Lancet Global Health Oxygen Commission

Medical oxygen is an essential medicine with no substitute for the treatment of at least 20 Global Burden of Disease conditions, including HIV/AIDS, TB, pneumonia, malaria, maternal and neonatal disorders, tracheal, bronchus, and lung cancers, anemia, sickle cell disease, heart disease, stroke, COPD, asthma, transport injuries, poisonings, foreign body injuries, self-harm, and interpersonal violence. Together, these conditions caused a massive 25 million deaths in 2019, almost 50% of all human deaths.

Medical oxygen is particularly lifesaving for newborns and children. A recent review found that deaths among hospitalized children fell by 25% when pulse oximetry and oxygen was provided, and that oxygen is as cost-effective as childhood vaccination. But oxygen is often unavailable in health facilities, especially those located in low- and middle-income countries (LMICs). And where it is available, it is often unaffordable leaving the most vulnerable patients without access to a lifesaving medicine.

COVID-19 exposed a tragic gap

Lack of medical oxygen was a defining inequity of the COVID-19 pandemic, with LMICs bearing the brunt of oxygen shortages and related deaths. The pandemic exposed not only a tragic gap in inadequate supplies of medical oxygen and respiratory therapies, but also the trained workforce needed to install, operate, and maintain the lifesaving equipment. The gap had always been there – contributing to a massive burden of death that was largely hidden. When COVID-19 unleashed a new wave of patients needing oxygen, hospitals were unable to meet the demand and the world watched as patients died waiting for oxygen on gurneys in the parking lots of hospitals, in the backseats of cars, and at home waiting for loved ones to return with filled cylinders.

A study of COVID-19 deaths in 64 intensive care units across 10 African countries showed that one in two patients died without receiving medical oxygen, and a study from Peru, which recorded the highest COVID-19 death rate in the world, found that oxygen saturation below 90% on admission was a strong predictor of mortality. The authors concluded that in settings with limited resources, efforts to reduce COVID-19 deaths should focus on early identification of hypoxemia and timely access to oxygen.

Oxygen gaps remain in many countries

Despite the additional oxygen supplies many countries received during the pandemic, including $US 1 billion from the ACT-Accelerator Oxygen Emergency Taskforce, access gaps remain. Many governments still do not know how much oxygen their health systems need to meet the needs of patients during routine times, or how much surge capacity will be needed when the next respiratory pandemic strikes. Likewise, global health partners are in the dark about how much, and what kind, of oxygen support different countries need to strengthen their health systems most cost-effectively.

The Lancet Global Health Commission on Medical Oxygen Security is a major effort to change this. Announced in September 2022, the Commission will shed light onto the number of patients needing medical oxygen each year in each country and the cost of meeting that need, how to define and measure oxygen access, which oxygen solutions work best in different settings, and how to generate the financing and political will to achieve transformational change. It will address all levels of care from hospital to home, all age groups from neonates to the elderly, all health conditions where oxygen is a recommended treatment, and all the ways in which access to oxygen can contribute to health system strengthening and pandemic preparedness.

Promising new developments

Governments and global health and development agencies urgently need this information as they pivot from pandemic response to preparing for the next crisis and return to the job of achieving the Sustainable Development Goals. The new Global Oxygen Alliance (GO2AL), co-chaired by The Global Fund and Unitaid, and the World Health Organization’s Increasing Access to Medical Oxygen Resolution, endorsed by all 194 Member States, are both welcome additions to the global health architecture and vital to the successful implementation of the Commission’s recommendations.