A breath of life for medicinal oxygen

Covid-19 took at least 18 million lives, and no one knows for sure how many of those deaths were due to a lack of medicinal oxygen.

Governments don't want to talk about the problem, because it would mean admitting that thousands – or even hundreds of thousands – of their citizens died unnecessarily.

But unless health systems take care to ensure a sufficient supply of oxygen for the future, they risk repeating what happened in the last two years.

While high-income countries are already working to ensure the availability of medical oxygen, many low- and middle-income countries (LMICs) will continue to require international assistance.

Deaths due to lack of this resource in those countries already existed before the pandemic, because world health and development agencies had not made a serious effort to help governments close the gap between needs and supply.

This gap is one of the factors underlying stubbornly high neonatal and infant mortality, adult deaths from infectious and chronic diseases, and from injuries requiring surgery in lower-income countries.

Research published before the pandemic found that four out of five children hospitalized in Nigeria with pneumonia did not receive the oxygen they needed, and that simply having it available on pediatric wards could reduce child deaths by 50%.

As Mike Ryan of the World Health Organization (WHO) says, covid-19 tore the bandage off an old wound and, in some countries, multiplied the need for oxygen by 10 in a few weeks.

LMICs currently need 500,000 large bottles per day to treat coronavirus patients, and this is just the tip of the iceberg.

For every one of these patients who needs oxygen, there are at least five others who also require it, including the 7.2 million children with pneumonia who are admitted to hospitals in these lower-income nations each year.

The main mechanism for the international response is the Access to COVID-19 Tools Accelerator Oxygen Emergency Task Force (ACT-A), which is led by Unitaid's expert leadership and created a system to help the LMICs to avoid the scarcity of this resource.

To date, the Task Force has delivered nearly $1 billion (€945 million) – including $530 million exclusively from the Global Fund – to low- and middle-income country governments and their partners at the United Nations. and NGOs.

This money went toward liquid oxygen, pressure swing adsorption oxygen generation plants, mobile concentrators, therapies, and the personnel needed to install, operate, and maintain that equipment.

This funding helped more than 100 countries, mainly in Africa and Asia, but there are still countries struggling to provide oxygen, so the task force requested an additional $1 billion in 2022. The Second World Summit on covid-19 of US President Joe Biden, held in April, also highlighted the issue and called on governments, businesses and philanthropic organizations to achieve more.

Oxygen is not only an essential treatment for almost all the diseases considered in the UN Sustainable Development Goals, it is also one of the pillars for effective preparation and response against pandemics

The arguments for donors are clear.

We have a moral obligation to treat covid-19 patients and definitively flatten the curve of deaths due to the pandemic.

Investing in oxygen will do just that and will also save lives in the future.

Not only is it an essential treatment for almost all diseases considered in the UN Sustainable Development Goals, it is also one of the pillars for effective pandemic preparedness and response.

As the world moves to long-term management of COVID-19, oxygen production and distribution systems will need to be incorporated into the global health infrastructure.

All international organizations with a mandate to improve neonatal and child survival, chronic and infectious disease management, and pandemic preparedness and response have a stake in access to oxygen.

Those agencies should formalize their nascent gas partnership with ACT-A by transforming it into a Global Oxygen Partnership with a mandate extending to 2030 (to align with the SDGs), and broaden membership to include international agencies. dedicated to chronic diseases.

A successful partnership to close the oxygen access gap must include five components.

First, the governments of low- and middle-income countries, and the national institutions responsible for the provision of medical oxygen must take the lead.

Ideally, they should be guided by politically supported national access plans, with governments funding the effort as part of their health budgets.

Second, governments that need external support to finance their national plans should be able to obtain loans and subsidies from a variety of multilateral, bilateral, and philanthropic sources.

The Global Fund should continue to finance grants as part of its new goal for pandemic response, and multilateral development banks should also offer loans for this purpose.

Next, more incentives and opportunities need to be provided for oxygen producers to work together with least developed country governments and global health and development agencies.

Agreements of understanding and non-disclosure agreements, and tenders for the procurement, installation and maintenance of the equipment should be made available, taking advantage of the existing program for association with companies of the ACT-A Oxygen Emergency Working Group against the covid-19.

In addition, development finance agencies should provide credit, equity capital and guarantees to oxygen producers, and support countries seeking to reduce their dependency on oxygen imports and fragile global supply chains.

Fourth, UN agencies and NGOs with a strong presence in these countries should continue to support their governments in developing national plans for oxygen provision.

They are also to boost data collection, procurement of supplies, training of health care workers and biomedical engineers, and monitoring and evaluation of progress.

To do this they will need ongoing funding from bilateral development agencies (such as USAID and the European Commission, among others) and philanthropic organizations (such as the Bill & Melinda Gates Foundation and the Skoll Foundation, among others).

Finally, governments must be given access to timely and high-quality information on national oxygen demand – such as the number of patients with hypoxemia per year and the oxygen they need – and the capacity of the health system to produce it, in order to that can quickly remedy those deficits.

Donors need to invest more in national health surveillance and statistical institutions, while taking advantage of available data to generate estimates of the burden of hypoxemia as part of the global burden of disease.

And independent agencies like the Access to Medicine Foundation must be funded to hold the oxygen industry accountable.

The next few months will be critical, as we move away from the acute phase of the pandemic.

Ideally, by September, the ACT-A Covid-19 Oxygen Emergency Task Force will have become the Global Oxygen Alliance, led by Unitaid, and will continue to meet regularly to coordinate investments, mobilize resources and monitor the impact of efforts to ensure equitable access to essential medicine.

Leith Greenslade

is coordinator of the Every Breath Counts Coalition.

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