Lack of access to medicinal liquid oxygen is becoming an urgent global health concern

Gas companies must now intensify their long-term efforts to provide access to medical oxygen, building on existing Covid-19 initiatives. Picture: Pexels

Gas companies must now intensify their long-term efforts to provide access to medical oxygen, building on existing Covid-19 initiatives. Picture: Pexels

Published May 19, 2023


Premature birth, pneumonia, and other illnesses that affect people from all walks of life can all be treated with oxygen, making it a crucial medication.

A greater proportion of disorders that require oxygen for treatment are to blame for the rising demand for medical oxygen over the past 10 years, Covid-19 being the most recent.

Some of the top medical liquid oxygen manufacturers in the world reacted to the Covid-19 pandemic by increasing access to their life-saving product in low- and middle-income countries (LMICs) that were suffering from severe oxygen shortages. But the fundamental issue of medical oxygen access in LMICs is still largely unresolved.

The Access to Medicine Foundation has released new research that looks at what gas companies have done to address this problem and suggests practical steps they may take to increase long-term access to medical liquid oxygen.

In addition to being necessary for routine medical procedures like surgery and delivery, medicinal oxygen is a critical component of the therapy for numerous illnesses like pneumonia and tuberculosis.

Despite being on the World Health Organization’s Model 2021 List of Essential Medicines – the 22nd list of its kind, according to the WHO’s official website – medical oxygen is not reliably accessible to around half of healthcare institutions in LMICs.

Oxygen access requires a variety of high-tech tools as well as accessories for dosing and administering the medication. All of these need routine maintenance as well as instruction on how to operate them, Path Uganda’s research shows.

Six of the top global gas producers of medical liquid oxygen are examined in the paper from the Access to Medicine Foundation: Air Liquide, Air Products, Linde, Messer, Nippon Sanso Holdings Corporation, and SOL Group.

Although several businesses made efforts to improve availability of medical oxygen during the Covid-19 pandemic, the research cautions that more explicit pledges are needed to give LMICs priority in gas companies’ business operations.

The paper identifies stand-out instances of corporate involvement, particularly during the Covid-19 pandemic, as well as potential to capitalise on this momentum.

The problem is significant and urgent. The Asian Development Bank’s “Strengthening Oxygen Systems in Asia and the Pacific” guidance note, which was released in November 2022, estimated that in 2021, 73 million people with low blood oxygen (hypoxia) sought medical attention in LMICs, but only 22 million of them had Covid-19.

In these facilities, a lot more people – including 32 million children – needed oxygen owing to various conditions and standard procedures, such as if they required anaesthesia during surgery.

However, all too frequently, these hospitals lacked the necessary supply of medical oxygen to provide medical care to their patients, and they continue to do so today, which results in avoidable loss of life.

Despite being on the WHO’s Model List of Essential Medicines, which states that it should be provided in every nation, medical oxygen is not reliably accessible to half of health-care institutions in LMICs, according to the WHO.

A few corporations control the majority of the world’s medical liquid oxygen supply, hence their importance to the global health ecosystem must be prioritised.

The business of these enterprises consists primarily of medical gases. However, according to Jayasree K. Iyer, CEO of Access to Medicine Foundation, society needs them to guarantee that this crucial lifeline is accessible in times of need and to meet the everyday medical oxygen needs of all health systems.

The foundation has identified a few quick fixes to enhance the supply of medicinal liquid oxygen in an effort to keep up with demand spikes brought on by the Covid-19 pandemic after analysing the report’s firms’ activities to date.

These businesses now have the chance to advance long-term access planning in order to assure a sustainable supply after the current global health crisis.

The paper recommends six key areas where businesses should concentrate their efforts in order to expand access to medical liquid oxygen in LMICs, both during crises and on a regular basis:

1. Set goals for and track the development of medicinal liquid oxygen.

2. Make it possible for various populations and health systems to be more affordable.

3. Supply a steady flow of medicinal liquid oxygen.

4. Create and maintain long-lasting alliances to close access gaps.

5. Support the human resources needed to run medical liquid oxygen systems, provide oxygen therapy, and support the health systems.

6. Make proactive preparations for upcoming emergencies.

Some of the corporations covered by the scope have shown that they are taking long-term access improvement measures, but more explicit pledges are needed.

According to Johann Kolstee, research programme manager of Access to Medicine Foundation, the priority areas for action outlined in this report show gas companies what they can do to prioritise and invest in LMICs, be proactive in finding new ways to increase supply, and engage in long-term sustainable approaches to access.

In an effort to shift additional production capacity from industrial liquid oxygen to critically required medical liquid oxygen, some gas companies responded by airlifting entire medical liquid oxygen tankers and trailers into LMICs using specially leased planes.

The geographical scope of these initiatives was therefore constrained. Only 39 of the 108 LMICs in scope (about one-third) had measures to boost the provision of medicinal liquid oxygen during the Covid-19 pandemic have been reported, publicly or directly to the foundation among the six major gas firms examined in this analysis.

Moreover, it is not always certain that businesses will continue to close access gaps in LMICs over the long term once the current public health emergency has passed.

Air Liquide is now the only company among those in the report that has a clear access-to-medical-oxygen strategy that specifically targets LMICs. Despite not having any explicit LMICs or medical oxygen targets, Air Products, Linde, Messer, Nippon Sanso Holdings Corporation, and SOL Group have demonstrated wide commitments to health.

The research cites certain corporate initiatives that may result in a longer-term, more reliable supply of medicinal liquid oxygen in more LMICs. For instance, Air Liquide and Linde have reported supplying medicinal liquid oxygen in areas they had not before since the beginning of the Covid-19 pandemic.

Positive developments include the installation or acquisition of new liquid oxygen-producing air separation units (ASUs) by Air Liquide, Air Products, Messer, and Nippon Sanso Holdings Corporation in South Africa, China, Egypt, India, Vietnam, and Thailand. The supply could be greatly increased by these ASUs.

The infrastructure of health-care facilities and a disjointed supply chain with convoluted logistics and distribution networks are just two of the obstacles to enhancing access to medical oxygen in LMICs. However, gas companies play a significant part in assisting in the resolution of some of these issues, particularly through the pursuit and formalisation of long-term alliances with authorities and global health stakeholders.

To address access issues in LMICs, Air Liquide and Linde have already formalised collaborations with international health organisations. With Unitaid and the Clinton Health Access Initiative (CHAI), both businesses signed Memorandums of Understanding (MoUs).

The foundation requested that gas firms commit to and take action to increase and sustain long-term accessibility to the lifesaving commodity they provide, which is essential to resolving this critical global health issue.

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