Opinion: Adopting WHO's oxygen resolution is imperative to save lives

If adopted and implemented, the World Health Organization’s draft resolution to increase access to medical oxygen will help save hundreds of thousands of lives. At the end of January, WHO’s executive board announced its plan to introduce the Increasing Access to Medical Oxygen resolution for adoption at this year’s World Health Assembly. Although this received little fanfare outside of those working directly in respiratory care, it marks a significant milestone in global health efforts to address medical oxygen shortages in low- and middle-income countries. No one, no matter where they live, should die from lack of oxygen, a condition we can diagnose easily, treat affordably, and prevent globally. Yet in many countries in Africa, Asia, and South America, a shortage of oxygen has created a health equity crisis. Almost half of the hospitals in LMICs have an inconsistent supply of medical oxygen or lack it entirely, while almost 9 in 10 health facilities do not have access to pulse oximeters needed to diagnose hypoxemia — the condition of having low blood oxygen levels. It is estimated that hypoxemia contributes to a million preventable deaths each year and that 650,000 children are unable to receive the oxygen they need for deadly conditions such as pneumonia, malaria, and diarrhea. These shortages put a terrible strain on front-line health workers, who are forced to make difficult decisions about which patients receive lifesaving oxygen and which don’t. Medical oxygen is a cross-cutting investment that provides a lifeline for a range of conditions and stabilizes patients to make other treatments possible. The truth is, medical oxygen is an unrecognized cornerstone of health care and is fundamental for the development of sustainable health systems. Yet, despite the importance of medical oxygen throughout the health care system, it has not received the attention and funding of individual disease areas such as malaria or HIV. The COVID-19 pandemic of course has helped shine a light on the need for adequate and reliable medical oxygen supplies. The pandemic has provided a catalyst for many countries to prioritize investments and resources at a national level to build out sustainable oxygen ecosystems, strengthen health systems and better prepare themselves for future health crises. Thanks to investments from Unitaid, the Bill & Melinda Gates Foundation, and The Elma Foundation, CHAI and many other partners are supporting governments around the world to advance medical oxygen. Many have made impressive progress, from developing and implementing their first national oxygen policies to installing new production plants, training thousands of health workers and biomedical engineers, and procuring essential equipment, such as pulse oximeters to better identify hypoxemia. Infrastructure has also been key to expanding access to oxygen, with significant new investments in the past two years by The Global Fund to Fight AIDS, Tuberculosis and Malaria, USAID, UNICEF, and others. Many countries have concentrated on increasing medical piping in health facilities, enabling patients to easily access oxygen at their bedsides and reducing the need to transport cumbersome gas cylinders around. And significant investments in pressure swing adsorption, or PSA, plants — oxygen production units in medical facilities — and infrastructure for the use of liquid medical oxygen, an affordable industrial product used in most high-resource settings, are dramatically increasing access for patients. Regardless of the kind of oxygen utilized, gaseous from PSAs or liquid, this infrastructure, if maintained, can last for a generation and save thousands of lives. However, more needs to be done to reach all patients in need. More governments must prioritize improving the supply of medical oxygen, which remains inadequate in many places, and additional investment is required to develop and implement national medical oxygen programs that can be sustained for the long term. The Access to COVID-19 Tools Accelerator estimates that globally a minimum of $1 billion remains unfunded in the near term to deliver medical oxygen to meet the most immediate needs in LMICs. Considering the number of lives taken by hypoxemia annually, this should not be an insurmountable number. It is our hope that WHO’s medical oxygen resolution, and a new global oxygen alliance being set up, called GO2AL, will result in more governments, donors, and partners across the world paying attention to this global health crisis and prioritizing improving oxygen availability. The resolution recognizes the vital importance of medical oxygen supplies particularly for reducing maternal, newborn, and child mortality, and urges countries to undertake 20 actions to scale up access to medical oxygen, including: • Developing national medical oxygen plans. • Ensuring medical oxygen and associated medical devices are on national lists of essential medicines and medical devices. • Assessing and monitoring oxygen access gaps. • Raising public awareness about the lifesaving role of medical oxygen. It is vital that WHO’s oxygen access resolution is adopted. Unitaid and CHAI, along with all members of GO2AL, including the Every Breath Counts Coalition, and the governments who are already supporting the resolution are now calling on WHO member states to support the Access to Medical Oxygen Resolution at the World Health Assembly in May 2023. If they do, and if the actions listed in the resolution are implemented, then 2023 will truly mark a turning point in ensuring every patient around the world can receive lifesaving oxygen when they need it.