Medical oxygen: an essential medicine without substitute

Medical oxygen is a lifesaving essential medicine without substitute. It is used to treat a wide range of infectious diseases and chronic conditions including pneumonia, coronavirus disease 2019 (COVID-19), advanced HIV infection, severe forms of tuberculosis (TB) and malaria, chronic heart and lung conditions. Oxygen is a vital medicine for maternal and newborn survival and essential for surgery, emergency and critical care. Each year, hypoxaemia (low blood oxygen) directly contributes to the deaths of approximately 9 million people in LMICs, including 1.6 million children under five. For many of these people, adequate access to pulse oximetry and oxygen therapy could have saved their life.

Most health facilities in LMICs do not have access to medical oxygen

Access to safe oxygen remains a critical challenge, particularly in LMICs. It is estimated that fewer than half of all health facilities in LMICs have uninterrupted access to medical oxygen. The vast majority of patients who need oxygen for acute medical or surgical conditions are not receiving it, with the greatest inequities in sub-Saharan Africa, South Asia and the Pacific. This gap in access to oxygen was severely exposed during the COVID-19 pandemic. The African COVID-19 Critical Care Outcomes Study found that one in two patients hospitalized with COVID-19 in intensive care units in sub-Saharan Africa died without receiving oxygen support.

The Global Oxygen Strategic Framework aims to strengthen oxygen systems in LMICs post-pandemic

Closing the oxygen gap would save hundreds of thousands of newborn and child lives and is essential to achieve the health-related Sustainable Development Goals (SDGs). To this end, the Global Oxygen Alliance (GO₂AL), a multistakeholder collaborative that aims to harness collective efforts to increase access to oxygen in LMICs, has developed the Global Oxygen Strategic Framework and Investment Case (2025–2030) as a global good or resource that various actors working to increase oxygen can use, including countries, in creating their own costed oxygen plans or case for investing in oxygen. The Global Oxygen Strategic Framework (Strategic Framework) provides an overarching guide for all global health actors – including countries, donors, development finance institutions (DFIs), academia, international agencies, civil society organizations and industry – to work individually and together to comprehensively address oxygen ecosystem barriers. The Strategic Framework outlines five priority objectives to close the oxygen access gap in LMICs:

1. Drive, consolidate and sustain investment;
2. Strengthen supply chains and shape markets;
3. Strengthen country planning and implementation;
4. Advocate and generate demand; and
5. Generate evidence and drive accountability.

The Strategic Framework calls for all actors to each play a part in contributing towards achieving these objectives.

An additional US$ 4 billion in donor funding will be needed by 2030 to close the oxygen gap in high-burden countries unable to mobilize sufficient domestic funding alone

The Strategic Framework calls for all global health agencies, DFIs and the private philanthropic sector to mobilize an additional US$ 4 billion by 2030 for targeted, high-impact investments to close the oxygen access gap in high-burden, low-resource countries which are unable to mobilize sufficient domestic funding alone. This is where external support will save the most lives now and in the event of another respiratory pandemic. This is the contribution needed from the global health community – alongside domestic ownership and funding – to achieve the vision of making oxygen available and equitably accessible to all who need it. Without action, many countries will be unable to sustain the funding needed to operate and maintain existing systems. The recent gains made during the pandemic will not be protected and hundreds of millions of dollars of donated production equipment could be wasted. The window of opportunity is now.

Support for oxygen systems in high-burden countries can be extremely cost-effective – making it a “best-buy” for donors, especially for protecting children

This investment case presents novel analysis demonstrating the significant health benefits, cost-effectiveness and return on investment of oxygen systems strengthening in high-burden LMICs. Giving adequate oxygen therapy to 24 million more people could save 860 000 lives by 2030 if we act now to close the gap in countries that need help the most. The prize is worth the cost. Each dollar invested could deliver estimated returns of US$ 21. On average, additional funding for improving oxygen systems over 2025–2030 can be expected to cost approximately US$ 168 per disability-adjusted life year (DALY) averted, and as little as US$ 23 in countries with very high burdens.

Acknowledgements

The Global Oxygen Strategic Framework and Investment Case was commissioned by the Global Oxygen Alliance (GO₂AL). The collaborative development process took place during July to October 2024

Photo © UNICEF/UN0730098/Rutherford