Covid-19 claimed the lives of at least 18 million people, and no one can guess how many of those deaths were due to a lack of medical oxygen. Governments don’t want to talk about the issue because it could mean admitting that thousands, or even hundreds of thousands, of their citizens died unnecessarily. But unless health systems take steps to ensure adequate oxygen supplies in the future, they risk repeating the past two years.
While high-income countries are already struggling to secure their medical oxygen supply, many low- and middle-income countries (LMICs) will continue to need international support. Deaths from lack of medical oxygen in these countries preceded the pandemic because global health and development agencies made no serious effort to help LMIC governments close the gap between need and l ‘offer.
This gap is one of the factors underlying the stubbornly high infant and child mortality, adult deaths from infectious and chronic diseases, and deaths from injuries requiring surgery. Research published before the pandemic found that four out of five children hospitalized with pneumonia in Nigerian hospitals were not getting the oxygen they needed, and that simply putting oxygen on pediatric wards could reduce 50% child deaths.
As the World Health Organization’s Mike Ryan puts it, Covid-19 ripped a bandage from an old wound, increasing the need for oxygen tenfold in the space of a few weeks in some countries. LMICs now need around 500,000 large cylinders of oxygen every day to treat patients with Covid-19, and that’s just the tip of the iceberg. For every Covid-19 patient who needs oxygen, there are at least five other patients who also need it, including the 7.2 million children with pneumonia who enter LMIC hospitals each year.
The main vehicle for the international response is the ACT-Accelerator (ACT-A) Covid-19 Emergency Oxygen Task Force, expertly chaired by Unitaid, which has put in place a system to help LMICs to prevent oxygen shortages. To date, the task force has provided nearly $1 billion, including $560 million from the Global Fund alone, to LMIC governments and their UN and NGO partners. This money was spent on liquid oxygen, pressure swing absorption oxygen generating plants, mobile oxygen concentrators, oxygen therapies and the labor required to install, operate and maintain the equipment. .
This funding has helped more than 100 countries, mainly in Africa and Asia. But there are still LMICs struggling to provide oxygen, so the task force has requested an additional $1 billion in 2022. US President Joe Biden’s second Covid-19 Global Summit this week will also put the focus on the issue with a call for governments, businesses and philanthropies to do more.
The arguments to present to donors are clear. There is a moral obligation to treat patients with Covid-19 and flatten the pandemic mortality curve once and for all. Investments in oxygen will serve this purpose and also save lives in the future. Not only is oxygen an essential treatment for almost all of the health conditions targeted by the United Nations Sustainable Development Goals; it is also an essential pillar of effective pandemic preparedness and response (PPR).
As the world moves towards long-term management of Covid-19, oxygen production and delivery systems will need to be integrated into the global health infrastructure. International organizations with a mandate to improve infant and child survival, the management of infectious and chronic diseases and PPR all have a stake in access to oxygen. These agencies should formalize their fledgling partnership on oxygen ACT-A by transforming it into a Global Oxygen Alliance with a mandate extending to 2030 (to align with the SDGs) and with an expanded membership to include international agencies focused on chronic diseases.
There are five components to a successful alliance to bridge the oxygen access gap. First, LIC-MIC governments and national institutions responsible for providing medical oxygen must take the lead. Ideally, they would be guided by politically endorsed national oxygen access plans, with governments funding the effort through their health budgets.
Second, LMIC governments that need external support to fund their national plans should be able to mobilize loans and grants from a variety of multilateral, bilateral and philanthropic sources. The Global Fund should continue to provide grants under its new PPR objective, and multilateral development banks should also provide loans for this purpose.
Third, oxygen producers should be given more incentives and opportunities to work in partnership with LMIC governments and global health and development agencies. Memoranda of understanding, non-disclosure agreements and transparent and competitive bidding for the purchase, installation and maintenance of equipment should all be made available, building on the existing plan of the ACT-A Covid-19 Oxygen Emergency Task Force for Industry Partnerships. Additionally, development finance institutions should provide loans, equity and guarantees to oxygen producers and support LMICs seeking to reduce their dependence on oxygen imports and fragile global supply chains.
Fourth, UN agencies and NGOs with a strong presence in LMICs should continue to support these governments in developing national oxygen plans, collecting data, sourcing supplies, training health and biomedical engineers, and monitoring and evaluating progress. To do so, they will need continued funding from bilateral development agencies (such as USAID, the European Commission, and others) and philanthropic organizations (such as the Bill & Melinda Gates Foundation, the Skoll and others).
Finally, LMIC governments must have access to timely, high-quality data on national oxygen needs, such as the annual number of hypoxemic patients and the amount of oxygen they need, and the oxygen capacity of the system. of health in order to be able to make up for the shortfalls quickly. Donors should invest more in national health surveillance and statistical institutions, while using available data to generate estimates of the burden of hypoxemia as part of the global burden of disease. And independent agencies like the Access to Medicine Foundation should be funded to hold the oxygen industry accountable.
The next six months are critical as we move beyond the acute phase of the pandemic. Ideally, by September, the ACT-A Covid-19 Emergency Oxygen Task Force will have evolved into a Global Oxygen Alliance, chaired by Unitaid and continuing to meet regularly to coordinate investments, mobilize resources and monitor the impact of efforts to ensure equitable access to essential medicine.