The New York Times
The world needs syringes. He jumped to do 5,900 a minute.
BALLABGARH, India – In late November, an urgent email appeared in the inbox of Hindustan Syringes & Medical Devices, one of the largest syringe manufacturers in the world. He was from UNICEF, the United Nations agency for children, and he was desperately looking for syringes. Not just anyone would. These syringes must be smaller than normal. They had to break if used a second time, to prevent the spread of disease through accidental recycling. Most importantly, UNICEF needed them in large quantities. Now. Subscribe to the New York Times newsletter The Morning “I thought, ‘No problem,'” said Rajiv Nath, the company’s managing director, who has invested millions of dollars in preparing his syringe factories for the vaccination attack. “We could possibly deliver it faster than anyone else.” As countries struggle to ensure sufficient vaccine doses to end the COVID-19 outbreak, a second race is taking place with syringes. Vaccines are not so useful if health professionals do not have a way of injecting them into people. US and European Union officials said they did not have enough vaccine syringes. In January, Brazil restricted exports of syringes and needles 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 might have to discard millions of doses of the Pfizer-BioNTech vaccine if it could not guarantee enough special syringes to extract a sixth dose from its vials. In January, the Food and Drug Administration informed health professionals in the United States that they could extract more doses from Pfizer bottles after hospitals there found that some contained enough for a sixth – or even seventh – person. “Many countries have been taken by surprise,” said Ingrid Katz, associate director at Harvard Global Health Institute. “It seems like a fundamental irony that countries around the world have not been fully prepared to receive these types of syringes.” The world needs 8 billion to 10 billion syringes just for the COVID-19 vaccination, experts say. In previous years, only 5% to 10% of the estimated 16 billion syringes used worldwide were destined for vaccination and immunization, said Prashant Yadav, senior researcher at the Center for Global Development, a think tank in Washington, and a specialist in health care supply chains. Wealthier nations like the United States, Britain, France and Germany have injected billions of dollars of taxpayer money to develop vaccines, but little public investment has been made to expand needle manufacturing, said Yadav. “I am concerned not only with the general syringe-making capacity, but with the capacity for specific types of syringes,” he said, “and whether 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 production of a bottle 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 accelerated to meet demand. New Jersey-based Becton Dickinson and a major syringe maker said it would spend $ 1.2 billion over four years to expand capacity, in part to deal with pandemics. The United States is the world’s largest supplier of syringes in sales, according to Fitch Solutions, a research firm. The United States and China are side by side in exports, with combined annual shipments worth $ 1.7 billion. Although India is a small player globally, with only $ 32 million in exports in 2019, Nath, from Hindustan Syringes, sees a huge opportunity. Each of his syringes sells for only three cents, but his total investment is considerable. He invested nearly $ 15 million in the mass production of special syringes, equivalent to almost a sixth of his annual sales, even before purchase orders were in sight. In May, he ordered new molds from suppliers in Italy, Germany and Japan to make a variety of barrels and plungers for his syringes. Nath added 500 workers to his production lines, which generate more than 5,900 syringes per minute in factories spread across 11 acres in a dusty industrial district on the outskirts of New Delhi. With Sundays and holidays away, the company produces about 2.5 billion a year, although it plans to increase to 3 billion in July. Hindustan Syringes has a long history of providing UNICEF immunization programs in some of the poorest countries, where needle reuse is common and a major source of deadly infections, including HIV and hepatitis. In late December, when the World Health Organization released the Pfizer vaccine for emergency use, Robert Matthews, contract manager at UNICEF in Copenhagen, and his team needed to find a manufacturer who could produce millions of syringes. “We said, ‘Oh, dear!’” Said Matthews, while looking for a syringe that met WHO specifications and was compact for shipping. Hindustan Syringes’ product, he said, was the first. The company is expected to start shipping 3.2 million of these syringes soon, UNICEF said, provided they undergo another quality check. Nath sold 15 million syringes to the Japanese government, he said, and more than 400 million to India for his COVID-19 inoculation campaign, one of the largest in the world. More are in the queue, including UNICEF, for which he offered to produce about 240 million more, and Brazil, he said. Inside the company’s No. 6 plant, machines coated with yellow paint buzz 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 trays filled with syringes before unloading them in crates that they carry in their hands to a packaging area next to them. To increase efficiency, Nath relies on a syringe design by 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 thin capillary tubes, which the machines stick into plastic cubes. To make the kebabs less painful, they are dipped in a silicone solution. The syringe business is a “bloodsucker,” said Nath, where the upfront costs are astronomical and the profits marginal. If the demand for his syringes drops by half in the next few years, he will lose almost all of the $ 15 million he has invested. It is clearly an economical operation. The blue carpet in Nath’s office looks as old as her desk or the glass chandelier on the stairs, accessories her father installed in 1984, before handing the company over to Nath and his family. A family business is exactly how he likes 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 were the case today, he said, he would not be able to follow his gut and produce his syringes on a huge scale. “Get a good night’s sleep,” said Nath. “It is better to be a big fish in a small pond.” This article was originally published in The New York Times. © 2021 The New York Times Company