KARACHI, Pakistan – Faced with lockdowns and massive disruptions to supply chains, distributors and manufacturers of surgical equipment in countries across South Asia like Pakistan, Indian, Bangladesh and Nepal are struggling to find a way forward but also looking for opportunities to expand their share of the global market while reducing their existing reliance on imports of basic supplies.

Pakistan’s surgical instrument industry has taken a hit from the COVID-19 pandemic, said Inzamam Mehmood, a spokesman for the Surgical Instrument Manufacturing Association of Pakistan (SIMAP).

The industry traditionally exports more than 95% of its production but this production has dropped by about 40% since the pandemic started as a result of slowdowns in manufacturing, lockdowns in export destinations and cancelled orders. The impact is likely to be a significant reduction in export revenue for the country.

“The industry belongs to the light engineering industry category, is specialized and has had a stable export market share,” Mehmood told BioWorld. There are about 3,600 companies, industrial units, vendors and traders in Pakistan involved in the production and distribution of beauty and surgical equipment for international companies and brands.

For now, Pakistan’s share of global trade in the space is a tiny 0.3%, said Mehmood, but the country is looking to grow that market share. Pakistan currently lags behind neighbors India and Bangladesh as an exporting country but a recent government proposal would aim to boost exports under a Strategic Trade Policy Framework (STPF) over the next five years. Surgical equipment is one of the 18 priority sectors that would fall under the framework.

The drop in exports has happened despite the country’s relatively successful response to the SARS-CoV-2 pandemic. Pakistan has received praise from World Health Organization Director-General Tedros Adhanom Ghebreyesus.

“Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children for polio have been utilized for surveillance, contact tracing and care,” said Ghebreyesus on Sept. 7.

India’s response has been less successful, with the country reporting around 90,000 cases of COVID-19 per day. The pandemic has affected India’s import-dependent medical and surgical product supply chain, which has resulted in a shortage of critical medical devices and surgical equipment.

India imports a variety of consumables, disposables, surgical equipment including orthopedic implants, gloves, syringes, bandages, tomography and magnetic resonance imaging devices from China, according to the Association of Indian Medical Device Industry (Aimed).

The pandemic and political issues between India and China have created barriers between buyers and sellers. India’s medical devices market accounts for about 13% of the entire Asia-Pacific market and is growing at about 7.5% per year, according to market research company Globaldata.

COVID-19 and political issues between India and China have created a barrier among buyers and sellers, said Globadata medical devices analyst Rohit Anand. These barriers have impacted both margins and profitability for Indian companies.

Still, India has taken steps to reduce dependency on China, said Minister of State for Health and Family Welfare Ashwini Kumar Choubey. Choubey has said that the current situation could create an opportunity for India to become a global hub for medical and surgical device manufacturing.

The situation is not dissimilar in neighboring Bangladesh, although the country is more dependent on imports.

“Due to the huge demand for surgical instruments throughout the year, the market for it has been growing but Bangladesh has been unable to capitalize on this as the market here is totally dependent on imports,” said Bangladesh Medical Association (BMA) Convener Akram Hossain. “Every year, importers bring in medical equipment, surgical instruments, devices, disposables, electro-medical equipment and technologies, laboratory equipment, surgical equipment and accessories from several countries, and pay a huge amount of money.”

“Dealers and sellers say they have been left frustrated due to the lack of local producers. There are three or four companies in Bangladesh who have been manufacturing these medical products for years but they are not sufficient,” Hossain said.

Arif Mushtafa, a distributor of medical and surgical equipment in Bangladesh, said the country usually imports medical and surgical instruments from China, Germany, the U.K. and other countries. Almost three-quarters of products are imported from China alone. Mushtafa said his company sells millions of dollars of equipment “but no company from Bangladesh has come forward to produce such items.”

Another neighbor, Nepal, is also totally dependent on India and China for medical equipment.

According to Nepal’s Ministry of Health the Tripureshwor-Thapathali area around Kathmandu has been growing as a surgical goods hub with more than 500 shops selling surgical equipment along a 1.5 km stretch on the banks of the Bagmati River. Revenue is miniscule but there are more than 2,000 people working in these shops.

“We are facing acute shortages of surgical equipment,” said Sudeep Meshra, owner of importer Sudeep International. “Enterprises here import surgical equipment mainly from India and China and other countries. Most of them import their supplies through their own contacts. The outlets here supply surgical equipment across the country through sub-distributors.”

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