Episode 2: Innovation Action Insights podcast

Giulia Barbareschi  00:07

Hi, everyone, and welcome to our second episode of Innovation Action insights, a space where we share stories of amazing innovations and innovators. We're working to tackle some of the biggest global challenges of our time. My name is Giulia Barbaresci, and I'm joined by my friend and co-host Ben Oldfrey. This podcast is brought to you by the Innovation Action collaborative initiative, led by the Global Disability Innovation Hub, and funded by UKaid. Innovation Action was created by a consortium of organisations that believe in the importance of connecting the dots, and that bringing people together can help spark and grow innovations that make a real impact on the lives of people that live in less resource settings. In our last episode, we explored exciting and innovative manufacturing models developed by entrepreneurs in Nepal and Uganda, in answer to the particular challenges and opportunities linked to the local context. In this episode, we'll take a closer look at how the Covid 19 pandemic triggered rapid responsive innovations from teams working to tackle this global health challenge. Since the 30th of January 2020, when the World Health Organisation declared the outbreak of COVID-19, a public health emergency of international concern, life has radically changed for billions of people across the globe. In the last year, many of us have been trying to navigate basic and advanced concepts of epidemiology, microbiology, economics, data science and public health, comparing health resources and policy implementations of different countries following the development of vaccines and drugs to combat the spread and impact of the virus. The impact the science and technology have on our lives, and the importance of rapid and responsive innovation has never been more evident. Overnight, the pandemic as made the world both larger and smaller place by highlighting how countries need to work together, despite their differences. Today, we'll hear stories from two different innovators who in the last year have worked on two of the biggest healthcare challenges that have emerged in relation to the Covid 19 pandemic. The development of breathing aids for patients affected by respiratory difficulties, and the use of data for policy development.  In the middle of March 2020, as the UK Government and the general public started to grapple with the severity of the covid 19 pandemic, a team of UCL engineers, UCLH clinicians and industry partners from the Mercedes AMG high performing power trains from the Formula One team worked tirelessly together to develop the UCL-Ventura CPAP. This device is a breathing aid that can be used to support COVID patients with respiratory difficulties, keeping them out of intensive care and relieving the pressure on NHS hospital. Our guest today is Professor Rebecca Shipley from the UCL Institute of Healthcare Engineering, who is going to tell us a little bit more about how the UCL-Ventura CPAP device was developed and the impact that it had in less than a year since its release. Hi, Becky, it's great to have you here with us.

Rebecca Shipley  04:14

Hi, thank you. It's brilliant to join you. Thank you for having me.

Giulia Barbareschi  04:17

Can I ask you exactly what the UCL-Ventura is, and why is it such an important device?

Rebecca Shipley  04:25

Absolutely. The UCL-Ventura is a CPAP device that that stands for continuous positive airway pressure. And essentially, it's a non invasive ventilator for treating COVID-19 patients. Now, if you look back to last March, March 2020, seems like a lifetime ago. And yesterday at the same time, somehow, and but at the time, and obviously cases were were really starting to expand in the UK. And at the time, there was a kind of dogma that when patients needed more than facemask oxygen to treat them for, you know, severe COVID disease, then then to jump straight to essentially mechanical ventilation, which is when you sedate a patient, and you put essentially put a tube down into their lungs and the mechanical ventilator breathes for them. Now, that's absolutely necessary for the most severe of COVID cases. But it obviously is really heavily invasive. Patients are often ventilated for weeks at a time. And there's lots of complications. So about 30% of patients on ventilators needed cardiovascular support about 40%, it needed renal support. And you also would need really highly trained healthcare workers to look after patients. So essentially, there was a potential role for a bridge, a non invasive device that could potentially alleviate patients from progressing to needing full mechanical ventilation, which would have good outcomes for the patients but also help optimise healthcare resource, maximise health care,  available health care resource. And our clinicians at University College London hospitals, Professor Mervyn Singer, and they've really had this whole network of colleagues across the world. So they had friends in China and Italy, in particular had obviously been hit severely by COVID, before we were in the UK, so they were talking to their colleagues. And their experience was that when they were jumping straight to mechanically ventilated patients, their hospital soon became very quickly overwhelmed. And so they'd started using CPAP instead. And their experience was that it was alleviating about 50% of patients from needing mechanical ventilation. So essentially, our clinicians Merv and Dave Brealey said we need more CPAPs at the time. There was the ventilator challenge that was set out in the UK, which was to kind of corral the engineering and manufacturing community to make as many mechanical ventilators as possible. And that but you know, Mervyn, Dave, and other clinical colleagues really defined the focus for us on CPAPs, which, you know, as I already explained, the motivation was very much about patient outcomes, but also about hospitals being able to cope.

Giulia Barbareschi  07:20

It sounds like such a key device, especially as you mentioned earlier, a lot of what we hear is about the incredible amount of strain that healthcare systems, both here in the UK, but also abroad, have been put under and to some something that can support patients and help them to improve without needing sort of the incredibly complex care package that comes with an intensive therapy bed. It's it's really crucial in situations like this. You mentioned really fast development and on some of the articles that I read on the UCL-Ventura, they mentioned a development cycle from initial ideas, the hospital testing of less than 100 hours. How was that fast sort of development cycle possible?

Rebecca Shipley  08:30

Well, you know, we knew basically that if we were going to be able to contribute something meaningful, we had we had week. So we first started talking about this, we went for a drink in the CAR. This is the senior common room at UCL. And it was a Tuesday evening, it was the 17th of March. And the peak of the first wave was due to hit London at Easter weekend. So there was literally weeks to be able to do something. So we went back to a CPAP device called the Philips Respironics Whisper Flow, which was off patent. So it had run out of patent about six months previously. And but it had been used really widely in the NHS and internationally, which meant that was a really robust evidence base for its clinical utility and safety. It was also a really simple device. It's purely mechanical. There's no embedded electronics. So again, it meant that we kind of had a hope of moving quickly with it. So what we did, first of all, was to reverse engineer that device. Now, first of all, we had to get hold of one. And it turns out that there was there was one in the in the UCLA  University College London hospital anaesthesia museum, which we went and picked up and and the Mercedes team also managed to buy one on eBay and got that delivered. So the first thing that we did was essentially cut them open, redo all of the internal measurements and did the 3D drawings. And as I said, it was super simple, no embedded electronics. So that meant that the Mercedes teams could then manufacture it very quickly. So, from that first meeting, within 100 hours, we had a prototype that had been, we said, we did all of this process at the makerspace, which is a dedicated engineering design hub in UCL Mechanical Engineering. And then the Mercedes teams actually made the prototype on their production line at Brixworth. And they drove back to London with it, it was a Sunday evening. And we started hospital testing, which, you know, in normal in normal times, you wouldn't be able to get through that whole process that quickly and not least because of the bureaucracy, because because there was such an urgent need for COVID. You know, the hospital had streamlined its processes, etc. It helped that obviously, we were mimicking an existing device for which there was this really sound safety, evidence base. And also we have this existing partnership with the hospital. So at UCL, and you know, we already, we already work really closely with many clinicians at University College Hospital and have a very strong partnership, which is all about translating biomedical research into clinical and implementation. So, so we were back on the wards at University College London Hospital on the Sunday evening, and plugging them plugging these devices into, you know, the oxygen ports on the intensive care wards, and the theatre wards, which were all being repurposed as intensive care beds ready for the surge of patients that was coming down the line. And, yeah, we were testing it. And, you know, we were the healthy volunteers. We were the healthy volunteers. So we were putting them on ourselves, we were trying them out, we were plugging them into different breathing circuits, which make a really big difference to the oxygen utilisation. And, you know, seeing how it worked. And and, you know, one of the things that we learnt very quickly what was that a CPAP isn't just the physical device, it isn't just the physical mechanical device, which is the flow generator that connects to a patient through a breathing circuit, which is a series of tubes and masks and filters. And actually, the design of that breathing circuit makes a huge difference to the patient comfort and also the oxygen utilisation. So that evening, we very quickly moved on to our next stage, which was designing the breathing circuits and worrying about supply chains and where we could get all the components and the parts from and, and, you know, that really then started defining a focus on oxygen utilisation, which was our kind of next challenge. While this is indeed really fast development, and also really goes to show I think, how when when people come together, especially in situations of, of emergencies, things can be made so much more efficiently and so much faster.

Giulia Barbareschi  13:06

So once the development was completed, how was then the UCL-Ventura provided to hospitals around the UK? And and what impact did he have?

Rebecca Shipley  13:18

That was that was the kind of next stage then so you know, after we've done all of this process, and we submitted to the regulator in the UK, and got regulatory approvals, that was within 10 days of the first meeting, we then did a Mark 2 device which we redesigned essentially to minimise oxygen utilisation and managed to reduce that by up to 70%, which was a really important step in enabling use in the NHS. So at that point, we were essentially talking to the Cabinet Office and the Department of Health and Social Care, we, we had the regulatory approvals, and we you know, we were presenting the evidence base. So we've got an order for 10,000 units from the Department of Health and Social Care, which we delivered on the 15th of April, Mercedes, manufactured all of them at the peak rate, they were manufacturing them at an at a rate of 1200 a day, which was amazing. So we delivered those and then the next challenge was how to distribute them. So at the time, there were kind of daily meetings through the Department of Health and Social Care in the NHS, about managing ventilator and non invasive ventilator stocks. And we partnered with a logistics company called GTEM, who are just in time automotive logistics company. And they essentially offered to set up kind of hub for the Ventura kits in their warehouse in Gloucestershire. And then they did next day delivery of devices and all of the circuits to NHS hospitals across the UK. So, to date, they've got out to about 130 NHS hospitals in England and Ireland, Scotland, Wales, and then Overseas Territories as well. So they've gone to Monserat, Jersey, Isle of Man too, but again, you know, this partnership with GTEM who don't normally work in healthcare. So it was another example of a partnership with another part of the kind of engineering manufacturing base in the UK, if you like that, this is very much what they do on a normal day to day basis, but within a different industry. So, so it's kind of amazing, because even now, you know, they're, they're very busy working very closely with us again, and they have amazing experiences. So they'll turn up at a hospital with a new set of breathing circuits for a team that are using the Venturas. And, and often the hospital will order them and sometimes they even deliver them on the same day. So they sometimes they get rounds of applause as they work, they walk into the intensive care units with them. But the team has just been phenomenal. And, like, so collaborative, and supportive and responsive, and, you know, just really dedicated to trying to do something to help. And I think, you know, with to your earlier point, it's amazing what we can achieve together when everyone's united under a common goal, which I think COVID certainly gave us.

Giulia Barbareschi  16:17

Yeah, and it also really shows the ability to pivot that certain industries, and companies have been able to showcase and this would be very important going forward as well. As you mentioned, the Covid 19 pandemic, it's, it's a problem that is affecting us all, not just in the UK, but all over the world. Have hospitals outside the UK also been able to access to the UCL-Ventura, and how was this facilitated?

Rebecca Shipley  16:57

Yeah, this, this has been probably one of the most for me, like amazing parts of the whole programme, actually. So, you know, we went into this very much motivated by the UK need, but wanting to do something to help and but we hadn't, we've had by no means planned, you know what this programme would look like. But essentially, when we got regulatory approval in the UK, we then got quite a lot of media interest. So we were, you know, covered on the BBC. And then it was a lot of international coverage as well. So very quickly, we started getting a lot of emails from teams and other countries about how they could access the devices. And I think it kind of coincided with, obviously COVID spreading more globally, if that makes sense. And also a beginning of a shift from the use of mechanical ventilation to non invasive, ventilators like CPAPs. So we had to decide very quickly how to tackle this. And you know, the whole Consortium, were completely committed to doing everything we could to help other countries, you know, we pick, we were doing this to try and help people with COVID, it didn't matter where in the world, they were, we should do everything we could. So we did two things. So first of all, we released all of our designs and manufacturing instructions at zero cost. So we set up an essentially an open source platform where any teams in any other country could get access to all of our data, all of our designs, and manufacture them themselves in country. And we put in place around that a whole kind of platform of technical support, manufacturing support, clinical guidance, translated documents, regulatory support, as well. And that's, that really took off. So within within a very short space of time, the designs have been downloaded across 105 countries. And we've approved 1900 licences. And I'll come back to that in a second. But there's a lot of teams there who have made really fantastic progress. There's about 20 now who are who are really manufacturing in scale, and are testing in hospitals, and have either got regulatory approvals or very close to getting them and deploying them in country. So I mean, that's been amazing. And there's a few real kind of success stories, but maybe we can come back to that in a moment. And then the other part is that obviously, that kind of platform works well for countries that have the local manufacturing capability. But there's obviously many countries who don't and, and or potentially didn't have the capacity to respond as quickly as the urgency of COVID was presenting to them. So for that we've sought to supply devices directly where we could. And that's quite a complex thing to do in terms of legal frameworks and all this kind of thing and but, but where where we've really been able to make a difference is where we partnered with charities or NGOs. So one real highlight has been a new partnership with the International Medical Education Trust 2002 who are a relatively small charity, but they do a huge amount of work in the developing world, essentially. So Africa, Asia, and and beyond. So with them, we've we've done a lot of work in Palestine. So they've partnered up to deliver around 40 devices to five hospitals in Palestine. And alongside that medical aid for the Palestinians have done a training programme across 750, doctors and nurses, they're so so those devices are all being used. We've also supplied them to, to hospitals in Uganda who are using them in in quite big field hospital stations there. And then Mercedes actually donated 500 devices to South Africa, which are being used in 90 hospitals across the East Cape. So so that has been, they're all kind of individual cases, if that makes sense. So so we haven't, so it's been very difficult to have a strategic coherent international approach. And we've we've tried to work with the government and various big international organisations on that, but that's been a challenge. But we have worked very closely with individual teams to try and make it happen where there were was particular motivations or links that we could nurture and, and develop

Giulia Barbareschi  21:30

Thanks to Professor Rebecca Shipley, for sharing with us the amazing story of how the UCL-Ventura CPAP device came to be. I think that from beginning to end, the story really shows how collaborations both across disciplines, and countries are really the key for successful innovation that can literally save lives, especially when dealing with emergencies, such as the ongoing pandemic. Would you agree with that? Ben?

Ben Oldfrey  22:04

I'd absolutely agree. And, you know, COVID, as shown as the the absolute crucial need for innovations like these, thinking, how they fit in with systems approaches to improving the resilience of, you know, local and regional communities, you know, the next problem that the world faces, we need to be better prepared. And it doesn't necessarily just have to be on a global scale. You know, it could be on a regional scale, but the resilience of those places need integration like this.

Giulia Barbareschi  22:40

In the last year, we all keen to understand the importance of data. Many of us regularly consult newspapers, websites and government repository to look at the number of reported cases of COVID-19,  tracking the ongoing pandemic, across our local communities, or countries and the world at large. Data are also essential for government to formulate appropriate policies, and introduced and lift restrictions as the situation constantly evolves In short, good quality and reliable data have become one of the most important tools that we can use to contain the impact of COVID-19 and minimise the negative impact that the pandemic has on people's life. In light of this, the UK fFreign Commonwealth and Development Office's Frontier Tech Hub, launched the COVID action data challenge to identify and support data innovations that might help low and middle income countries in the response to the pandemic. Today, we have with us Mike Klein from IMC worldwide, and the head of the COVID action data team to tell us a little bit more about the scope of the challenge and the work done by some of their amazing grantees. So Mike, the FCDO COVID action data challenge was launched on the 26th of April 2020 by the Frontier Tech and a range of partners across the world to help collect and curate data about the pandemic in support of government and health system in low and middle income countries. But can you tell us a little bit more about the scope of the initiative and why it is important?

Michael Klein  24:41

Sure. So the COVID Action data challenge started, as you noted, back in April of 2020. And you know, at the time, what we were seeing was a proliferation of lots and lots of data tools and applications. I think there was one particular resources kind of industry spreadsheet that was set up. And it showed, I think, like 140, new COVID specific tools that had been debuted. And we looked at that and said, Wow, there's a lot here. But it's hard to make sense of really, you know, what actors in low and middle income countries could or should be using as NGOs and, and governments and policymakers? What within this portfolio's wide array of data tools they could and should be using? And really, you know, how do we make sense of a lot of this noise. And so you're talking with a whole host of individuals within FCDO, and national governments and regional and global programmes, we settled on this the idea of kind of creating a data challenge so that we could crowd in or crowdsource rather, all of these, these solutions, and so that we would give them the incentive to give us a little bit more information about the tools. And then you know, how and who could be using them, and then be able to use all that information, to kind of judge and make awards to then support what we saw as kind of the best best in class tools that could address specific problems related to COVID-19.

Giulia Barbareschi  26:25

Yeah, that sounds like a really crucial task. Can I ask you, why do you think it's preferable to leverage existing systems to collect and manage data, rather than creating new ones?

Michael Klein  26:42

Sure. So you know, in April, when we created the data challenge, there were lots of hackathons that were on the go, there were lots of individuals kind of creating new applications. If you recall, there was contact tracing, which was lots of applications that were kind of in vogue at the time, there was global initiatives between, say, Apple and Google to create a protocol for contact tracing. And if you picked up a paper, you're likely to see kind of people working on this problem. And what we saw was, you know, going back to that list of, you know, hundreds of potential COVID-19 data tools and solutions that, that were in that spreadsheet that we were seeing passed around in March, April, we kind of saw that as kind of something to be addressed through kind of a crowd sourced problem where we're looking at, you know, what has already been created. We don't want to add more solutions to that spreadsheet, frankly, through this challenge in the midst of a crisis. So instead, we're saying what have you already created? Where is there already existing user capacity, people familiarity with tools, so that we're not trying to teach people to use new tools, at the same time, we're responding in the context of emergency. And so the data challenge picked up. The idea was to pick up on cases or rather tools that already had existing capacity and user bases that were then pivoting to address COVID-19. And the benefit there is that, you know, we can kind of quickly work with existing users and and take tool developers to work with their existing user bases to bring to bear solutions that can impact in users quickly and efficiently.

Giulia Barbareschi  28:42

I got to say that sounds like a very sensible idea, especially as speed in implementing decisions. It's such an important factor and context of the covid 19 pandemic, and probably overloading people with information in the middle of an emergency isn't that helpful. But you probably had to move really fast when the initiative was first launched. How did you go about selecting your first grantee?

Michael Klein  29:15

So I think speed plays a big role in two different kind of facets. First, is in the ability to kind of bring a specific solution to market and the other is in terms of us kind of making those making the awards and being able to put resources in the hands of these kind of solution providers or innovators as quickly as possible. So April 26, was the day that we launched the data challenge. And we had our first awards out the door by I believe it was the end of June or first of July. So just within a couple of months. And I think that's important, because you know, we're able to step in and offset some of the risk of these kind of big existing providers that are engaged in kind of developing and being entrepreneurial, in bringing their innovations online offset some of that risk for financial perspective. So the second component of speed, which is impacting in users, you know, in one case, our first awardee, which was to Surgo Foundation, was out the door within a couple months, as I had noted, but it was using existing data tools that were already in use across, in this case, Africa, and putting it in the hands of policymakers. So the two different aspects of speed I just touched on, which is one getting the word out the door, and then to pulling on existing data tools and putting it in the hands of users so that it can be used. I think we're kind of we addressed both with with this, that initial award.

Giulia Barbareschi  31:08

Wow, that is a truly impressive, fast pace. And I think you're right speed of implementation is always key, especially in these situations. Would you be able to give us another example of an additional grantee that you think is doing very innovative and impactful work?

Michael Klein  31:34

Yeah, so let's let's take that first award, as as an example, then I'll give you one other. So that first award that we made was to an organisation that I mentioned, which is called Surgo Ventures. They were initially called Serco Foundation, and Surgo Ventures created a pan African dataset that tracks risk and vulnerability to COVID-19, across the African continent. So that includes 751 regions across 48 countries. And what it allows you to do is, you can actually go to their website, which is PrecisionForCOVID.com/Africa. And on the website, you're able to scroll across the 48 countries in Africa and understand how different what we call 'admin one' so first, administrative regions within specific countries in Africa are impacted by COVID-19, and how they're impacted differently. So certain countries and certain regions within those countries may say be impacted more from socio economic risk than specific health risks. And this gave policymakers across Africa, some real insight into how they were uniquely being impacted, and to governments as well as their national donors and humanitarian organisations, how they could step in and assist within different contexts in different regions. Now, alright, and this other grantee that we work with, so organisation called BAO Systems, creates an open source tool that actually collects that data, right, data, that would be maybe, the data that would be used in say, that Surgo data set. And in the context of BAO systems, they created an open source data collection tool, called DHIS 2 and DHIS 2 is kind of one of the more preeminent solutions for clinic based data collection. It's a eHealth system that is used across you know probably hundreds of countries at this point, to collect data around, just traditional clinic based care and health system systems generally. And they created a, when COVID-19 really was was was a kind of emergent within low and middle income countries where we saw this as kind of a clear threat, this is in say February or so, they created a COVID-19 surveillance package, which allowed countries across the world to then track cases using this open source solution. So to date, there are currently I believe, 37 different countries that are now using the DHIS 2 open source platform to collect information on sort of just traditional surveillance data on COVID-19. And that, to us was incredibly impressive. We're talking about having DHIS 2 which is a tool that is used by lots of actors already in the health space created a new package that added on to that system to help them track COVID-19. And then was then operationalized, and is now operate, is now functioning in 37 different countries. So for us to go to identifying that tool to awarding and supporting that tool, and their growth really being really, really being driven by the users and what they needed, we saw that as just a really clear success story.

Giulia Barbareschi  35:37

Thank you to Mike from IMC worldwide. I think the most powerful takeaway I get from the work been done by the COVID action data challenge and the grantees they support, it's the importance of building on existing strengths and tools and systems as much as we can to develop solutions that can scale up really quickly. I also feel there is a lot to be say about choosing an approach that helps to provide clarity and select the right tools for each context, rather than constantly adding new possible solution that might create more confusion for decision makers. Would you agree with that, Ben?

Ben Oldfrey  36:20

Yeah, that's a really interesting point. And we've seen within COVID Action, both with the innovation of physical devices and how we get those produced, and with, you know, digital devices and apps and data approaches, that innovation can happen rapidly and respond to the, you know, emergency needs of the day. But at the same time, in supporting those innovators to do this, we've had to think about what the long term resilient models are, to take that forward. So it's, there's an interesting balance there between the short term needs and the long term needs. And hoping that you know, the learnings from trying to balance those two things, really, really enables us to think about how to how to do this better in the future.

Giulia Barbareschi  37:13

Today, Becky, and Mike shared with us the amazing and inspiring stories of the UCL, Ventura CPAP and the COVID Action data challenge, showing how scientists and innovators across the world have been working tirelessly to address many of the challenges generated by the ongoing Covid 19 pandemic. I think the most interesting thing to see in the future for me, is what is going to be the long term impact of these innovations. Once the emergency of the pandemic will subside, how are we going to keep leveraging all the advances that have been made this year? And I was wondering if you got any insight on that, Ben?

Ben Oldfrey  38:01

Yes, because we have to take that long term view, the innovators that are the pivoted to new products or have really responded to the needs of the world right now. They're often their businesses, and they need to have long term perspective, although in the short term, these markets are highly unstable. We don't know what's going to happen. And the learning from trying to balance those two things, will hopefully create greater resilient systems in the future.

Giulia Barbareschi  38:34

That's really interesting. Thank you so much, Ben Oldfrey. It was great to hear how the pandemic has not just caused an immense level of hardship across the world, but also created new networks of international collaboration, more direct pathways for innovation that can be leveraged not only to address the needs of today, but also to create a better future for tomorrow. I invite the listeners to check out the podcast page on the website InnovationAction.org, where they will be able to find the links provided by our guests to access more information about the past, present, and future of the UCL-Ventura CPAP and the COVIDAction data challenge. Thank you so much for listening to the second episode of the Innovation Action Insight, a space where we share stories of innovations and innovators working to address global challenges for social good. In the next episode, we'll be talking about sustainability and how more environmentally conscious innovations are crucial to address the challenges that our planet is facing.