Access to Medical Oxygen for All: A Human Need and Business Case
Remarks as delivered to Gasworld: A World Beyond COVID - Next Level Healthcare
World Health Day, 7 April 2022
Thank you Gasworld for hosting a conversation about access to medical oxygen on World Health Day. Your timing is perfect.
And a special shout out to John Raquet and Rob Cockerill who have been such vital partners for two years as we all struggled to help countries meet the surging demand for medical oxygen. That struggle continues in many parts of the world. The pandemic is NOT over.
I’m delighted to be opening Session II: Africa & Asia.
The title of my remarks: Access for All: a Human Need and Business Case.
What exactly are we talking about here?
Access to what? Well medical oxygen.
An essential medicine and just how essential we all now know. The pandemic has shown us what happens when hospitals do not have enough oxygen - not just in one country, but across entire regions of the world. It’s a recipe for mass fatality.
And that’s exactly what has happened.
COVID-19 has officially claimed more than 6 million lives - but the true death toll could be five times higher. Many have died because they could not get oxygen.
And each week we are still officially losing 25,000 more - another underestimate.
This brings us to the Human Need part of the equation and to Africa and Asia - the focus of my remarks today.
80% of the world’s population - 5.7 billion people - live in Asia (4.5 billion) and Africa (1.2 billion).
This is where the patients are!
And in the last two years not one month has gone by without reports of oxygen shortages and related deaths in these two regions.
Beginning back in July 2020 - when South African hospitals started running out of oxygen.The crisis spread quickly into southern Africa - Zambia, Malawi, Zimbabwe and further. And then West Africa, and East Africa, even northern Africa - no part of the continent was spared in subsequent waves of infection.
Remember those days - media headlines like, “Hospitals overwhelmed as Johannesburg runs out of oxygen,” “Lack of oxygen leaves patients in Africa gasping for air,” “Coronavirus exposes Africa’s oxygen problem,” and many more.
And then in India in May 2021 - who can ever forget the images of patients lying in the parking lots of hospitals and on the backseats of cars suffocating as their loved ones searched frantically for oxygen. Nepal went into oxygen crisis soon after. Then Indonesia, Myanmar, the Philippines, Malaysia, Thailand, and more.
The need for oxygen to treat COVID-19 rose 10 times in the space of weeks in some of these countries!
And even now it is East Asia - Viet Nam particularly - and the Pacific where countries are still struggling with rapidly rising COVID-19 transmission.
Right now all low- and middle-income countries (LMICs) need about four million cubic meters of oxygen every day just to treat COVID-19 patients - Africa and Asia are about 70% of that.
This is data from the COVID-19 Oxygen Needs Tracker - an online tool built by NGOs PATH, the Clinton Health Access Initiative and Every Breath Counts to expose the massive daily need for oxygen to treat COVID across LMICs.
And tomorrow, next week, next month - who knows.
We really can’t take our foot off the pedal with COVID-19. It can change and move so quickly.
We shouldn’t have been surprised by this chain of tragic events.
Before COVID-19 there were studies suggesting shockingly high levels of under-treatment of patients needing oxygen across Africa and Asia.
Studies from Nigeria alone found four in five children hospitalized with pneumonia needed oxygen but did not get it.
Studies from Asia revealed a similar lack of access.
There is no question that lack of oxygen is one of the reasons pneumonia has been the leading infectious killer in Africa and Asia for so long, according to the Global Burden of Disease.
But it wasn’t just children with pneumonia who were missing out on oxygen. Newborns in respiratory distress, adults with infectious and chronic respiratory conditions, women in childbirth, and patients needing surgery - all were missing out.
So these health systems could not have been more vulnerable to a pandemic of respiratory infection like COVID-19 - when waves of patients needing 30, 40, 60 LPM of oxygen started turning up en masse at hospitals.
As Dr Mike Ryan from the World Health Organization said just last month - COVID RIPPED A BANDAID OFF AN OLD WOUND - lack of access to oxygen.
Why was it like this?
Now we get to the other concept in our title today - the Business Case.
Despite having 80% of the world’s people, Africa and Asia produce just 28% of the world’s GDP - the buying power that drives markets - in this case the market for medical oxygen.
When you have a lot of people who need an essential medicine like oxygen but with a limited capacity to buy it from industry you have a major public health problem.
This is typically when global health agencies step in - to help governments who can’t afford a medicine to buy it - and to negotiate with industry.
This is what the Global Fund does to make medicines available to treat HIV/AIDS, TB, and malaria and what Gavi does to make vaccines affordable for many low income countries.
But there was no public health support for oxygen prior to the pandemic.
Why not?
Simply put - there was no architecture for it - no agency responsible for oxygen, no donors deeply interested in oxygen, no program dedicated to oxygen access, limited oxygen expertise in global health agencies, and few relationships with industry - especially the medical gas industry.
The pandemic has changed all of this.
Access to oxygen now has the attention of the leading global health agencies and their donor governments.
We have the ACT-Accelerator Oxygen Emergency Taskforce - the epicenter of the International pandemic oxygen response.
It was launched in February 2021, and is chaired by Unitaid with membership from WHO, UNICEF, the Global Fund, the Africa CDC, the World Bank, the Gates Foundation, the Access to Medicine Foundation, other UN agencies and many INGOs.
This group has spent the past year building a system to help LMICs prevent oxygen shortages.
In just one year, about $US700 million has flowed through the Taskforce directly to LMIC governments and their UN and NGO partners.
The Global Fund alone has moved ~$500 million worth of oxygen support this past year.
This money has been spent on PSA plants, mobile oxygen concentrators, other oxygen therapies and increasingly on liquid oxygen. More than 100 LMICs have benefited - many in Africa and Asia.
The Taskforce was also instrumental in signing Memoranda of Understandings - MoUs - with two of the largest medical gas companies - Air Liquide and the Linde Group - in June 2021.
I want to particularly acknowledge the leadership of Air Liquide - who are a member of Every Breath Counts - and especially Jean-Marc de Royere whom you heard from earlier today. Our continued progress is really going to depend on leaders like this emerging from industry.
Taskforce members are working hard to deepen their relationships with the medical gas industry.
We hope other medical gas companies will also sign MoUs with the Taskforce sooner rather than later.
UNICEF has recently entered into long term agreements with Afrox and Linde Asia Pacific.
Unitaid just announced a further $US56 million for oxygen, with a special focus on liquid. You’ll hear more later from Unitaid’s Robert Matiru who chairs the Taskforce.
And the US Government has been a champion for access to medical oxygen as part of their Save Lives Now agenda announcing $US75 million in support most for liquid oxygen. You’ll hear more from Nikki Tyler from USAID shortly.
A handful of G7 governments and private donors have funded the Taskforce’s work to date - especially the United States, Germany, Canada, France and the Gates Foundation.
Although this represents the largest amount of International donor financing for medical oxygen ever - still more is needed.
The Taskforce is asking for $US1 billion more to close remaining oxygen access gaps.
Other G20 governments will be asked to step up. Most have not yet done so. Where is Australia, Japan, Korea, Italy, the UK?
We need to sustain the public financing for oxygen to ensure that no more COVID-19 patients anywhere die for lack of access before this pandemic is over.
But we can’t stop there.
We need to make sure health systems everywhere have the oxygen they need to address the underlying needs of all patient populations.
Because in many countries - in Africa and Asia particularly - the COVID-19 oxygen need is just the the tip of the iceberg.
For every COVID-19 patient arriving at a hospital needing oxygen, there are at least 5 more patients with other conditions who also need oxygen.
There are 7.2 million children under five with pneumonia alone entering hospitals in LMICs each year needing oxygen. We need to make sure they all get it.
There is a window of opportunity open now that we need to keep open - because it may take a decade to close oxygen access gaps.
LMIC governments have never been as sensitized to medical oxygen or as well-financed to increase supply in their health systems.
Global health agencies know how to support governments and work more effectively with industry.
The business case has never been stronger for industry to close access to oxygen gaps.
So what can industry do?
I want to finish by leaving your with three “asks” for the next decade. These are targeted to the medical gas industry but are equally applicable to any company with a medical oxygen solution.
First.
Develop an "Access to Oxygen" strategy - a company plan to tap the massive underserved markets for medical oxygen across Africa and Asia (and other LMICs).
Set bold goals, develop creative ways to deepen your footprint in these markets, measure your progress, publish it - put good people on it - hire people with public health expertise to complement your deep technical expertise.
These are your growth markets of the future - look at birth rates and aging across these regions! Look at rising rates of chronic disease, look at both the hospital and home markets as major growth opportunities.
Second.
Engage public health agencies - sign MoUs that give you access to the global health agencies leading on oxygen. I’m not talking about charity or philanthropy - but leveraging the public monies, data, expertise, and access to governments that will help you have impact on your access to oxygen agenda.
The oxygen industry is part of the public health landscape now and will be forever. Work with independent groups like the Access to Medicine Foundation to share best practices and to hold yourselves accountable for progress - just as the pharmaceutical industry has done. You’ll hear more from Jay Iyer about that shortly.
And third.
3. Innovate, innovate, innovate — invest in new, more cost-effective oxygen generation technologies that work in the toughest settings - you’ll hear about one from John Graf at NASA later.
And new business models that increase profitability in low resource settings. Why so little innovation in this industry? Is it related to the historic lack of competition - the divide and conquer market access strategies that may secure profitability in the short term but at the expense of long-term business growth?
Understand that you control one of the most lifesaving of essential medicines. We have data showing that just putting oxygen into the pediatric wards of hospitals can reduce child deaths by 25%! The companies that figure out how to produce and distribute medical oxygen more cost-effectively will reap business benefits with major public health impact.
Will we shake hands and go our separate ways after the pandemic? Or will we keep going and build on all that we have achieved in such a short space of time?
Will we embed an access to oxygen agenda inside companies and in the global health architecture and find ways to drive business growth and meet the human need for medical oxygen?
Or will we walk away and leave millions of patients to die each year, because they can’t get oxygen? As if the pandemic didn’t even happen.
Let’s not do that. Let’s show the world that by working together on access to medical oxygen it is possible to achieve both business and public health goals.