‘Code Red’ Oxygen Shortages in 32 Countries; But with Finance Available Countries Need to Step up to Bat
Numerous countries are facing oxygen shortages, while readily available oxygen products are in short supply.

As some 32 countries worldwide, including seven African nations, face “code red” oxygen shortages, WHO and its partners are in the midst of a major effort to recruit sufficient supplies to meet countries’ urgent needs for life-saving oxygen.  

But while over US$500 million is now available in funds and finance for oxygen through the Access to COVID-19 Tools (ACT) Accelerator initiative, many African countries at risk of oxygen shortages have yet to apply for available funding to bolster their oxygen supplies – including Algeria, South Africa and the Democratic Republic of Congo.  

Delays in asking for funding, or asking for the wrong mix of supplies, can make response to oxygen demand surges an even bigger challenge, warned experts at an event Thursday co-organised by Unitaid, Waci Health, and the Every Breath Counts partnership, a coalition of UN agencies, businesses, donors and NGO.

They urged countries to fine-tune requests and accelerate their applications to meet the next deadline for financing requests – as well as to fine-tune demands to ensure a faster and more flexible response to shortages – including a “very dire” situation in some African nations.

‘Very dire’ situation in Africa

Globally 70 countries are at risk of oxygen shortages. Surges in COVID cases – due in large part to the Delta variant (B.1.617.2) – and hospitalizations are overwhelming health systems and driving up deaths.  

Among the African countries facing dangerous levels of oxygen shortages are: Ethiopia, Nigeria, Ghana, Benin, Togo, Cote d’Ivoire, and Somalia. Meanwhile, Somalia and nine other African at-risk countries have yet to even apply for funding for oxygen supplies. They include: Algeria, Libya, Mauritania, Guinea, the Democratic Republic of Congo, South Africa, eSwatini, Mozambique, and Botswana. 

As a result of health systems lacking oxygen and other supplies needed to manage serious COVID cases, the African region is also witnessing “worrying mortality trends,” according to WHO. Last week eight African countries reported increases of over 50% in weekly deaths.

“[There are] large and critical surges in the need for oxygen and too many unacceptable deaths [have been] associated with the lack of access to it,” said Robert Matiru, Director of Programmes at Unitaid, at the event.

Robert Matiru, Director of Programmes at Unitaid, at an event on Thursday co-organized by Unitaid, Every Breath Counts, and Waci Health.

“Medical grade oxygen is one of the most critical medicines for people with severe and critical COVID-19…but unfortunately it is not something that is readily available,” said Dr Raji Tajudeen, Head of the Division of Public Health Institutes and Research at Africa Center for Disease Control and Prevention (CDC). “When oxygen is available, the cost is prohibitive.”

Financing requests exceed available oxygen supplies 

The ACT-Accelerator’s COVID-19 Oxygen Emergency Taskforce, which was launched in February, has mobilised over US$340 million for oxygen-related products in low- and middle-income countries (LMICs) through the Global Fund’s COVID-19 Response Mechanism (C19RM)

In addition, some US$182 million has been donated to the therapeutics pillar of UNICEF’s Access to COVID-19 Tools Accelerator Supplies Financing Facility (ACT-A SFF). The finance mechanism is dedicated to the procurement and delivery of therapeutics for LMICs, including oxygen. 

But while this represents significant progress toward ACT-A’s goal of raising US$1.2 billion for COVID oxygen needs – bottlenecks in the manufacture of oxygen cylinders and long lead times required for the construction of large-scale pressure swing absorption (PSA) oxygen generating plants are delaying the acute deployment of crisis support, officials said. 

Challenges faced by the Access to COVID-19 Tools (ACT) Accelerator’s COVID-19 Oxygen Emergency Taskforce to address the immediate demand surges in oxygen.

“Even though it’s really encouraging news that we have almost US$340 million awarded, we don’t have enough supply to meet that once procurement and delivery actually begin,” said Robert Matiru, Director of Programmes at Unitaid, at the event on Thursday.

“That is why it’s really critical to already be putting in place interventions to accelerate procurement and delivery and also medium-term measures to ensure that these lead times are cut dramatically for subsequent suppliers and awards,” he added.

Countries urged to fine-tune demands & prioritise oxygen sourcing options that could accelerate access

A breakdown of the approved funding requests from the Global Fund’s COVID-19 Response Mechanism (C19RM).

He urged countries to fine-tune their oxygen supply plans and finance requests accordingly – by considering a wider range of oxygen supply options.

Rather than prioritizing the construction of new PSA facilities, which take a long time to build, countries should consider alternatives like the repair of existing PSA systems, and procurement of bulk liquid oxygen supplies, Matiru said.

“Once you have massive surges, you really need a larger generation capacity and a larger supply capacity than PSA can provide,” said Matiru. 

Procurement of liquid oxygen, which can be stored in bulk at facilities or converted to oxygen cylinders for delivery, may be the fastest way to increase oxygen supply in countries that have existing supply lines for deliveries, he said.

Repairing existing PSA plants may also be more cost-effective and faster than constructing new facilities, as new plants can cost up to US$250,000 and take three to 12 months to complete. 

Algeria, DRC, South Africa and other countries yet to apply for oxygen support finance

In addition, more LMICs should be encouraged to apply for funding for oxygen supplies through the Global Fund’s COVID-19 Response Mechanism, said Matiru.

The deadline to submit the financing request is fast approaching on 17 September, he warned, urging countries to meet it.

Officials from organisations on the ACT-A taskforce also said that there was room for improvement among partners in their coordination of efficient procurement and delivery services. 

“We know as a taskforce we need to be more effective as partners to more effectively attract demand, financing, technical cooperation, and supply, so that we can ensure tight coordination, avoid duplication and be efficient with these resources that are being channelled at unprecedented rates in countries,” said Matiru.

Building local technical and manufacturing capacity – avoiding ‘white elephants’

Along with increasing the supply of oxygen products, building technical capacity and human capital is essential for the sustainable continuation of oxygen infrastructure, said the experts. 

Investing in the health workforce, and expanding biomedical human capital in member states, is important for the service and maintenance of oxygen services and facilities. 

“This unprecedented amount of equipment and supplies has to be maintained and sustained,” said Matiru. “We can’t afford to have white elephants and not sustain the benefit of these investments through this pandemic and even beyond this pandemic for the critical needs we know are out there and predated this pandemic: childhood pneumonia, trauma, complications in childbirth, sepsis and so on.”

One of the key steps moving forward is investing in local manufacturing capacity and developing a “new public health order” in Africa, said Tajudeen.

Dr Raji Tajudeen, Head of the Division of Public Health Institutes and Research at Africa Center for Disease Control and Prevention (CDC).

“To guarantee continental health security, we cannot continue to rely on importation of [oxygen products] from the outside,” Tajudeen said. 

“We know that with new COVID-19 waves there will definitely be new variants,” he added. “And with the low level of vaccine coverage on the continent, we need to continue to make the case for the investment in medical grade oxygen.” 

Some 2.8% of the African population are fully vaccinated, compared to 47.7% in Europe and 42.3% in North America. 

“Going forward [we] really need to begin to look at investing in an oxygen infrastructure so that people with severe COVID and those who…cannot afford oxygen will be able to have access to this oxygen,” said Tajudeen.

Image Credits: WHO/Blink Media – Nada Harib, UNICEF/Ralaivita, Unitaid.

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