Puerto Rico’s homegrown ventilator gives struggling island a shot in the arm
The stainless-steel and plexiglass device, sitting just off the factory floor in central Puerto Rico, twitches rhythmically, its metal and plastic pincers squeezing a lifesaving ventilator bag.
The assisted breathing device on display at AutoPak is designed to be simple — an emergency “bridge” apparatus to keep people afflicted by the coronavirus and in respiratory distress off of invasive ventilators as long as possible.
Based on designs from the Massachusetts Institute of Technology, the machine has been tweaked and modified by a team of Puerto Rican researchers and engineers to make it a homegrown, device. In the process the machine, known as the A3B Puerto Rico Ventilator, has become a symbol of the island’s pharmaceutical know-how.
When the coronavirus was first detected in Puerto Rico on March 13, it set off alarms across the U.S. territory. The island is still recovering from the 2017 hurricane season and a series of damaging earthquakes that began in late 2019 — not to mention a decade-long economic downturn.
The images of hospitals in Italy, Spain and New York overwhelmed by coronavirus patients seemed like a warning of things to come. At the time, health officials said they had fewer than 550 ventilators on the island; a disaster seemed imminent.
Within days, a group of researchers and academics had formed the “ventilator development committee” to solve the problem. Gilberto Alvarez is the business development manager with AutoPak, a Caguasbased firm that designs robots and manufacturing machines for the pharmaceutical industry.
He signed on as project manager and quickly recruited some of the island’s best engineers and academics, including from a nearby manufacturing firm, EngiWorks Corp.
“We’re direct competitors of EngiWorks, but we’ve all been working hand-in-hand,” Alvarez said. “This potential tragedy has brought together a whole group of experts and professionals from different fields. … This feels like a once-in-a-lifetime experience.”
Within weeks, the team had come up with eight prototypes. Most of them centered around a “bag valve resuscitator” — a handheld pouch usually carried by paramedics. Some of the machines used vertical pistons to smash the bag, others were horizontal presses; some were made from PVC pipes and water bottles. The idea was to create something from local components that would be cheap and fast to assemble.
Iván Lugo is the executive director of the Industry-University Research Center, a nonprofit that promotes technological development on the island and helped jump-start the team.
Lugo said the rapid turnaround time for the device was actually decades in the making.
Famed for its beaches and tropical setting, Puerto Rico has been a pharmaceutical powerhouse since the 1960s, when companies flocked here to take advantage of a now-expired tax incentive known as Section 936.
Even though the industry has fallen on hard times, it still exported $44 billion worth of pharmaceuticals in 2019. Of that, $31 billion went to the mainland and $13 billion was sent to other countries.
By comparison, the mainland’s top two exporters, Indiana and California, shipped $7 billion and $6.5 billion abroad, respectively.
In addition, Puerto Rico is home to 12 of the world’s top-grossing pharmaceutical companies and five of the world’s best-selling drugs: Humira, Eliquis, Opdivo, Enbrel and Xarelto.
But the industry’s lingering power is often overshadowed by news of plant closings and fears that its best and brightest engineers are heading to the mainland where they can command higher salaries.
In that sense, the emergency ventilator project has been a morale booster for the entire industry, Lugo said.
“This is a great demonstration of Puerto Rico’s capabilities” as a pharmaceutical and medical-device powerhouse, he said. “We have a significant amount of talent that supports those industries.”
While the machine looks simple (YouTube is full of DIY respirator devices) the one on display at AutoPak is constantly making calculations about breathing patterns and lung pressure and adjusting its behavior.
“Otherwise, it would kill you pretty quickly,” said AutoPak General Director Ignacio Muñoz Guerrra.
The global pandemic has exposed fundamental weaknesses in the United States’ ability to respond, and reinforced the idea that rebuilding American pharmaceutical manufacturing capacity is a national security issue.
That’s driving hopes that Puerto Rico’s industry could make a comeback. Rod Miller, the CEO of Invest Puerto Rico, a nonprofit organization that promotes investment on the island, said he’s been fielding calls from pharmaceutical companies interested in starting or expanding production.
Puerto Rico has existing production facilities, a deep talent pool and lower labor costs than anywhere else on the mainland, Miller said.
“There is a capacity to do more sophisticated research and development here,” he said. “We have a strong pharma workforce.”
But the biggest question is whether federal tax incentives for manufacturers — like the ones repealed under the Bill Clinton administration — might ever be reinstated.
“That’s the question we don’t know,” Miller said. “But any incentive that supports bringing pharmaceutical and manufacturing back to Puerto Rico — we want to be a part of that.”
Last month, the Fiscal Oversight and Management Board, a federally appointed body that oversees the island’s finances, sent a letter to the White House promoting Puerto Rico’s potential role.
Even as the island remains in the grips of the coronavirus, there’s a growing sense of relief among the ventilator-design team. The pandemic has sickened 1,539 people on the island and killed 92, but thanks in part to a strict lockdown, there are still plenty of hospital rooms and ventilators.
“I’ve worked my entire life in the pharmaceutical industry, but this is the first time I’ve worked on what feels like a national project,” Alvarez said of the machine, which could quickly be produced in the hundreds. “For the good of Puerto Rico, we hope it’s never needed.”