By: David Ostrowsky

For well over a century, medical oxygen has been used for treating patients with an assortment of medical needs, most notably respiratory issues such as pneumonia, as well as those undergoing surgery, experiencing heart failure, and receiving maternal care. Utilized by over 370 million medical patients worldwide, medical oxygen was, in fact, added to the World Health Organization’s Essential Medicines List in 2017. And yet, according to a recent report published in The Lancet medical journal, well over half of the world’s population does not have access to safe and affordable medical oxygen services; unsurprisingly, this segment of the population is largely comprised of those living in lower-income and developing nations where it is more difficult to access facilities that offer basic oxygen services of reasonable quality.

Further analysis of the report’s findings paints a grim picture of a glaringly obvious health equity issue that was magnified during the COVID pandemic and, tragically, remains quite relevant now. As cited in the Lancet Global Health Commission report, which represents the first comprehensive estimate of disparities in medical oxygen availability, “more than 5 billion people—i.e., more than 60% of the world’s population—do not have access to safe, quality, and affordable medical oxygen services. In low- and middle-income countries (LMICs), only 89 million (30%) of the 299 million people who need oxygen for acute medical or surgical conditions receive adequate oxygen therapy, with the lowest access in sub-Saharan Africa.” Meanwhile, in addition to acute medical needs, approximately 9.2 million people with chronic obstructive pulmonary disease (COPD) require long-term oxygen therapy (LTOT) annually.

Increasing the number of worldwide oxygen recipients will be a costly endeavor. The commission estimated that it would cost $6 to $8 billion annually to narrow this coverage gap due to the many complexities and multi-faceted steps inherent in the process of supplying patients with medical oxygen. After all, delivering oxygen requires having the proper infrastructure for transporting heavy oxygen tanks across long distances. Even when oxygen supply is secured, the equipment to transport the oxygen directly to patients has to be routinely maintained and sanitized, while spare parts could take months to be delivered. Furthermore, healthcare facilities also necessitate pulse oximeters to screen and monitor blood oxygen levels during treatment—however, in poorer nations, pulse oximetry is used on fewer than one in five patients in general hospitals, and it is hardly ever used at primary healthcare facilities.

Of course, it is not just a matter of investing in appropriate equipment—it’s a matter of investing in the training of healthcare workers who can properly operate the equipment, which is often unfeasible in less industrialized countries. While this may be an extreme example, only until recently, Sierra Leone, where over half of the population lives below the national poverty line, had merely one public hospital in the entire country with a functioning oxygen plant, which by all accounts, resulted in thousands of avoidable deaths. Conversely, Nigeria, a few countries east of Sierra Leone, has recently made substantial investments in bolstering oxygen access by establishing 20 cost-effective plants for generating oxygen on-site for hospitals while also exploring liquid oxygen plants that can supply large swaths of urban areas.

Though the medical oxygen crisis may not be particularly acute in the United States right now— at least when compared to less industrialized countries—there’s no telling if the dire situation could eventually become an American problem whereby millions of our fellow countrymen suffering from infections and chronic lung conditions are left gasping for air on hospital beds. A problem that would, of course, become greatly exacerbated should a new pandemic descend on humanity.