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The New York Times

The world needs syringes. He jumped to do 5,900 per minute.

BALLABGARH, India – In late November, an urgent email appeared in the inbox of Hindustan Syringes & Medical Devices, one of the world’s largest syringe manufacturers. He was from UNICEF, the United Nations agency for children, and he was desperately looking for syringes. Not just anyone would do. These syringes should be smaller than usual. They had to be broken if they were used a second time, to prevent the spread of disease through accidental recycling. More importantly, UNICEF needed them in great numbers. Now. Subscribe to the New York Times The Morning newsletter “I thought, ‘No problem,’” said Rajiv Nath, the company’s managing director, who has invested millions of dollars preparing its syringe factories for the onslaught of vaccines. “We could possibly deliver it faster than anyone else.” As countries scramble to secure enough doses of vaccine to end the COVID-19 outbreak, a second fight over syringes is unfolding. Vaccines are not as useful if healthcare professionals do not have a way to inject them into people. Officials in the United States and the European Union have said they do not have enough syringes for vaccines. In January, Brazil restricted syringe and needle exports when its vaccination effort fell short. To further complicate the rush, the syringes have to be the right type. Japan revealed last month that it could have to discard millions of doses of the Pfizer-BioNTech vaccine if it could not secure enough special syringes that could draw a sixth dose from its vials. In January, the Food and Drug Administration (FDA) warned healthcare providers in the United States that they could withdraw more doses from Pfizer vials after hospitals found that some contained enough to a sixth or even a seventh person. “Many countries were caught off guard,” said Ingrid Katz, associate director of the Harvard Global Health Institute. “It seems a fundamental irony that countries around the world have not been fully prepared to obtain these types of syringes.” The world needs between 8 billion and 10 billion syringes for COVID-19 vaccines alone, experts say. In previous years, only 5% to 10% of the estimated 16 billion syringes used worldwide were for vaccination and immunization, said Prashant Yadav, principal investigator at the Center for Global Development, a Washington think tank and health expert. care supply chains. Richer nations like the United States, Britain, France and Germany invested billions of dollars of taxpayer money into vaccine development, but little public investment has gone into expanding syringe manufacturing, Yadav said. “I am concerned not only with the overall syringe manufacturing capacity, but the capacity for specific types of syringes,” he said, “and if the syringes would already be in the places where they are needed.” Not all syringes in the world are suitable for this task. To maximize the output of a vial of Pfizer vaccine, for example, a syringe must contain an exact dose of 0.3 milliliters. Syringes should also have low dead space, the infinitesimal distance between the plunger and the needle after the dose is fully injected, to minimize waste. The industry has grown to meet the demand. New Jersey-based Becton Dickinson, a major syringe maker, said it will spend $ 1.2 billion over four years to expand capacity in part to deal with pandemics. The United States is the world’s largest syringe supplier by sales, according to Fitch Solutions, a research firm. The United States and China are shoulder to shoulder on exports, with combined annual shipments worth $ 1.7 billion. While India is a small player globally, with only $ 32 million in exports in 2019, Nath of Hindustan Syringes sees a great opportunity. Each of their syringes sells for just three cents, but your total investment is considerable. It invested nearly $ 15 million in mass production of specialty syringes, which is equivalent to roughly a sixth of its annual sales, even before purchase orders were in sight. In May, it commissioned new molds from suppliers in Italy, Germany and Japan to make a variety of cylinders and plungers for its syringes. Nath added 500 workers to his production lines, which produce more than 5,900 syringes per minute in factories spread over 11 acres in a dusty industrial district outside New Delhi. With Sundays and holidays off, the company produces nearly $ 2.5 billion a year, though it plans to climb to $ 3 billion by July. Hindustan Syringes has a long history of providing UNICEF immunization programs in some of the poorest countries, where reuse of syringes is common and a leading source of deadly infections, including HIV and hepatitis. In late December, when the World Health Organization cleared Pfizer’s vaccine for emergency use, Robert Matthews, a UNICEF contract manager in Copenhagen, and his team needed to find a manufacturer that could produce millions of syringes. “We said, ‘Oh my God!'” Said Matthews, as they searched for a syringe that met WHO specifications and was compact for shipping. The Hindustan Syringes product, he said, was the first. The company is ready to start shipping 3.2 million of those syringes soon, UNICEF said, provided they pass another quality check. Nath has sold 15 million syringes to the Japanese government, he said, and more than 400 million to India for its COVID-19 inoculation campaign, one of the largest in the world. More are online, including UNICEF, for which it has offered to produce about 240 million more, and Brazil, he said. Inside the company’s 6th plant, machines covered in yellow paint hum as they squirt plastic barrels and plungers. Other machines, from Bergamo, Italy, assemble each component, including needles, monitored by sensors and cameras. Workers in blue protective suits inspect the trays full of syringes before unloading them into boxes that they carry by hand to the next door packing area. To increase efficiency, Nath relies on a syringe design from Marc Koska, a British inventor of safety injections, and his ability to produce all components in-house. Hindustan Syringes manufactures its needles from stainless steel strips imported from Japan. The strips are rolled into cylinders and welded at the seam, then stretched and cut into fine capillary tubes, which the machines glue to the plastic cubes. To make the punctures less painful, they are dipped in a silicone solution. The syringe business is a “bloodsucker,” Nath said, with start-up costs astronomical and profits marginal. If the demand for your syringes is even cut in half in the next few years, you will lose almost all of the $ 15 million you invested. It is clearly a frugal operation. The blue carpet in Nath’s office looks as old as his desk or the crystal chandelier by the stairs, fixtures his father installed in 1984, before handing the company over to Nath and his family. A family business is exactly how you like it. No shareholders, no interference, no worries. In 1995, when Nath needed money to increase production and buy many new machines, he sought private capital for the first time. If that had been the case today, he said, he would not be able to follow his instincts and produce his syringes on this enormous scale. “Have a good night’s sleep,” said Nath. “It’s better to be a big fish in a small pond.” This article originally appeared in The New York Times. © 2021 The New York Times Company

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