Opinion: Ensuring oxygen access is essential to achieving health for all

Increased investments in medical oxygen and continued private-public partnerships are vital to creating a more resilient global health system. This will mean the world is better prepared for future pandemics and capable of providing universal access to oxygen, saving millions of lives. During the COVID-19 pandemic, medical oxygen received extensive attention — both its vital importance and the gaps in accessing it. Global health donors responded by mobilizing $1 billion to strengthen oxygen supplies in over 120 countries. In 2023, at the World Health Assembly, all 194 member states unanimously adopted a resolution to increase access to oxygen. Last year, the first investment case for oxygen financing commissioned by the Global Oxygen Alliance, or GO₂AL, launched in Berlin during the World Health Summit. And earlier this year, a landmark report released by The Lancet Global Health Commission on medical oxygen security revealed the first-ever estimates of oxygen coverage gaps globally and the total cost of closing them. Yet despite this momentum, less than 1 in 3 people who need oxygen for acute medical or surgical conditions receive it due to gaps in service contact, readiness, provision, and quality in low- and middle-income countries. As a result, hypoxemia (low blood oxygen) directly contributes to the deaths of nearly 9 million people every year — more than the global number of deaths from stroke — including 1.6 million children under the age of 5. The daily impact of such inequitable access is enormous. Oxygen is vital in treating respiratory illness in people of all ages, helping women during childbirth, treating newborns and children in respiratory distress, for safe surgery and emergency care, and for management of noncommunicable diseases and infections caused by severe forms of tuberculosis, malaria, and advanced HIV. That impact becomes starkly apparent during a respiratory pandemic. And when the next one strikes, it is very likely we will see a repeat of the COVID-19 oxygen shortages and their tragic consequences. More than 8 in every 10 patients needing medical oxygen live in LMICs, with most concentrated in South Asia, East Asia and the Pacific, and sub-Saharan Africa. The barriers in these regions are many, including the high capital costs of medical oxygen production and infrastructure, and the even higher operational costs required to maintain equipment, train a skilled workforce, and cover energy expenses. The lack of innovative business and financing models that ease the burden on governments to manage complex medical oxygen systems further undermines sustainable supply. While some of the work funded through COVID-19 investments is still underway in 2025, a cliff in oxygen financing is well within sight. Without financial backing, the continued functionality of oxygen infrastructures established during the pandemic — including plants, equipment, and trained personnel — is at risk. Meaning, hundreds of millions of dollars already invested will be jeopardized, and millions of patients needing oxygen will continue to be denied treatment. $34 billion is needed between 2025 and 2030 to close oxygen coverage gaps in LMICs, according to the Lancet Commission report estimates. This is why global health agencies are calling for $4 billion of additional development funding now to catalyze the next wave of oxygen access gains across the most vulnerable LMICs by 2030. This commitment is the initial resource mobilization target set by GO2AL in its commissioned Global Oxygen Strategic Framework and Investment Case 2025-2030, expected to increase oxygen access by 25%, benefiting an additional 24 million patients and saving 860,000 lives — including 331,000 children under 5. Why should global health donors and country governments remain committed to investing in oxygen? 1. Oxygen investments are a best buy for global health Every dollar invested in medical oxygen returns $21, putting oxygen on a par with investments in HIV/AIDS, malaria, and tuberculosis interventions, as well as childhood immunization. Oxygen investments are also extremely cost-effective, at $168 per disability-adjusted life year averted on average, and as little as $23 in some countries. The call for an initial $4 billion of additional development funding is estimated to generate health gains with a monetized intrinsic value of $85 billion — e.g., the monetary value that affected populations themselves would attribute to projected gains in survival and health-related quality of life — and direct economic productivity gains of $14 billion through 2030. 2. Oxygen investments do double duty on global health goals Investments in oxygen will not only accelerate achievement of the health-related Sustainable Development Goals, including universal health coverage, or UHC, but also prepare health systems for future emergencies. Oxygen is essential for eight out of the nine health-related SDG goals, including ending preventable child deaths, reducing newborn and maternal mortality, and achieving UHC. 3. Oxygen is a critical pillar of pandemic prevention, preparedness, and response Oxygen needs can rise exponentially during emergencies, putting enormous pressure on health systems. An additional 1.9 billion cubic meters of oxygen were needed in 2021 to address the needs of an additional 52 million COVID-19 patients. With the risk of another respiratory pandemic in the next 25 years estimated at 66%, the stakes are high for governments to pay attention. There are very few health investments with the power to advance so many health goals simultaneously. 4. Oxygen investments can leverage domestic spending Global financial commitments can leverage increases in domestic health spending on oxygen, which is critical for the sustainability of national medical oxygen ecosystems. Global funding can complement national spending by strengthening planning and implementation, increasing local manufacturing capacity, testing innovative financing solutions and more effective business models, and reinforcing local advocacy and demand generation. There are promising signs of financial commitments fueled by public-private partnerships underway. The Government of Japan has been contributing to the discussion for achieving universal health coverage through strengthening health systems, and is determined to keep leading global efforts to achieve UHC by 2030 for the entire world. In March 2024, the Government of Japan committed $7.3 million to global health initiative Unitaid to expand access to a sustainable supply of medical oxygen in Kenya and Tanzania. This investment is part of the East African Program on Oxygen Access, a first-of-its-kind investment to support three Kenyan and Tanzanian oxygen manufacturers to establish Africa’s first liquid oxygen regional manufacturing program which will expand medical oxygen production by 300% in East Africa and reduce oxygen prices by up to 27%. This will make oxygen more affordable for health care systems across the region and enable treatment of thousands of additional patients each month. Over the next decade, this initiative has the potential to save up to 154,000 lives in Kenya and Tanzania alone, by addressing life-threatening conditions such as pneumonia, preterm birth complications, and surgical emergencies. It will also help ensure that countries in East and Southern Africa are better prepared for future respiratory pandemics, by strengthening health systems and security through regional and local production of medical oxygen. In 2025, Unitaid plans to invest up to $20 million to accelerate global access to medical oxygen by driving innovation in both the design of oxygen technologies and their delivery systems. This initiative will focus on testing newly developed technologies with the potential to transform oxygen access in real-world settings where they have not yet been implemented. At the same time, Unitaid will explore innovative business models to enhance the utilization and sustainability of existing equipment. These combined efforts aim to strengthen health systems, increase efficiency, and improve equitable access to lifesaving medical oxygen for patients worldwide. The global health community has come a long way on medical oxygen access since COVID-19 — and we can’t stop now, even as the global health landscape continues to evolve. Uninterrupted investments are vital, both from international sources and domestic financing; so are continued partnerships between public and private players to optimize and strengthen sustainable solutions for oxygen coverage and pursue innovation. These are the only ways to guarantee universal access to medical oxygen for everyone — the patients who need it now, and many more who will need it when we face future health crises. To keep the oxygen flowing — we need to do more.