Over five billion people worldwide lack reliable access to medical oxygen, a crucial resource for treating various health conditions.
A new report stresses the need for national oxygen plans, increased funding, and stronger public-private collaboration. While pandemic-related investments helped, many regions still struggle due to infrastructure and equipment shortages.
Filling the Global Medical Oxygen Gap
Expanding access to medical oxygen through universal coverage targets, national action plans, and more affordable care is critical to addressing a global shortage that affects more than half of the world’s population, according to a new report.
The Lancet Global Health Commission highlights, for the first time, how strategic investments in medical oxygen systems could save millions of lives and strengthen pandemic preparedness.
Each year, nearly 400 million people—children and adults—require medical oxygen. Yet, more than five billion people, or 60% of the world’s population, lack reliable access to safe and affordable oxygen therapy.
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 U.S., was launched in 2022 in response to the COVID-19 pandemic. Its goal is to provide actionable recommendations for governments, healthcare systems, global health agencies, donors, and industry leaders.
Lessons from COVID-19 and the Oxygen Crisis
Dr. Hamish Graham of MCRI emphasized that the pandemic exposed deep inequalities in access to medical oxygen, a critical resource for treating a wide range of conditions.
“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 channeling 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 percent of general and 83 percent 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 percent 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.”
Integrating Oxygen Access into National Strategies
Dr. Graham said the importance of medical oxygen must also be recognized 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 optimize 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 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 Oxygen Resolution.
Expanding Oxygen Access in the Asia-Pacific Region
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.
One of the initiatives includes strengthening local health systems data to improve care and the use of oxygen as an essential medicine in Cambodia, Lao PDR, and Papua New Guinea.
Read the full Lancet Global Health Commission on Medical Oxygen Security report.
Reference: “Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security” by Hamish R Graham, Carina King, Ahmed Ehsanur Rahman, Freddy Eric Kitutu, Leith Greenslade, Masooma Aqeel, Tim Baker, Lucio Flavio de Magalhães Brito, Harry Campbell, Karen Czischke, Mike English, Adegoke G Falade, Patricia J Garcia, Mireia Gil, Stephen M Graham, Amy Z Gray, Stephen R C Howie, Niranjan Kissoon, Ramanan Laxminarayan, Inês Li Lin, Michael S Lipnick, Dianne B Lowe, David Lowrance, Eric D McCollum, Tisungane Mvalo, Jacquie Oliwa, Stefan Swartling Peterson, Rediet Shimeles Workneh, Heather J Zar, Shams El Arifeen and Freddie Ssengooba, 17 February 2025, The Lancet Global Health.
DOI: 10.1016/S2214-109X(24)00496-0
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