India’s crisis shows how oxygen is a vital medicine not everyone can access

Oxygen is an essential medical treatment to save human lives. But, in recent weeks, it’s become clear just how vital it is as India reels from a deadly surge in COVID-19 cases. Express trains are racing across the country to deliver oxygen from the eastern town of Angul to the capital of Delhi and other regions. Meanwhile, desperate pleas fill social media from people forced to helplessly watch their family members slowly suffocate.

Throughout the COVID-19 pandemic, medical oxygen shortages have struck hospitals in Brazil, Peru, Nigeria, Jordan, Italy, and beyond. In the United States, too, oxygen supplies at hospitals in New York City and California have run dangerously low at times. Combined with the crisis in India, these have now captured international attention.

But these shortages are far from a new phenomenon. Experts say the pandemic is exacerbating the oxygen access gap that causes an untold number of preventable deaths every year in low- and middle-income countries.

“What COVID has done is expose how fragile actually the systems around oxygen have been over the years,” says Mphu Ramatlapeng, executive vice president for implementation at the Clinton Health Access Initiative (CHAI), which was recently a finalist for a $100 million grant from the MacArthur Foundation to fund its proposal to ensure oxygen access in India, Nigeria, Ethiopia, Kenya, and Uganda. “My worst nightmare was something like COVID happening.”

Why is it such a challenge for countries to get enough oxygen, one of the most fundamental of life-giving elements? Here’s a look at the complexities of delivering medical oxygen, how scientists are working to find solutions, and how the pandemic has prompted the international community to respond more forcefully—before another country becomes the next India. ...

Oxygen isn’t always easily available for patients in low- and middle-income countries. In 2014, a study of hospitals in Malawi found that only 22 percent of patients who needed oxygen received it. A 2019 study of hospitals in southwest Nigeria found that they were only able to provide oxygen to 20 percent of the children who needed it. And a 2020 study found that improving the quality of the oxygen program at health facilities in Papua New Guinea reduced overall pediatric death by 40 percent and death by pneumonia by 50 percent.

“That’s been essentially a decade’s work that shows that if you put oxygen into remote health facilities where pneumonia is a common problem among children at least, you can reduce mortality by 50 percent,” says Trevor Duke, lead author on the study, and a pediatrician at the University of Melbourne and adjunct professor of child health at the University of Papua New Guinea.

Despite clear evidence that medical oxygen saves lives, there are many complex challenges to actually getting it to health care facilities—starting with the way oxygen is delivered in the first place.

Oxygen delivery systems look different depending on location: large or small facilities; urban or rural environments; or high- or low-income communities. ...