By Evan Henry

When it became obvious that COVID-19 was to utterly change how we live, few would have predicted that a company from Galway could play an instrumental role in returning life across the world to normality. Aerogen, an Irish medtech company, produces a drug distribution system that delivers medicine through aerosols in acute hospital settings. John Power, Aerogen’s CEO, formed Cerus Medical in 1997 when he recognised a major gap in the technologies used to deliver drugs in hospitals. While life-support machines were among the most advanced medical technology used in hospitals, the drug-delivery systems that assisted these machines were developed over fifty-years ago. Power believed there were better ways to target the delivery of drugs, and it was common knowledge that drugs are efficiently administered by ingestion through the lungs. Cerus Medical merged with Aerogen Inc. in 2000 and launched its first nebulisation product, the Aerogen Pro shortly afterwards. Twenty years on and the company exports to more than 70 countries and their products are used in 60 of the top one-hundred hospitals in the world, benefitting over ten million patients. Its clients include Medtronic, GE Healthcare and Philips Healthcare.

Aerogen and COVID-19 So Far

Aerogen was overrun when COVID-19 broke out, given the huge demand created for ventilators by the respiratory illness. In fact, Aerogen’s products were in greater demand  than those of competitors because they are the largest producer of closed-circuit nebulisation system devices on the market. A closed-circuit nebulisation system is one that delivers gaseous drugs to patients while leaving ventilation uninterrupted (Medical-aerosols), ensuring that healthcare workers are not exposed to any gases exhaled by the patient (patient-generated Bio-aerosols). Closed-circuit nebulisation devices are far safer and more efficient than conventional nebulisation devices. Aerogen is also working with various hospitals and research groups to adapt ventilators unsuitable for COVID-19 patients. Along with this, the company is involved with more than 20 drug companies and research institutions that deliver antivirals and drugs to patients in ICUs. Power has predicted that Aerogen will move around four million units this year, up from two million in 2019. But despite the outstanding role played by Aerogen in the treatment of COVID-19, the delivery of its cure could be the company’s true magnum opus. 

An Emerging Alternative to Liquid Vaccines

The race for a COVID-19 vaccine has left the pharmaceutical industry in a frenzy, with dozens of companies and research groups competing to produce the immunisation treatment. While a vaccine could potentially be produced by the end of 2021, the timeline is still unclear. The only certainty surrounding the vaccine is that demand for it will exceed supply, likely by a substantial margin. However, Aerogen claims to have the solution to this problem. On RTÉ’s The Business programme, Power revealed that Aerogen is also working with “a leading [unnamed] pharmaceutical company” to produce and distribute an aersolised vaccine. If successful, this will reduce the quantity of dosage required per patient, because drugs ingested through the lungs are generally absorbed more efficiently by the body.

How would aerosolisation address the supply-demand inequity that will occur when a vaccine is finally approved? The inequity will be caused by two things: an insufficient number of doses and an inability to accommodate massive numbers of people gathering to seek vaccination. Should Aerogen’s efforts bear fruit, they will provide meaningful solutions to the issues facing both sides of the market. The first piece of the mass vaccination puzzle Aerogen hopes to solve involves providing enough doses to meet demand. The company predicts that their partners will produce around 500 million liquid doses by the end of 2021, which is a far cry from the amount required to eradicate the virus. However, if a liquid vaccination can be aerosolised, Aerogen predicts that only a fifth of the amount of medicine will be required to treat the patient. If their estimates are accurate, the result would be two and a half billion doses available by the end of 2021. This number will not result in universal immunisation, but it would nonetheless reduce the virus’ rate of spread. The outcome would be fewer new cases, fewer deaths and reduced pressure on healthcare systems worldwide. However, from the initial solution to vaccine shortages springs another challenge: distribution. How can two and a half billion people be vaccinated in a safe, timely and cost-effective manner? Speed of delivery is imperative the alleviation of not only suffering, but also of pressure on healthcare systems. Aerogen claims to have found the answer to this inevitable complication.  The company has developed a station for the aerosolisation of a vaccine which will allow patients to be vaccinated in a quick and orderly fashion. If the station is employed, their estimates, based on data collected from Chinese COVID-19 treatment procedures, predict that 2.5 billion people could be vaccinated in 39 days if ten-hour shifts are worked at 55,000 centres. Such rapid and systematic delivery of a COVID-19 vaccination is as much as anyone could hope for.

Can It Be Done?

The size and scale of Aerogen’s ambitions are clear. They hope to have roughly one-third of the world’s population vaccinated by the end of 2021. Of course, any discussion of a COVID-19 vaccine and its distribution is a mother lode of suspicion and further questions. Will a vaccine even be produced at all, never mind by the end of 2021? If so, can it be aerosolised? Will aerosolisation really require only a fifth of a liquid dose’s quantity? Will aerosolisation prove to be more or less effective than liquid vaccinations? Can other countries work as efficiently as the Chinese in their administration of a vaccine? Will the vaccine be affordable? All of these questions raise valid points and will undoubtedly be the subject of future debate. The honest answer to most of them for now is that we simply do not know. What we do know is Aerogen is one company making substantive strides towards returning life to something like its pre-COVID configuration. Time will tell us whether or not it succeeds.