Medical oxygen is a critical treatment for patients with a range of medical conditions – from newborns in respiratory distress, to children with pneumonia, to adults with chronic obstructive pulmonary disease (COPD), and many more. It is also essential for surgery.
But it is often unavailable in health facilities in low-resource settings. And where it is available, it is often unaffordable for the poorest and most vulnerable.
Lack of medical oxygen has been one of the defining inequities of the COVID-19 pandemic, with low- and middle-income countries (LIMCs) bearing the brunt of oxygen shortages and related deaths.
COVID-19 exposed a tragic gap
The pandemic exposed a tragic gap – inadequate supplies of medical oxygen and respiratory therapies, and the 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 across LMICs were unable to meet the demand; images of patients lying on gurneys in the parking lots of hospitals, in the backseats of cars, or at home waiting for someone to bring oxygen became tragically familiar.
One in two patients died without receiving oxygen in 10 African countries
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; a study from Peru, which has 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.
Yet there is still a lack of awareness about the magnitude and consequences of unmet oxygen needs for different patient populations. Most LMIC governments do not have the data on the amount of oxygen required to meet patient needs, where the gaps are, and how to address them.
Thinking big and acting bold
The Lancet Global Health Commission on Medical Oxygen Security is a major effort to change this.
The Commission will shed light onto the burden of hypoxemia, 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 home to hospital, all age groups from neonates to the elderly, all health conditions where hypoxemia is a risk, and all the ways in which access to oxygen can contribute to health system strengthening.
Governments and global health and development agencies urgently need this information as they pivot from pandemic response to preparing for the next crisis and returning to the job of achieving the Sustainable Development Goals.
The Commission is led by Makerere University in Uganda, icddr,b in Bangladesh, and the University of Melbourne and Murdoch Children’s Research Institute (MCRI) in Australia, with Every Breath Counts providing support.