Breathing New Life into Medical Oxygen

members of the mainstream roughly agreed.

As for the Fed’s own economists, Rogoff concedes the possibility that when “price growth accelerated in late 2021, … [they] really thought inflationary pressures were temporary.” Yes, this is possible. After all, the first round of post-pandemic oil price hikes was over by June, along with the big jump in used-car prices, which had been driven by a semiconductor shortage that stalled production of new cars.

Under the circumstances, the central bank’s sensible technicians might well have expected price stability to return (at the new levels). Perhaps they didn’t realize the political pressure that would build on their bosses, partly fueled by Ivy-League loudmouths, when the media kept the old news in the headlines, month after month. Unlike unemployment or the GDP reports, inflation numbers are published on a 12-month rolling basis, which meant that the price jumps from early 2021 kept on making news. Having delivered headlines about “record inflation” for almost a full year since they occurred, they are only now on the verge of fading from the numbers.

Nor could a sensible technician have reasonably forecast the oil price spike to $130 per barrel that occurred in early March. That, too, will sustain sensational headlines for a while, even though the price increase itself has already been mostly reversed.

In any case, the Fed has now acted, raising interest rates by half a percentage point. That is the largest incremental increase in 22 years, though it is not, by itself, an economic earthquake. The timing is possibly brilliant. With negative real GDP growth in the first quarter of 2022, fiscal stimulus is obviously finished for now, and there is no prospect that any more will be enacted. With the 2021 price spikes finally passing from the 12-month window, and with oil back down a bit, there is a chance that those technicians on Team Transitory (if they existed) will be proven right after all.

If so, they won’t get any credit. Instead, that will go to Chairman Jerome Powell for waving his magic wand. The inflation hawks and the moneylenders will applaud the Wizard of Oz maneuver, claiming that they were right all along. The only grumbling will be among all the farmers, the small-business people, the indebted, and the unemployed.

NEW YORK – COVID-19 has taken at least 18 million lives, and it is anyone’s guess how many of those deaths were due to a lack of medical oxygen. Governments don’t want to talk about the issue, because that could mean admitting that thousands – or even hundreds of thousands – of their citizens died unnecessarily. But unless health systems take steps to ensure a sufficient supply of oxygen in the future, they will be risking a repeat of the past two years.

While high-income countries are already working to secure their supplies of medical oxygen, many low- and middle-income countries (LMICs) will continue to need international support. Deaths from a lack of medical oxygen in these countries preceded the pandemic, because global health and development agencies made no serious effort to help LMIC governments close the gap between need and supply.

That gap is one factor underlying LMICs’ stubbornly high newborn and child mortality, adult deaths from infectious and chronic conditions, and deaths from injuries that require surgery. Research published prior to the pandemic found that four out of five children hospitalized with pneumonia in Nigerian hospitals did not receive the oxygen they needed, and that simply putting oxygen into pediatric wards could reduce child deaths by 50%.

As Mike Ryan of the World Health Organization puts it, COVID ripped a bandage off an old wound, driving a tenfold increase in the need for oxygen in the space of just weeks in some countries. LMICs now need about 500,000 large oxygen cylinders every day to treat COVID patients, and this is the just the tip of the iceberg. For every COVID patient who needs oxygen, there are at least five other patients who also need it, including the 7.2 million children with pneumonia who enter LMIC hospitals each year.

The main vehicle for the international response is the ACT-Accelerator (ACT-A) COVID-19 Oxygen Emergency Taskforce, expertly chaired by Unitaid, which has built a system to help LMICs prevent oxygen shortages. To date, the Taskforce has delivered almost $1 billion – including $560 million from the Global Fund alone – to LMIC governments and their United Nations and NGO partners. This money has been spent on liquid oxygen, pressure swing absorption oxygengenerating plants, mobile oxygen concentrators, oxygen therapies, and the workforce needed to install, operate, and maintain the equipment.

This funding has helped more than 100 countries, mostly in Africa and Asia. But there are still LMICs struggling to provide oxygen, so the Taskforce has asked for another $1 billion in 2022. US President Joe Biden’s Second Global COVID-19 Summit this week also will emphasize the issue with an appeal to governments, companies, and philanthropies to do more.

The case to make to donors is clear. There is a moral obligation to treat COVID patients and to flatten the pandemic death curve once and for all. Investments in oxygen will serve that goal and also save lives in the future. Not only is oxygen an essential treatment for almost all of the health conditions targeted by the UN Sustainable Development Goals; it is also a critical pillar of effective pandemic preparedness and response (PPR).

As the world pivots to longterm COVID management, oxygen production and distribution systems will need to be embedded in global health infrastructure. International organizations with mandates to improve newborn and child survival, infectious- and chronic-disease management, and PPR all have a stake in access to oxygen. These agencies should formalize their nascent ACT-A oxygen partnership by transforming it into a Global Oxygen Alliance with a mandate extending to 2030 (to align with the SDGs), and with a membership broadened to include international agencies focused on chronic diseases.

There are five components to a successful alliance to close the oxygen access gap. First, LMIC governments and the national institutions responsible for providing medical oxygen need to take the lead. Ideally, they would be guided by politically en

The case to make to donors is clear. There is a moral obligation to treat COVID patients and to flatten the pandemic death curve once and for all. Investments in oxygen will serve that goal and also save lives in the future. Not only is oxygen an essential treatment for almost all of the health conditions targeted by the UN Sustainable Development Goals; it is also a critical pillar of effective pandemic preparedness and response (PPR) dorsed national plans for oxygen access, with governments financing the effort as part of their health budgets.

Second, LMIC governments that need external support to finance their national plans should be able to leverage loans and grants from a variety of multilateral, bilateral, and philanthropic sources. The Global Fund should continue to provide grant funding as part of its new PPR objective, and multilateral development banks should provide loans for this purpose as well.

Third, oxygen producers should be given more incentives and opportunities to work in partnership with LMIC governments and global health and development agencies. Memoranda of understanding, non-disclosure agreements, and transparent and competitive tenders for equipment procurement, installation, and maintenance should all be made available, building on the ACT-A COVID-19 Oxygen Emergency Taskforce’s existing blueprint for industry partnerships. Moreover, development finance institutions should offer loans, equity, and guarantees to oxygen producers, and support LMICs seeking to reduce their dependence on oxygen imports and fragile global supply chains.

Fourth, UN agencies and NGOs with a strong LMIC presence must continue to support these governments as they develop national oxygen plans, collect data, procure supplies, train health-care workers and biomedical engineers, and monitor and evaluate progress. To do so, they will need ongoing funding from bilateral development agencies (such as USAID, the European Commission, and others) and philanthropies (such as the Bill & Melinda Gates Foundation, the Skoll Foundation, and others).

Finally, LMIC governments need access to highquality, timely data on national oxygen needs – such as the annual number of hypoxemic patients and how much oxygen they require – and oxygen capacity in the health system so that they can move quickly to close deficits. Donors should invest more in national health surveillance and statistical institutions, while using the available data to generate estimates of the hypoxemia burden as part of the Global Burden of Disease. And independent agencies such as the Access to Medicine Foundation should be funded to hold the oxygen industry accountable.

The next six months are critical as we move beyond the acute phase of the pandemic. Ideally, by September, the ACT-A COVID-19 Oxygen Emergency Taskforce will have become a Global Oxygen Alliance, chaired by Unitaid and continuing to meet regularly to coordinate investments, mobilize resources, and monitor the impact of efforts to ensure equitable access to an essential medicine.