Global action needed to solve the medical oxygen crisis

The Lancet Global Health Commission report details for the first time how future investment in strengthening medical oxygen systems could have a huge impact by saving millions of lives and improving pandemic preparedness.

Almost 400 million children and adults require medical oxygen every year. More than five billion people, 60 per cent of the world’s population, don’t have access to safe and affordable medical oxygen services.

The Commission, co-chaired by Makerere University in Uganda, the International Centre for Diarrheal Disease Research (icddr,b) in Bangladesh, Murdoch Children’s Research Institute (MCRI) in Australia, Karolinska Institute in Sweden and the Every Breath Counts Coalition in the US was launched in 2022 against the backdrop of the COVID-19 pandemic. The Commission was tasked with submitting actionable recommendations for governments, industry, global health agencies, donors and the healthcare workforce.

MCRI Dr Hamish Graham said the COVID-19 pandemic had put a spotlight on the longstanding global inequities in accessing medical oxygen.

“Oxygen is required at every level of the healthcare system for children and adults with a wide range of acute and chronic conditions,” he said. 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.”

Dr Graham said channelling investments into national oxygen plans and bolstering health systems, including wider use of pulse oximeters (a small device that measures how much oxygen is in the blood), would help solve the medical oxygen crisis.

“We urgently need to make high-quality, pulse oximeters more affordable and widely accessible,” he said. Pulse oximeters are available in 54 per cent of general and 83 per cent of tertiary hospitals in low- and middle-income countries, with frequent shortages and equipment breakdowns.

“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. We see the greatest inequities in small and rural government health facilities and across Sub-Saharan Africa.”

Dr Graham said the importance of medical oxygen must also be recognised and integrated into broader national strategies and pandemic preparedness and response planning.

“Governments should bring together public and private sector partners with a stake in medical oxygen delivery, including health, education, industry, energy and transport to design a system and set up a governance structure that supports the new Global Oxygen Alliance (GO₂AL) and replenishing The Global Fund with a strong oxygen access mandate,” he said.

Key findings from the report published in The Lancet Global Health include:

• The global need for medical oxygen is high. Every year, 374 million children and adults need medical oxygen, including 364 million patients with acute medical and surgical conditions and nine million patients with long-term oxygen needs due to chronic obstructive pulmonary disease.
• Global access to oxygen is highly inequitable with huge gaps in coverage despite pandemic-related investments. Less than one in three people in low- and middle-income countries who need oxygen for acute medical or surgical conditions receives it.

• Costs to fill the oxygen gap are large but represent a highly cost-effective investment that will have wide reaching impacts. Closing the large acute medical and surgical oxygen access gap in low- and middle-income countries requires an additional $US6.8 billion annually.

• National Medical Oxygen Plans are essential to facilitate investment and effectively coordinate service delivery. Less than 30 countries have developed National Oxygen Plans to date but all governments are encouraged to have one by 2030.

• Oxygen systems must be designed to suit the context, include operational costs, and be affordable to all patients. There is no one-size-fits-all national medical oxygen system. Governments should define priorities and optimise their systems to suit local conditions.

• Pulse oximetry is the gateway to safe, quality, affordable oxygen care and needs to be integrated in clinical guidelines, education and all levels of the healthcare system. Pulse oximetry measures should be routinely assessed in patients at all levels of health care.

• A need for closer collaboration between the medical oxygen industry, national governments and global health agencies. Companies should adopt specific oxygen access targets and publish progress while global health agencies should regularly assess oxygen industry progress similar to how the pharmaceutical industry operates.

• Accurate and timely data on oxygen systems is essential for effective decision making and oxygen service access. New toolssuch 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 Oxygen Resolution.

The report comes after it was announced MCRI would partner with 12 countries in the Pacific and Southeast Asia under a $10 million initiative to improve child and adolescent health across the region.

The Australian Government has awarded MCRI a strategic grant as part of its Partnerships for a Healthy Region Initiative.

The three-year funding will be used to establish the ReALiSE program — the Regional Alliance for Learning in Systems for Equitable Child and Adolescent Health — which will strengthen resilience in public health systems and engage with youth leaders and local communities to improve the health of all young people.