Millions of people in poor countries, even hospitals, literally died in breath at the height of the Covid-19 pandemic. What they lacked was medical oxygen, which is lacking in most parts of the world.
On Monday, a panel of experts released a comprehensive report on the shortage. Every year, the report states that over 370 million people around the world need oxygen as part of their healthcare, but fewer than one in three receive it, risking the health and lifestyle of those who don't. He says he is exposed to the Access to safe and affordable medical oxygen is particularly limited in low- and middle-income countries.
“The need is very urgent,” said Dr. Hamish Graham, pediatrician and lead author of the report. “We know there's more outbreaks coming, and there's probably another pandemic, like Covid, in the next 15-20 years.”
The report, published in Lancet Global Health, comes just weeks after the Trump administration frozen foreign aid programs, including those that could improve access to oxygen.
Approximately $6.8 billion in investment would be needed to increase the availability of medical oxygen, the report said. “In the current climate, that would clearly be a little more challenging,” said Karina King, an infectious disease epidemiologist at the Karolinska Institute and lead author of the report.
Still, she said governments and fundraising organizations should prioritize medical oxygen due to the importance of healthcare as a whole. People of all ages may need oxygen for pneumonia and other respiratory diseases, severe infections including malaria and sepsis, surgery and chronic pulmonary symptoms.
“We should be embedded in all of those programs and their priorities, rather than catching oxygen against other priorities,” Dr. King said. “This is completely fundamental to a functioning health system.”
Medical oxygen has often been used for over 100 years to treat patients with pneumonia. However, it was added to the World Health Organization's Essential Drug List in 2017.
In the early days of the Covid-19 pandemic, all breaths were counted, and a coalition of over 50 organizations was called for increased access to medical oxygen. By the end of 2022, the emergency task force had mobilized over $1 billion in medical oxygen equipment and supplies to more than 100 countries.
One country that invested heavily in improving oxygen access was Nigeria, which had taken steps in that direction even before Covid.
Nigeria has installed around 20 cost-effective plants for hospitals to produce oxygen on-site, and is exploring liquid oxygen plants that can supply a large urban area.
Many hospitals do not have a system that can provide reliable oxygen supply. “It's kind of design, it's a legacy issue that we have to deal with,” he said. “There's more to do.”
Changing hospital systems to provide oxygen can cause engineering and market problems, and providing oxygen requires infrastructure that can transport heavy oxygen tanks over long distances.
Even if oxygen is guaranteed, equipment to deliver oxygen directly to the patient must be maintained and cleaned regularly, and spare parts may take several months to deliver. Healthcare workers need to be trained to use the equipment effectively.
“We've seen a lot of investment in equipment, but there's very little investment in ways that we can operate that equipment sustainably,” Dr. King said.
Health facilities also require a pulse oximeter to screen and monitor blood oxygen levels during treatment. However, in low- and middle-income countries, pulse oximetry is used in less than one in five people in common hospitals, and according to the report, it is rarely used in primary healthcare facilities.
The panel included testimony from patients, families and healthcare workers suffering from oxygen deficiency. In Sierra Leone, prior to the Covid-19 pandemic, thousands of avoidable deaths occurred as public hospitals across the country had only one functioning oxygen plant. In Pakistan, a man with chronic lung condition said he stayed indoors and avoided stairs to prevent his lungs from rupture under tension. He had to borrow money from friends and family to pay $18,000 in medical treatment at home.
In Ethiopia, doctors were forced to take oxygen from one patient and treat another more desperately sick patient. “It was very heartbreaking to try and decide who lives and who dies,” he said.
