John Minchillo/AP Photo
Centralized and fragile repair systems cannot respond to the systemic shock of a global pandemic.
From face mask shortages and empty grocery shelves to diminished rural hospital capacity and offshored drug production, the novel coronavirus pandemic has exposed the dire consequences of economic choices that for decades prioritized shareholder fortunes over community resilience.
One of the most reckless profiteering trends has been restrictions on repair that force consumers to use original manufacturers’ repair services so that manufacturers can extract additional revenue during the lifespans of their products. Corporations have unleashed a bevy of design and legal tactics during the past several decades to prevent people from fixing things they own, as detailed in a new report by the Open Markets Institute. These include refusing to make parts, tools, and manuals available, installing locks on embedded product software, or leveraging intellectual property rules and contracts to prevent or punish “unauthorized” repair. Corporations deploy these tactics in virtually every industry, whether consumer electronics, farm equipment, military weapons, or, in the case of COVID-19, medical equipment.
During the pandemic, public officials and health care providers have run into repair monopoly barriers such as long wait times, limited traveling technicians, and patented parts, as they scramble to bring more medical repair in-house and build arsenals of critical equipment, including lifesaving ventilators. Major manufacturers such as General Electric, Fisher & Paykel, and Medtronic recently caved to advocates’ urging to make some manuals and repair information public or available by request. But Medtronic, for instance, has yet to make all its ventilator manuals available, and other ventilator manufacturers, including Vyaire Medical and Dräger, still have restricted access to manuals. In the meantime, Good Samaritans are exposing themselves to legal risk by publishing medical device manuals, jail-breaking continuous positive airway pressure (CPAP) machines to function as ventilators, or 3D-printing missing parts.
“[Manufacturers] built this fragile monopolized system. It drove up health care costs, it didn’t provide benefit to anyone other than their shareholders, and now it is a point of failure in a crisis,” says Nathan Proctor, Right to Repair campaign director for the U.S. Public Interest Research Group. “We should never have permitted it, but now we need to move away from it.”
Even before COVID-19 began to overwhelm health care systems, providers were raising concerns about costly and slow medical device repair. Original equipment manufacturers (OEMs) can sometimes charge between 10 and 15 percent of the original product cost just for repair service contracts. This model relies on a handful of traveling technicians, who sometimes serve large multi-state regions, to come in and fix equipment. Alternatively, health care providers must ship equipment back to a central warehouse for repair.
In the face of COVID-19, health care providers have prohibited visits from traveling techs who could be disease vectors, making the ability to complete repairs in-house even more critical.
In-house or third-party repairs can be anywhere from 30 to 50 percent cheaper and, more critically, much faster than waiting for OEM technicians or shipping equipment. And in the face of COVID-19, health care providers have prohibited visits from traveling techs who could be disease vectors, making the ability to complete repairs in-house even more critical.
But software locks and lack of access to service manuals, parts, and authorized trainings have limited independent and in-house medical device technicians’ ability to provide cheaper and timelier repairs. “In many cases these tools are not provided unless service agreements, training, dongles, or passwords are purchased. Usually all of these are relatively expensive,” one hospital system explained in a comment to the Food and Drug Administration.
These centralized and fragile repair systems cannot respond to the systemic shock of a global pandemic. For instance, when the state of California sought to refurbish its stockpile of idle ventilators, one service provider said it would take a month to fix them. The state circumvented this bottleneck by enlisting a fuel-cell corporation to take up repairs. The corporation, Bloom Energy, trained their team in ventilator repair with the help of a manual that the CEO said they received in a direct agreement with the manufacturer and fixed 170 ventilators over the course of one weekend. Repair advocates want these critical guides to be widely available, so more engineers and technicians can follow in Bloom Energy’s footsteps.
The repair resource iFixit has answered the call by crowdsourcing a medical device repair database, but making these guides available could expose them to a copyright violation suit. This also holds true for one biomedical repair technician in Tanzania, Frank Weithoener, who has been sharing medical equipment manuals and providing repair training for hospital technicians for many years. These resources are particularly critical in the developing world, where half of all medical equipment is unusable at any given time, according to World Health Organization estimates, and repair by original equipment manufacturers is not accessible. But Frank’s website has drawn several legal threats and takedown notices from equipment manufacturers.
Unfortunately, medical devices are far from the only critical items with a fragile, monopolized repair system. Cellphones and laptops are especially crucial as more people work from home, but consumers have fewer places to turn, as a limited number of authorized repair entities close up shop. In Minneapolis, for instance, the nearest open iPhone repair shop is 200 miles away in Sioux Falls, South Dakota, forcing consumers to wait for mail-in repairs. And anyone who brought an Apple device into a store for repair cannot pick it up now that stores have closed. Farmers are also worried about longer wait times for yearly spring tune-ups, as dealerships limit hours and technicians fall sick. This could further strain an already cracked food supply chain.
Right to Repair activists are at the forefront of solving our nation’s repair crisis and helped get legislation introduced in 20 states last year that would require manufacturers to make critical parts, tools, and software available to independent technicians. These bills are modeled, in part, on a 2013 Massachusetts statute that made these tools available in auto repair.
Federal and state antitrust authorities can also step up and utilize existing laws and legal precedents to break repair monopolies. In 1992, the Supreme Court allowed plaintiffs to sue manufacturers for monopolizing product aftermarkets, and another Supreme Court precedent prevents conditioning the purchase of one product or service on another, which could apply to tying goods to repair service contracts. Prosecutors could also use the Sherman Antitrust Act to challenge product design changes that unlawfully extend or entrench market power. The Federal Trade Commission can use its broad rule-making authority to prohibit “unfair methods of competition,” such as repair restrictions.
We have seen regulators make an endless series of changes to federal rules to make allowances for business during the pandemic. Accelerating the number of usable ventilators and other medical supplies in circulation by opening up repair markets should be at the top of that list.
Monopolized repair has made the COVID-19 crisis worse, but we can learn from this calamity to build more resilient and self-reliant communities. Open and accessible repair must be a critical component of this better future.
