obstacles are big, but not insurmountable. Ventilator production normally entails navigating a complex regulatory process. Some of those processes will have to be streamlined, probably supported by legal changes to ensure companies and individuals are not later prosecuted under laws and rules made for safer times.

The companies that make ventilators sensibly guard their intellectual property and designs carefully to protect commercial advantage. Some will need to share their proprietary knowledge openly with a global design and manufacturing community, including in Australia.

The UK government has published specifications for rapidly produced ventilators. That’s a great start. Australia’s Department of Industry is also working with our companies on the problem.

The various components and materials required for ventilator production will be in short supply in some places, whether in Australia or elsewhere, so no one design is likely to be producible everywhere on the globe.

That’s not enough to stop urgent work to develop and produce ventilators that are fit for purpose,  not perfect for purpose, and have the chief attribute we lack now: availability. This is about helping people who will otherwise die.

We’re used to thinking speeded-up design and production aren’t possible with safety-critical equipment—but there’s at least one example of a safety-critical system that was devised and made quickly, and it worked. It also involved keeping people breathing. Gizmodo called it ‘the greatest hack in history’.

In 1970, NASA scientists and engineers, with the crew of Apollo 13, designed and built an improvised air scrubber to prevent the astronauts dying from carbon dioxide poisoning. And they did it just hours using spare items from the damaged spacecraft.

Ventilator parts are already being produced using 3D printers, so the Apollo 13 precedent might be relatively easy to follow. With the UK’s standards, and ventilator companies willing to open up proprietary knowledge and make their specialist designers and engineers available to assist ‘crowd source’ designers, we could make huge strides in the availability of ventilators.

Big medical device manufacturers like GE Healthcare and Beijing Aeonmed, or one of the innovative new entrants with simple ventilator designs developed for use in poorer nations, like OneBreath, have the proprietary knowledge the world needs—and they could share it, no doubt with government encouragement and funding. Tesla boss Elon Musk has made an offer to help. So have the big US car companies.

GE Health, Ford and 3M are now working together to manufacture GE-designed ventilators. They’re also working on a simpler design that can be produced more quickly and on a larger scale. In a nod to the space program, the three companies are calling their work ‘Project Apollo’. GE and Ford should share their designs and their development work openly with other partners that have urgent national needs and can also contribute to simplifying design and production proposals at speed. Australia as a close ally with strong design and capable precision-manufacturing firms is a good one to start with.

The US and Australian governments must quickly agree that this will be a joint national endeavour. Then our companies, industrial designers and health technology professionals can jointly develop designs using our nations’ supplies and production systems.

Australia has some of the world’s best medical researchers and medical device designers and manufacturers, including ResMed and Cochlear. We also have scientists and engineers in universities and in government agencies like the Therapeutic Goods Administration, CSIRO, and the Defence Science and Technology Group in the Department of Defence.

Add to that the precision engineering and automotive supplies sector, and some of the big defence companies with strong national supplier relationships—like ASC—and you see a base of medical knowledge and design capability coupled with local precision manufacturing. And precision manufacturing in almost every sector, including defence, is about safety-critical systems.

This is a design and manufacturing ecosystem that can be joined with the efforts of the US and other international partners and turned to this urgent national and international purpose.

It’s appropriate in these strange times to think the otherwise unthinkable. Fast-tracking open-source ventilator designs that can be produced from items we have available is possible. It certainly requires our government to move on changing the regulatory environment to cope with the changed risk balance we face.

But, more importantly, it requires an urgent marshalling of national and global expertise. This, like the Apollo missions, is a moon shot, but with more purpose than putting one man on the moon.

So, this should be the substance of an early call between the US president and our prime minister. And when the G-20 or G-7 meet, it should be on the agenda.

If they can’t lead or agree, the US and Australia can begin this international effort. Partners like Japan, the UK, Germany, France, South Korea, Canada, Israel and Taiwan are likely to want to be a part of it. Our government science agencies, whether the TGA, the CSIRO or Defence’s DST Group could lead.

A DARPA-like ‘grand challenge’ to develop the best open-source design for a rapidly producible ventilator and make it available to all who can produce it would be a fine thing to see in the various packages being assembled by the national cabinet. It will be a wonderful example of the relevance of Australia’s close strategic and economic partnership with the US during this crisis.

We already have cooperation between NASA and our new Australian Space Agency. Let’s make the ventilator grand challenge our new, joint Apollo mission. We are in these times.