From patients lying in the parking lots of hospitals, in the back seats of cars suffocating as their family members searched frantically for oxygen in India during its second wave of COVID last year, to the inability to receive emergency care amidst constant bombing and shelling in current war-torn Ukraine, global health experts and leaders are desperately searching for ways of improving the global oxygen supply.  

At a media briefing on the issue Thursday, speakers emphasized the need for both access to oxygen on the ground and more funding to the WHO co-sponsored Access to COVID-19 Tools Accelerator (ACT-A), which is attempting to beef up oxygen supplies in low and middle-income countries. 

“Oxygen has been treated for too long like a commodity, treated as something that must be delivered,” said WHO Executive Director of Health Emergencies Programme Dr Mike Ryan, speaking at the briefing, cosponsored by the Act Acccelerator and Unitaid. 

But “oxygen is a capability, not a commodity,” he stressed. 

Rethinking oxygen’s lifesaving capacities 

Ryan and others made the case for rethinking oxygen as a health tool that requires not only a sustainable supply at a country level, but an entire ecosystem of supply and maintenance  technology and infrastructure.

Its role – and the chronic lack of capacity in many countries – has been underscored by COVID – and again in the very different setting of the Ukraine crisis – where the lack of access for people ranging from COVID patients to mothers in birth and children with pneumonia has prompted widespread alarm.  

Oxygen remains a critical component of the global COVID-19 response – 75% of patients hospitalized for COVID-19 can be treated with oxygen alone – without any further advanced care. Yet the current global supply of oxygen does not meet needs for both COVID-19 and other serious illnesses. 

“COVID didn’t cause [the oxygen shortage], COVID uncovered this. COVID laid bare, tore away the bandages from some very old wounds,” said Ryan. 

UNITAID Commits $56 million to boost access to global medical oxygen supply

The ACT-A Strategic Plan and Budget for 2022 has identified a funding deficit of $1 billion for oxygen supplies worldwide for this year alone. As a first step to closing that gap, Unitaid has announced that it will invest $56 million to increase access to medical oxygen both for short-term needs related to  COVID-19 as well as for the longer term – as a critical foundation for fighting future pandemics. 

The Unitaid pledge builds on the $50 million USAID has committed in funding for oxygen as pledged at US President Joe Biden’s Global COVID-19 Summit in September 2021. 

Four Unitaid-funded projects, designed to address global inequities in oxygen access, will be implemented by The Alliance for International Medical Action (ALIMA), the Clinton Health Access Initiative (CHAI), Partners in Health (PIH), and the WHO Health Emergencies Programme. 

These will also support the work of the ACT-A Oxygen Emergency Task Force by ensuring access to more affordable oxygen solutions such as bulk liquid oxygen, oxygen generation systems, and other important oxygen equipment. 

Unitaid called on donors, including governments, foundations, and private sector partners to join in the efforts.  

“Our call here is not just for the present, for this pandemic, but to recognize that donors and funders that come forward and step forward, over and above the generous contributors to date, will help drive a more sustainable ecosystem and [deliver] essential medicines to countries that are lacking it,” said Robert Matiru, Chair of the ACT-A Oxygen Emergency Taskforce and Director of Programmes at Unitaid. 

Children with pneumonia unrecognized victims – 40% of hospitals in some African countries lack oxygen

Children are among the unrecognized victims of the lack of oxygen supplies – with childhood pneumonia still one of the biggest killers of under-fives. 

Accounting for almost a million deaths a year, the highest burden is in sub-Saharan African and South-East Asian countries where children face a double whammy of disease from both the lack of preventive treatments, like vaccinations, along with exposure to heavy indoor air pollution from the open burning of coal, biomass and other such fuels. 

But an estimated 20 to 40% of these deaths are preventable with increased availability of oxygen therapy. 

The shortage is particularly acute in low-income sub-Saharan African countries such as Tanzania, Sierra Leone, Liberia, and Gambia, where 40% of health facilities had no access to oxygen and other basic life saving supplies, said Atul Gawande of the United States Agency for International Development (USAID).   

COVID has led to big surges in needs 

Along with the chronic shortages, COVID led to a major surge in oxygen needs. 

Low and middle-income countries (LMICs) need at least 23 million cubic meters of oxygen every day, just to treat COVID patients alone, according to the PATH COVID-19 Oxygen Needs Tracker. 

On the brighter side, the pandemic has brought a long-ignored aspect of health capacity in LMICs more to  the forefront. 

USAID is currently working in 11 countries to build ‘oxygen ecosystems’ to support oxygen therapy for pneumonia patients, COVID patients, and others, Gawande said.  

Countries like Ghana now have oxygen generating capacity that can support up to 300,000 patients per day, per year. 

Gawande noted that the oxygen ecosystem includes liquid oxygen cylinders and concentrators, as well as the clinical engineering and technical assistance to use the technology. 

But expanding this initiative to other countries still needs more funding.  

“As the Omicron variant abates, I think we’re all starting to feel that we can catch our breath. Oxygen demand may be lower right now. But it is the time that we have to make these investments to enable this kind of [sustainable] capacity.” Gawande said.  

Oxygen ‘natural security’ and ‘high-return’ health investment  

While the recent funding commitments are a positive sign, ‘it is not enough to fund protection’, said Leith Greenslade of the Every Breath Counts Coalition. 

“It took a pandemic of respiratory infection to wake up the world,” she pointed out.

In the past year, about $700 million was invested into the ACT-A Oxygen Emergency Task Force, which has worked in LMICs to prevent oxygen shortages – jump-starting a more focused response. 

But so far, only a handful of governments – including the United States, Germany, Canada, and France – have borne the funding burden. 

“But most of the G-20 nations have not stepped up to invest in oxygen,” she charged.  

Greenslade appealed to donors to see oxygen as a high priority for three reasons: the moral obligation to flatten the COVID-19 curve; oxygen as a “national security” issue in moments of crisis; and finally, oxygen as a high-return health investment that will keep on saving lives beyond the pandemic. 

“When hospitals run out of oxygen, we have seen strikes and civil unrest in quite a few low- and middle-income countries,” she pointed out. 

“How many more deaths before this is over will largely depend on access to oxygen and critical care in the countries where the disease is greatest and the health systems are weakest,” she declared.

Image Credits: Mstyslav Chernov/ Wikimedia Commons, UNICEF/Ralaivita, PATH, Every Breath Counts .