The scenes in India of families desperately searching for oxygen for critically ill Covid patients will be repeated in Bangladesh, Ethiopia and other countries in Africa and around the world unless a significant international effort is made to ensure all countries have good oxygen supplies, campaigners have said.
The focus on vaccines and tests, while important, has been obscuring the need for oxygen, which is cheap and readily available in high-income countries but in short supply elsewhere, they say. Before India, there was similarly shocking footage from Manaus in Brazil where distressed relatives pleaded for oxygen to keep a family member alive.
Kevin Watkins, the director of Save the Children, said the crisis should have been foreseen. Oxygen shortages have cost the lives of children with pneumonia in Africa for years – fewer than one in five get the oxygen therapy they need – and now the scant supplies are even being diverted from children’s wards and maternity units because of the Covid crisis.
“It is outrageous that we have sleepwalked into a crisis that was so predictable months ago,” he said. “We have been just talking into the echo chamber, because everyone is so fixated with ventilators and vaccines.”
Boris Johnson was given oxygen to help him fight Covid in hospital last year, Watkins points out. “I was going through litres and litres of oxygen,” the UK prime minister said at the time. “I’m a very lucky man.”
Leith Greenslade, the coordinator of the Every Breath Counts Coalition, which has been trying to raise the alarm since March last year, said even well-resourced nations like Italy nearly ran out of oxygen at times in the first wave.
“Our members were saying this is going to be a nightmare,” she said. “People are going to be unable to get oxygen. It took us a year, until February 2021, to get the UN and others to set up the Act-Accelerator oxygen emergency taskforce.”
It took so long because there is “a blind spot” in the global health architecture, she says. The institutions, from the Global Fund to the World Bank, have few people with expertise in oxygen. And yet, on top of the existing unmet need for oxygen in pneumonia, malaria, sepsis and maternal health, we now have Covid and may have entered “an era of respiratory health pandemics”, she said.
The taskforce is part of the Access to Covid-19 Tools-Accelerator (Act-A), which has been working on getting vaccines and tests to low- and middle-income countries. Former UK prime minister Gordon Brown is spearheading a campaign to persuade the G7 to invest $60bn (£43bn) in Act-A for vaccines, tests and therapies including oxygen, when it meets in the UK in June.
The coalition has set up a Covid-19 oxygen needs tracker, which estimates that 27.4m cubic metres of oxygen is needed around the world to keep patients alive every day. That is 3.9m large cylinders every day. To meet that need for a year will cost $6.2bn, they say.
With the Access to Medicines Foundation, they are calling on the G7 to take immediate action to ensure that low- and middle-income countries have the medical oxygen they need to treat all Covid patients.
G7 leaders should engage directly with the leading medical gas, oxygen plant and concentrator companies to ramp up supply, invest in the oxygen emergency taskforce and start a dialogue with the worst affected low- and middle-income countries to prevent a repeat of the tragedy in India, they said.
Greenslade and Watkins said there had been no engagement in the past with the world’s seven big medical gas companies that supply oxygen, mostly to high-income countries and more often to industry and the military rather than cash-strapped publicly funded health services.
“In stark contrast to the pharmaceutical sector, which has a long history of engagement, the big oxygen companies don’t really have a track record of engaging in health emergency-type response work,” Watkins said.
The one company that has stood out is Air Liquide, he said, which contacted the World Bank offering to provide oxygen at cost, subject to safety standards. “There was no mechanism for them to work through, which is why we started trying to scale up the oxygen framework in the Act-A system.”
Greenslade hopes a new awareness of the vital role of oxygen in treating adults and children with breathing difficulties will lead to long-term agreements on supply around the world. “There’s always been a human need for oxygen in the health system. People have always died for lack of oxygen, just not at the Covid scale,” she said.