Market evolution: Therapeutic respiration apparatus (CN 9019) — 2015–2025

Introduction

This report examines the evolution of EU external trade in products classified under customs heading CN 9019, which encompasses mechano-therapy appliances, massage apparatus, psychological aptitude-testing apparatus, and — critically — ozone, oxygen, aerosol therapy, artificial respiration, and other therapeutic respiration apparatus. Over the 2015–2025 period, this market was shaped by a powerful combination of structural growth in global demand for medical devices and a dramatic exogenous shock: the COVID-19 pandemic, which caused an unprecedented surge in demand for respiratory equipment in 2020–2021. The EU's position evolved from near self-sufficiency to one of significant import dependence, with China emerging as the dominant supplier. Meanwhile, the EU's own production capacity expanded substantially, and export unit values remained well above import prices, reflecting a high-value-added manufacturing profile.

1. Pandemic-Driven Boom and the Long Tail of Structural Growth

1.1 Overall trade expanded strongly, with imports outpacing exports

Between 2015 and 2025, the EU's extra-EU trade in CN 9019 products grew significantly in both directions. Exports rose from €1.06 billion to €1.76 billion (+65.2%), while imports climbed from €1.57 billion to €2.74 billion (+74.0%). The EU thus remained a net importer throughout the period, with the trade deficit widening from €508 million to €978 million — nearly doubling over the decade.

A notable structural feature is the persistent price differential: EU export unit values are roughly 3.6 times higher than import prices, indicating that the EU specialises in high-value therapeutic and respiratory equipment while importing larger volumes of lower-cost products, particularly from Asia.

1.2 The COVID-19 shock: an extraordinary demand spike in 2020–2021

The most dramatic event of the decade was the COVID-19 pandemic. In 2020, EU imports of CN 9019 products surged to €4.07 billion — nearly 2.6 times the 2015 level and by far the peak of the entire period. Import volumes reached 239,772 tonnes, again the maximum observed. Exports also spiked to €2.45 billion and 53,396 tonnes, their respective peaks.

The segment data reveals that this surge was overwhelmingly concentrated in subheading 901920 — therapeutic respiration apparatus including ventilators. Import values for 901920 alone leapt from €1.20 billion in 2019 to €2.98 billion in 2020, while export values jumped from €1.03 billion to €2.11 billion. The 901910 segment (mechano-therapy, massage, and psychological testing apparatus) saw a more moderate increase, with its import peak arriving in 2021 at €1.77 billion.

Unit prices tell a striking story of scarcity. The average import price for 901920 products surged from €48,979/t in 2019 to €92,983/t in 2020 — nearly doubling — before collapsing to €29,107/t in 2021 as global supply expanded and emergency demand subsided. By 2025, prices had partially recovered to €39,212/t, still below the 2019 pre-crisis level. A similar, though less extreme, pattern is visible on the export side, where 901920 export prices peaked at €137,797/t in 2020 before falling sharply.

1.3 Post-pandemic normalisation left trade above pre-crisis trends

After the extraordinary years of 2020–2021, trade volumes and values normalised but settled at levels well above the 2015–2019 baseline. By 2025, imports (€2.74 billion) were roughly 1.7 times their 2015 value, and exports (€1.76 billion) were 1.65 times higher. This suggests that the pandemic not only created a temporary shock but also accelerated an underlying growth trajectory — driven by ageing populations, expanding healthcare infrastructure in emerging markets, and growing consumer interest in wellness and home-care devices.

2. Deepening Import Dependence and the Concentration Risk from China

2.1 The EU's net import reliance rose dramatically

Perhaps the most consequential structural shift over the decade was the sharp increase in import reliance. The net import reliance ratio — measuring the share of domestic consumption satisfied by imports — rose from just 6.3% in 2015 to 31.0% in 2025, an increase of 392%. At its peak during the pandemic (2020), this ratio reached 75.8%, reflecting the extreme surge in respiratory equipment imports. While the ratio subsequently declined, the 2025 level remains structurally elevated, indicating that the EU has not fully returned to its pre-pandemic degree of self-sufficiency in this product category.

2.2 China became the overwhelmingly dominant supplier

The partner data reveals a dramatic concentration of EU imports around China. Chinese exports to the EU in CN 9019 products grew from €514 million in 2015 to €1.30 billion in 2025 (+153%), but the trajectory was far from linear. During the pandemic, Chinese shipments to the EU peaked at an extraordinary €2.38 billion in 2020 — accounting for 77.8% of the import price shock value share that year.

By contrast, other major import partners showed more modest evolution:

Singapore (+205%) and Mexico (+170%) registered the highest growth rates, though from lower baselines, and may partly reflect re-routing of Chinese-origin goods or regional assembly hubs. The United States, the second-largest supplier, actually saw a decline of 18.2% in its exports to the EU over the period.

2.3 Import concentration intensified, raising strategic vulnerability

The Herfindahl-Hirschman Index (HHI) for EU imports by value rose from 1,758 to 2,632 (+49.7%), crossing into territory that many analysts consider moderately concentrated. This increase is almost entirely attributable to China's growing share. The pandemic amplified this dynamic: the import HHI peaked at 3,630 in 2020 before declining. Such concentration poses a strategic vulnerability — particularly for therapeutic respiration apparatus, a product category with clear public health implications — and aligns with broader EU policy discussions around supply chain diversification and strategic autonomy in medical devices.

The volume-based HHI also rose (from 5,286 to 6,338, +19.9%), confirming that the concentration dynamic is not merely a price effect but reflects genuine volume dominance by a small number of suppliers.

3. EU Production Expansion and the Two-Speed Segment Structure

3.1 EU production capacity grew remarkably over the decade

The EU's domestic production of CN 9019 products expanded enormously. Production value rose from €240 million in 2015 to €1.63 billion in 2025 (+581%), while production volumes measured in units grew from 1.2 million to 474 million pieces. These figures likely reflect both organic capacity expansion — partly stimulated by pandemic-era investment — and the inclusion of new production lines for respiratory and therapy devices that were scaled up during the health crisis.

This expansion is consistent with the EU's strong export performance: export propensity (exports as a share of production) grew from 84.8% to 109.0%, indicating that EU producers have increasingly oriented themselves toward global markets, exporting more than their total domestic output (accounting for re-exports and intra-EU flows).

3.2 The two subheadings tell different stories

The product segment breakdown reveals that CN 9019 contains two fundamentally different product families with distinct trade dynamics.

901910 (mechano-therapy, massage, and psychological aptitude-testing apparatus) is a volume-driven segment. EU imports grew from 78,247 tonnes to 121,230 tonnes (+55%), while the average import price remained in the range of €7,900–€11,600/t — relatively low and stable. This segment reflects the mature, commoditised end of the market: consumer wellness devices, massage equipment, and standardised therapy appliances, sourced predominantly from Asian manufacturers.

901920 (therapeutic respiration apparatus including ventilators, oxygen therapy, and parts/accessories) is a value-driven, high-volatility segment. Import volumes grew from 23,983 tonnes to 38,525 tonnes (+61%), but import values spiked far more dramatically — reaching €2.98 billion in 2020 alone, driven by emergency procurement of ventilators and respiratory equipment. Unit prices in this segment are 3–4 times higher than in 901910, reflecting the technological sophistication and regulatory requirements of medical-grade respiratory devices.

The 901920 segment's price spike and subsequent normalisation is the clearest fingerprint of the COVID-19 crisis in the data. By 2025, import prices had returned close to pre-crisis levels, but volumes remained elevated — suggesting a lasting increase in baseline demand for respiratory care equipment, potentially linked to Long COVID awareness, expanded ICU capacity, and ageing demographics.

3.3 The EU maintains a competitive edge in specialised, high-value exports

The specialisation analysis shows that several EU member states display strong revealed comparative advantage in CN 9019 products. The Netherlands (RSCA = 0.42), Ireland (0.28), and Czechia (0.19) lead the ranking, followed by France and Romania. These countries are home to major medical device manufacturers and serve as export hubs for therapeutic equipment.

On the export partner side, the United States and United Kingdom remain the two largest destinations, with exports to the US growing from €188 million to €429 million (+128%) and to the UK from €162 million to €324 million (+100%). Norway (+194%) and Türkiye (+58%) also showed strong growth. Conversely, exports to China fell by 42% and to Russia by 20%, the latter likely reflecting geopolitical sanctions following 2022.

The export HHI remained lower than the import HHI (1,117 vs. 2,632 in 2025), indicating that EU exports are more diversified across partners than imports — a more resilient structure from a vulnerability standpoint.

Conclusion

The EU market for CN 9019 products underwent a transformational decade between 2015 and 2025. Beneath a headline story of robust trade growth (+65% for exports, +74% for imports), the most significant developments were structural. The COVID-19 pandemic acted as both an accelerator and a stress test: it triggered an extraordinary demand spike for therapeutic respiration apparatus (901920), exposed the EU's heavy reliance on Chinese suppliers, and ultimately stimulated a substantial expansion of EU domestic production capacity. By 2025, the EU's net import reliance had settled at 31% — far above the 6% of 2015 — while import concentration toward China had intensified significantly (HHI up 50%). At the same time, EU producers retained a strong competitive position in high-value segments, with export unit values consistently 3–4 times above import prices and several member states displaying clear specialisation. The key challenge for the coming years will be balancing the efficiency gains of global supply chains against the strategic imperative of diversifying sources for medically critical equipment.