In its preparations for a worst-case coronavirus scenario in Israel, the state bought some 15,000 ventilators for around 1 billion shekels ($290 million), but only a small number have been supplied so far – and some of the breathing machines that have been provided are of poor quality.
According to a number of hospital officials, some attempts have been made to resell them to developing countries. Also, much of the personal protective equipment that was bought for around 750 million shekels has been found to be substandard.
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Most of the state’s purchases of equipment and materials for the coronavirus pandemic have been made by defense officials in a race to build up inventories, mainly for the country’s hospitals.
In March, the Defense Ministry’s Department of Production and Procurement was brought in to help in the effort. The command and control center that was set up in early March and headquartered at Sheba Medical Center headed the buying spree. The command center was led by Mossad chief Yossi Cohen in cooperation with public health and Defense Ministry officials.
The Defense Ministry bought medical equipment worth more than 3 billion shekels including ventilators, oxygen concentrators, medication and large quantities of laboratory equipment and materials. This sum does not include equipment purchased independently by some hospitals and health maintenance organizations.
The list of equipment bought by the Defense Ministry for the health system since the outbreak of the pandemic in Israel includes quantities and the names of suppliers. The numbers, which were provided in response to a Freedom of Information request by the Hatzlacha good-government organization, show that the state paid 985 million shekels for breathing machines and oxygen generators.
Due to the worldwide competition for medical equipment and the urgency of the matter, the defense establishment became the public health system’s main purchasing arm. Medical experts guided the procurement officials to the needed equipment, set the standards and approved the equipment, all while acting within a very narrow window of time.
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The figures show that the Defense Ministry’s procurement department ordered ventilators costing 921 million shekels and oxygen generators costing some 64 million shekels. Also purchased were medical monitors (276 million shekels), laboratory equipment (643 million shekels), nasal swabs for testing (65 million shekels), medicine (176 million shekels) and coveralls, shoe covers, gowns and various types of face masks (750 million shekels).
For its part, the Health Ministry said 1,699 ventilators had arrived in Israel, 10.6 percent of all ventilators purchased.
It said that “all protective equipment is checked by expert means ... before the process of recording and storage and approval by the Standards Institute.
“All the complaints that were received regarding defective equipment were dealt with and [the equipment was] immediately replaced. Most of the complaints were found to be incorrect and the equipment was in working condition.”
It said that at hospitals, any equipment that needed to be replaced was replaced immediately, adding that gear that did not undergo repairs and expert testing was returned to the supplier’s country of origin.
'Africans don't buy junk'
At the beginning of the crisis, the ventilators used to treat severely ill coronavirus patients were a key component of the preparations for handling the pandemic. As a result, they starred on the control center’s shopping lists.
The fear of untold numbers of patients needing ventilators led to a shopping expedition that involved many Israeli and foreign organizations and suppliers. There were also a number of initiatives to develop and make breathing machines in Israel, including by military manufacturers.
The Health Ministry allocated the ventilators to hospitals around the country according to their needs. Sources at hospitals and in the public health system say that at least some of these machines were substandard, and that in some cases hospitals refused to use them.
“Israel bought ventilators whose quality was so low, and for an enormous price, that no hospital wanted them,” said an official at a hospital that refused the devices and purchased others on its own. “According to people at the Defense Ministry, a large part of the equipment went into the trash,” said the official, who spoke on condition of anonymity.
He said Defense Ministry officials even tried to offload the ventilators, approaching a medical supply company that does business in certain African countries. “They were told that Africans don’t buy junk,” the hospital official said.
According to a person familiar with the purchasing process, “There are various levels of machines, and it’s correct that some of the ones that were delivered are the kind that people prefer less to work with, but they can be used if necessary."
“A lot of things were done on the fly, and people didn’t fully know about the damage caused by the virus. Overall, not only with ventilators, because all sorts of dealers and suppliers who don’t understand came in, and the Chinese market – where most of the equipment comes from – opened up, it was clear that a lot of things that were bought were poor-quality. A very large number of ventilators was bought, out of the belief that not everything would be delivered.”
Professionals, including senior emergency and intensive care physicians at hospitals, set the standards, evaluated the devices and even rejected certain types of ventilators. But a number of command-and-control-center personnel who were involved in the purchases dismiss the claims about subpar breathing machines.
“Everything that was ordered was examined very thoroughly, in laboratories and clinically, and only what was found to be high-quality was approved for purchase and for future use,” said one of the professionals involved in the purchase of ventilators. “We don’t compromise on quality because of quantity.”
According to a different person who took part in the acquisition process, “Under the very difficult conditions in which the system operated and the strict limitations of even the possibility of buying equipment when many countries embargoed the export of respiratory equipment, it definitely seems to me that the best was done. More than a few respiratory specialists were brought in, experts in purchasing ventilators, technologists and others.”
Masks from the dollar store
Another important part of increasing equipment supplies was personal protective equipment for medical personnel, which at the height of the crisis was in high demand all over the world. Israel operated in nearly every arena to quickly increase its inventory of these items, from military procurement organizations to medical supply companies and the civilian market, using various traders and importers.
The purchase list for protective equipment includes a wide range of suppliers. One of them was the Max Stock chain of dollar stores, from which face masks, coveralls and shoe covers for medical personnel totaling some 60 million shekels were bought.
“At first there simply wasn’t anything, and over everything that was bought the decision on whether or not to buy had to be made in seconds, otherwise someone else would snatch it from you,” said Prof. Yehuda Carmeli, chief of the epidemiology division at the National Center for Infection Control and Antibiotic Resistance. He was an adviser to the command and control center in purchasing protective gear.
“During that period, the prices constantly rose, and an item that usually costs 70 cents cost $5, and a decision had to be made in real time because you didn’t know if tomorrow the price would be $5.50 or if it would even be available,” Carmeli said.
“Efforts were made to guarantee the quality to the extent possible, but in such conditions you don’t always see the product itself, and sometimes you’re forced to buy on the basis of certifications. Even after the equipment was purchased, it had to be insured until it reached Israel – countries stole from one another, and gangs of thieves also tried to grab the equipment.”
A number of hospital officials and suppliers said the rapid purchase of the protective equipment came at a cost. “More and more hospitals, and some of the HMOs, complain that the protective equipment is totally substandard, that gowns and masks tear easily,” said a person involved in procurement in the public health system.
“There’s tons of equipment that came from China, and the more it’s used we see that a lot of the protective equipment is very poor-quality.”
He said one problem is that many suppliers from outside the area of medical equipment entered the market. “Some suppliers had no experience or understanding in the industry vis-a-vis companies in China, some of which may not have even been licensed to manufacture this kind of equipment,” he said. “It’s starting to come out; some medical personnel complain about the quality of the protective equipment.”