MSF: Oxygen must be at the heart of the global COVID-19 response

1 year of COVID-19 interventions

Yemen 2020 © Majd Aljunaid/MSF

NEW YORK/BRUSSELS, MAY 10, 2021—More must be done to ensure people with COVID-19 worldwide have access to oxygen, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today. As vaccines remain unavailable in the majority of countries worldwide, it is critical that oxygen is available for people who fall ill with COVID-19, as highlighted in an MSF briefing paper released today, “Gasping for Air.”

“Oxygen is the single most important medicine for severe and critical COVID-19 patients, yet oxygen supply is often insufficient because infrastructure has been neglected in lower- and middle-income countries for decades,” said Dr. Marc Biot, MSF director of operations. “Before the pandemic, we saw patients suffering from pneumonia, malaria, sepsis, and a variety of other conditions—as well as far too many premature babies—die due to a lack of medical oxygen. COVID-19 has brought this issue into sharp new focus. Unstable oxygen supplies kill.”


Gasping for Air

In many of the under-resourced countries where MSF teams work—especially in rural settings—hospitals and health centers are facing an unacceptable shortage of this essential medicine, often relying on unstable and expensive oxygen supply chains. While hospitals in wealthy countries have their own oxygen plants and can pipe highly concentrated oxygen to a patient’s bedside, people across lower- and middle-income countries must rely on bulky, expensive, and easily depleted oxygen cylinders or small oxygen concentrators that are not sufficient for a person in critical condition.

“People are being failed twice,” said Dr. Biot. “Not only are they at the end of the inequitable global vaccine line, but they also cannot receive care when they fall ill because they do not have access to the oxygen they need.”

Long-term solutions are needed to secure supply, but, in the meantime, medical oxygen must be urgently made available to health facilities battling COVID-19, particularly when the virus surges. Beyond the current catastrophe in India, the city of Aden, Yemen, is another prime example of the global oxygen shortage. The MSF-supported hospital there was more than 100 percent occupied in recent days and has been going through 600 oxygen cylinders per day, while still having to turn away people who are sick.

“Numbers are stabilizing now, but we know there will be another surge and there will be very sick patients who will need more oxygen than we can provide,” Dr. Biot said. “As a doctor, it’s very distressing to see that wave after wave of COVID-19, countries remain unprepared and medical teams are left without the essential medicines they need to save lives on the massive scale required.”

In addition to making sure health workers are being trained in the appropriate use of oxygen therapy and that the prices of oxygen are being regulated so the cost does not become an unnecessary barrier as demand increases, MSF teams are implementing creative solutions to get their patients the oxygen they so desperately need. In South Africa, oxygen concentrators—small machines that take the oxygen from the air but are not powerful enough for a person who is critically ill with COVID-19—were linked together to increase their capacity. In the Democratic Republic of Congo, oxygen cylinders were connected together to create a central oxygen bank.

“Today, we don’t have the luxury of time,” Dr. Biot said. “These kinds of practical solutions save lives, and we need to see more of them. More concentrators must be provided—especially in rural areas where there are no oxygen plants—the price of oxygen must be regulated, and buffer stocks and reliable supply chains for facilities that rely on cylinders from existing oxygen plants must be created and maintained. These steps are needed to save lives while we wait for governments to address the structural underinvestment in oxygen infrastructure that result in some patients gasping for air.”

Beyond COVID-19, access to oxygen therapy is critical for people with pneumonia and other respiratory illnesses, sepsis, severe malaria, epilepsy, trauma, obstetric and neonatal conditions, and those in need of surgical care and anesthesia.