Investment in medical oxygen systems could save millions of lives by filling gaps in oxygen access for more than half the world’s population and boosting pandemic preparedness, says a report published yesterday in The Lancet Global Health.
The Lancet Global Health Commission on medical oxygen, made up of an international slate of experts, was convened in 2022 to prevent crises such as the COVID-19 supply shortages from recurring and to speed achievement of the Sustainable Development Goals by making recommendations on medical oxygen to governments, industry, global health agencies, donors, and the healthcare workforce.
60% of world population lacks access
The group estimated acute medical, surgical, and long-term oxygen therapy needs by conducting systematic literature reviews, integrating Global Burden of Disease data, and consulting experts to inform model estimates. They also interviewed patients, caregivers, and healthcare providers about their experiences.
Every year, nearly 400 million children and adults around the world require medical oxygen for short-term needs during acute illness and surgery and in the long term owing to chronic obstructive pulmonary disease (COPD). But more than 5 billion people (60% of the global population) lack access to safe and affordable medical oxygen services, according to a news release from Australia’s Murdoch Children’s Research Institute (MCRI), a member of the Lancet commission.
“Oxygen is required at every level of the healthcare system for children and adults with a wide range of acute and chronic conditions” Hamish Graham, MBBS, PhD, MPH, of MCRI, said in the release. “Previous efforts, including the major investments in response to the COVID-19 pandemic, largely focused on the delivery of equipment to produce more oxygen, neglecting the supporting systems and people required to ensure it was distributed, maintained, and used safely and effectively.”
Cost-effective $34 billion investment
The report authors acknowledge that the cost of narrowing the oxygen gap in poor countries will be high, at an estimated $34 billion over the next 5 years, but would be a highly cost-effective investment with far-reaching effects. National oxygen plans, which have been developed by fewer than 30 countries, are also needed.
Oxygen systems must be designed to suit the context, include operational costs, and be affordable to all patients.
“This estimate does not include the substantial costs of meeting the additional oxygen requirements caused by pandemics (for reference, the additional cost of COVID-19-related oxygen requirements in LMICs [low- and middle-income countries] in 2021 was $6.8 billion) or costs for long-term oxygen therapy,” they wrote.
Meeting oxygen needs will require a systems approach addressing domains such as production, storage, distribution, supply, clinical use, coordination, regulation, and financing among the health, education, energy, industry, and transportation sectors, the authors added.
“Oxygen systems must be designed to suit the context, include operational costs, and be affordable to all patients,” they wrote. “There is no one-size-fits-all national medical oxygen system. Governments should define priorities and optimise their systems to suit local conditions.”
Regular evaluation of oxygen-industry progress
In addition to oxygen, high-quality pulse oximeters, which measure blood oxygen saturation, are also urgently needed, Graham said. These devices are available in only 54% of general and 83% of tertiary care hospitals in LMICs, and shortages and equipment malfunctions commonly occur.
Confrontation of the root causes of poor oxygen access will require action on addressing social injustices that drive health inequity more broadly.
“Concerningly, in these countries the devices are performed for only 20 per cent of patients presenting to general hospitals and almost never for those at primary healthcare facilities,” he said. “We see the greatest inequities in small and rural government health facilities and across Sub-Saharan Africa.”
As an example of scarce resources, one woman the team interviewed, the wife of an older man who had COVID-19, described the scene at a Philippines hospital where he sought treatment: “When we arrived, there were a lot of patients—it was very crowded—but they took us in and gave [my husband] an oxygen mask and big green cylinder. Five to six patients were sharing one cylinder.”
Governments, Graham said, should bring together public and private partners to design an oxygen-delivery system and set up a governance structure that supports the new Global Oxygen Alliance (GO₂AL) and replenishing The Global Fund with an oxygen access mandate.
Specifically, companies should adopt specific oxygen-access targets and publish progress, and global health agencies should regularly assess oxygen industry progress, similar to how the pharmaceutical industry operates, the authors said.
“New tools such as the 10 Oxygen Coverage Indicators and a national Access to Medical Oxygen Scorecard (ATMO2S) would help governments to both plan their national oxygen systems and report progress implementing the WHO [World Health Organization] Oxygen Resolution,” they wrote.
The need for oxygen is likely to continue, driven by poor nutrition, smoking, aging populations, and climate change, which is exacerbating deaths related to infectious diseases, air pollution, and extreme heat. In addition, slow economic recovery from the COVID-19 pandemic and rising debt levels are challenging national health budgets and international health financing.
“Confrontation of the root causes of poor oxygen access will require action on addressing social injustices that drive health inequity more broadly,” they concluded. “National medical oxygen systems can be at the forefront of efforts to create the future we want by ensuring the long-term health and sustainability of people and the planet.”