This February, The Lancet Global Health Commission made an urgent call for $34 billion over five years to reduce worldwide inequities in access to medical oxygen. The announcement came as the United States began gutting global health funding, raising doubts over whether these recommendations will ever be implemented. Reports are already emerging of oxygen deaths due to financial cuts to the U.S. Agency for International Development (USAID).
The Lancet Commission found that 7 of every 10 patients—most of whom live in low- or middle-income countries (LMICs) across Africa and Asia—needing medical oxygen for acute procedures or surgeries do not receive it. This massive shortage could be the largest global access deficit for any essential medicine, dwarfing treatment gaps for HIV/AIDS (25%) and tuberculosis (23%).
Medical Oxygen Patients Are Left Behind
More than two-thirds of medical oxygen patients are not receiving necessary treatment, a much larger gap than for tuberculosis and HIV
This lack of access should come as no surprise given what happened during the COVID-19 pandemic, when hospitals in most LMICs ran out of medical oxygen and even high-income countries came perilously close. The commission reports that in 2021, 52 million COVID-19 patients needed 1.9 billion cubic meters of oxygen—a colossal amount atop the 4.4 billion cubic meters required to treat 374 million newborns, children, and adults with other conditions and for surgery.
To alleviate these massive oxygen shortages to save lives now and be better prepared for the next pandemic, the Lancet Commission offers 52 recommendations to governments, global health agencies, donors, industry, and civil society.
U.S. Support During COVID-19’s Oxygen Crisis
Prior to COVID-19, little global health funding supported medical oxygen. The “golden age” of global health, which began in 2000, instead prioritized childhood vaccination, HIV/AIDS, malaria, and tuberculosis. In the subsequent decades, HIV/AIDS and child deaths halved as the U.S. government funded a major share of both efforts. The dearth of medical oxygen continued to kill silently.
When COVID-19 hit, the oxygen crisis emerged rapidly, and hospitals in Latin America, Asia, Africa, the Middle East, and even Eastern Europe were unable to supply enough oxygen. The Lancet Commission includes the testimonies of patients and family members who struggled to find oxygen during this period, and the tragic deaths that resulted. The Global Burden of Disease estimates 12.6 million direct COVID-19 deaths in 2020 and 2021, and more than 8 in 10 of those fatalities were in LMICs. Most died without ever receiving oxygen.
During the international pandemic response, global health agencies took 12 months to provide oxygen support to the worst-affected countries. Between 2021 and 2023, the International Oxygen Emergency Taskforce mobilized to help more than 100 LMICs increase their oxygen supplies.
Most of this funding—60%—came from the U.S. government, channeled primarily through The Global Fund ($600 million) and USAID ($100 million). According to the Lancet Commission, as vital as this support was, it represented a tip-of-the-iceberg response. Wide scarcity in access remains. In sub-Saharan Africa, 91% of patients who need medical oxygen do not get it. In East Asia, South Asia, and the Pacific, more than 70% of patients who require medical oxygen suffer, and many die without it.
Much of the oxygen equipment supplied during the pandemic—such as oxygen plants, liquid oxygen storage tanks, mobile concentrators, pulse oximeters—is now at risk because of a paucity in investment into operational and maintenance costs. This shortfall includes low numbers of trained clinicians and engineers, maintenance services, and spare parts.