It’s not only vaccines: Oxygen must be at the heart of the COVID-19 response

In a briefing paper released today, titled “Gasping For Air”, Doctors Without Borders (MSF) highlights the importance of placing medical oxygen supply, not only vaccines and PPE, at the heart of a global COVID-19 response. With vaccines unavailable in the majority of countries worldwide, people will continue to fall ill with COVID-19 and without a significant investment in oxygen infrastructure, those whose illness is severe and who cannot access oxygen will continue to die.

“Oxygen is the single most important medicine for severe and critical COVID-19 patients, yet oxygen supply is often insufficient because infrastructure has been neglected in lower- and middle-income countries for decades,” said Dr Marc Biot, MSF Director of Operations. “Before the pandemic, we saw patients suffering from pneumonia, malaria, sepsis, and a variety of other conditions, as well as far too many premature babies, die due to a lack of medical oxygen, but COVID-19 has brought this issue into a sharp new focus. Unstable oxygen supplies kill.”

In the under-resourced countries where MSF teams work, hospitals and health centres often rely on unstable and expensive oxygen supply chains. Whilst hospitals in wealthy countries have their own oxygen plants and pipe highly concentrated oxygen to the bedside, patients across lower- and middle-income countries must rely on bulky, expensive and easily depleted oxygen cylinders or small oxygen concentrators which are not sufficient for a critical patient. 

“People are being failed twice,” says Dr Biot. “Not only are they at the bottom of the inequitable global vaccine queue, but they also cannot receive care when they fall ill because they do not have access to the oxygen they need.”
Beyond the current catastrophe in India, the city of Aden, in Yemen, is another prime example of the global oxygen shortage. The MSF supported hospital was more than 100 per cent occupied in recent days and has been going through 600 oxygen cylinders per day, whilst still having to turn away patients at the door.

“Numbers are stabilising now, but we know there will be another surge and there will be very sick patients who will need more oxygen than we can provide. As a doctor, it’s very distressing to see that wave after wave of COVID-19, countries remain unprepared and medical teams are left without the essential medicines they need to save lives on the massive scale required” said Dr Biot.

MSF teams working in such places are implementing creative solutions to get their patients the oxygen they so desperately need. In South Africa, oxygen concentrators, small machines that take the oxygen from the air but are not powerful enough for a critically ill COVID-19 patient, were linked together to increase their capacity. In the Democratic Republic of Congo oxygen cylinders were connected together to create a central oxygen bank. Health workers are being trained in the appropriate use of oxygen therapy. In some contexts, the prices of oxygen have been regulated to ensure that the cost does not become an unnecessary barrier as demand increases. 

“Today, we don’t have the luxury of time. These kinds of practical solutions save lives and we need to see more of them. More concentrators must be provided, especially in rural areas where there are no oxygen plants, the price of oxygen must be regulated, buffer stocks and reliable supply chains for facilities that rely on cylinders from existing oxygen plants must be created and maintained” said Biot. “These steps are needed to save lives while we wait for governments to address the structural underinvestment in oxygen infrastructure that result in some patients gasping for air”.

Oxygen is a crucial medicine for severe COVID-19 patients, but in many places where we work, we see that oxygen supply is insufficient. While governments and donors focus on vaccines, we still see patients getting sick and facing an unacceptable shortage of an essential medicine. In the worst cases, this has led to catastrophic peaks in mortality. But even in places with less dramatic outcomes, medical teams have struggled to provide the right treatment for their patients. As oxygen is crucial for critically ill COVID-19 patients, it should be at the heart of every COVID-19 response.

Read the report below about oxygen shortages and recommendations on what can be done to improve oxygen supply.