The report analyses six major gas companies that also produce medical liquid oxygen: Air Liquide, Air Products, Linde, Messer, Nippon Sanso Holdings Corporation and SOL Group.
Some of these companies demonstrated agile approaches to increase supply during the COVID-19 pandemic, including pivoting more production capacity from industrial liquid oxygen to much-needed medical liquid oxygen, but efforts were limited in geographic reach.
By engaging in the six priority areas for action identified in this report, gas companies now have the opportunity to sustainably scale up access to medical liquid oxygen in LMICs.
In 2021, it was estimated that 73 million people with low blood oxygen (hypoxemia) attended healthcare facilities in LMICs to receive oxygen therapy. Of those, only 22 million were suffering from COVID-19. Many more people, including 32 million children, attending these facilities needed oxygen due to other conditions and routine procedures.
Yet, all too often, these healthcare facilities in LMICs did not have – and still do not have – adequate supplies of medical oxygen to treat their patients, leading to preventable loss of life. Approximately half of healthcare facilities in LMICs do not have reliable access to medical oxygen. This is despite the fact that medical oxygen is included in the World Health Organization’s Model List of Essential Medicines, meaning it is a product that should be available in every country’s health system.
A key role for gas companies
Given the essential nature of medical oxygen, and the fact that just a handful of gas companies produce the vast majority of the global supply of medical liquid oxygen, it is critical to the wellbeing of people living in low- and middle-income countries (LMICs) that these companies scale up access to this product as a priority.
With a small number of companies responsible for the world’s supply of medical liquid oxygen, the role they play in the global health ecosystem needs to be prioritised. Medical gases are a small part of these companies’ business, yet society needs them to ensure this vital lifeline is available both during emergencies and to meet the daily medical oxygen needs of all health systems.
This first published research report from the Foundation's Medical Oxygen Programme analyses companies' access initiatives to date. The report identifies some agile responses from the six major gas companies in scope – Air Liquide, Air Products, Linde, Messer, Nippon Sanso Holdings Corporation and SOL Group – to increase the supply of medical liquid oxygen* in an attempt to meet demand surges caused by the COVID-19 pandemic. These companies now have the opportunity to further pursue long-term access planning to secure sustainable supply beyond this global health crisis.
Six priority areas for company action
Based on analysis of the issue and what actions have been taken so far, the report identifies six priority areas for action that companies can focus on to provide access to medical liquid oxygen in LMICs, both in emergencies and to provide routine delivery. Each area is explored in depth to include examples of what companies are currently doing, as well as recommendations for what companies can do to better address access.
Prioritise, measure and report progress on medical liquid oxygen
Enable improved affordability for different populations and health systems
Provide sustainable supply of medical liquid oxygen
Develop and maintain long-term partnerships to close access gaps
Support health systems and the human resources required to operate and maintain medical liquid oxygen systems and administer oxygen therapy
Plan proactively for future emergencies
We have identified positive steps some major gas companies have taken to improve access to medical liquid oxygen in response to the COVID-19 pandemic, but a more comprehensive approach is urgently needed to address the scale of the problem. The six priority areas for action set out in this report highlight what companies have done, and can do, to ensure access to this lifesaving product on a sustainable, long-term basis.
What have companies done so far?
The examples outlined in the report show that, particularly in response to COVID-19, some gas companies took steps to address the access issue – from airlifting whole medical liquid oxygen tankers and trailers into LMICs via specially chartered aircrafts, to pivoting more production capacity from industrial liquid oxygen to much-needed medical liquid oxygen. However, these efforts were limited in geographic reach. Across the six major gas companies covered by this analysis, initiatives to increase the supply of medical liquid oxygen during the COVID-19 pandemic have been reported, publicly or directly to the Foundation, in only 39 of the 108 LMICs in scope – approximately one third.
Moreover, now that the immediate public health emergency has passed, it is not always clear whether companies will continue to address gaps in access in LMICs over the long term.
Of the companies examined in the report, Air Liquide is currently the only company with a clear access-to-medical oxygen strategy targeting LMICs. Air Products, Linde, Messer, Nippon Sanso Holdings Corporation and SOL Group are also taking some steps in the right direction, with broad commitments to health but with no specific targets related to medical oxygen or LMICs.
The report identifies some efforts from companies that could lead to a more sustainable supply of medical LOX in more LMICs over the long term. Since the start of the COVID-19 pandemic, for example, both Air Liquide and Linde have reported providing medical LOX in regions they did not previously supply. Encouragingly, Air Liquide, Air Products, Messer and Nippon Sanso Holdings Corporation have reported the installation or acquisition of new liquid oxygen-producing Air Separation Units (ASUs), including in South Africa, China, Egypt, India, Vietnam and Thailand. These ASUs have the potential to significantly boost supply of medical liquid oxygen.
There are several challenges to improving access to medical oxygen in LMICs, including healthcare facility infrastructure and a fragmented supply chain involving complicated logistics and distribution networks. However, the gas companies in scope of this report can play a critical role in helping to overcome some of these challenges, in particular by pursuing and formalising long-term partnerships with governments and global health stakeholders. Air Liquide and Linde have already formalised partnerships with global health organisations to address access gaps in LMICs, with both companies entering into Memoranda of Understanding (MoUs) with Unitaid and the Clinton Health Access Initiative (CHAI).
With the publication of this report, the Foundation calls for gas companies to further pursue progress and be proactive in finding new ways of increasing supply and engage in long-term sustainable approaches to access. In this way, they can help ensure people in all countries have access to medical oxygen, when they need it.
*While there are three types of medical oxygen production systems, each with its advantages and disadvantages, this report focuses on medical liquid oxygen, which the Foundation has identified as presenting a promising long-term sustainable supply solution to address the persistent gaps in access to medical oxygen in LMICs.