Despite using oxygen medically for over 100 years and WHO classifying it as an essential medicine in 2017, large population groups, especially in developing countries, do not have access to adequate supplies. WHO has consistently raised alerts about the ongoing and persistent shortages in Africa, the Middle East, and other developing regions. 1 1. WHO model list of essential medicines, 20th edition, WHO, August 2017, who.int. The adverse impact of the shortage is most critically felt in neonatal care, with an estimated half a million newborns around the world dying annually from oxygen shortages.

As COVID-19 patient-care protocols have evolved, medical-grade oxygen is considered essential to treatments for critically ill patients, such as invasive ventilation and low- and high-flow oxygen therapies. In regions such as Africa and the Middle East, the surge in demand for medical oxygen to treat COVID-19 exacerbates preexisting gaps in medical-oxygen supplies, leading to substantial supply shortages (Exhibit 1). Even though these regions may have lower incremental demand for oxygen to treat COVID-19 than, say, China, their lower preexisting supplies will contribute to greater shortages. 2 2. Stephen R. C. Howie et al., “Meeting oxygen needs in Africa: An options analysis from the Gambia,” Bulletin of the World Health Organization, October 2009, Volume 87, Number 10, pp. 733–804, who.int.

In this article, we explore potential ways to solve the supply shortage, help countries respond to the COVID-19 pandemic, and close the structural deficiencies in oxygen supply for large population groups.

Medical oxygen is produced at plants in quantity and delivered to hospitals in bulk in liquid tanks or in smaller amounts as pressurized gas in cylinders (Exhibit 2), depending on a hospital’s specific needs and infrastructure. Liquid oxygen, once received at hospitals, is distributed to patients through an internal network of pipes. Thus, hospitals need to have the right infrastructure, including cryogenic tanks, vaporizers, and piping throughout buildings, to have liquid oxygen delivered. 3 3. Payel Bose, Subhrajyoti Chattopadhyay, and Sabyasachi Das, “The anaesthesia gas supply system,” Indian Journal of Anaesthesia, September–October 2013, Volume 57, Number 5, pp. 489–99, ijaweb.org. Pressurized oxygen-gas cylinders do not require internal piping systems. They can be used in hospitals without a sophisticated infrastructure and in facilities such as clinics that do not need high-volume or continuous oxygen supplies. Cylinders are also commonly used for supplemental or emergency supply in hospitals that rely primarily on liquid deliveries.

While medical-oxygen production can be scaled to meet global demand, long-distance oxygen transportation has not been regarded as economically efficient, so favored sources are almost all local. Therefore, the primary consideration for a country’s ability to meet COVID-19-related oxygen demand adequately has been the maturity of its existing production and distribution infrastructures.

Developed regions such as the United States and Western Europe are thought to have relatively mature and sound medical-oxygen infrastructures, and incremental demand is likely to pose little threat to their supply chains. These regions generally had a sufficient supply of oxygen to meet prepandemic demand and have not experienced significant shortages during the pandemic. To provide continuous oxygen supplies, they redistributed medical oxygen from nonessential or underutilized healthcare facilities and repurposed existing nonmedical supplies. They also expanded delivery systems at healthcare facilities, such as pipeline networks and vacuum-insulated evaporators at hospitals.

However, many countries with less-developed medical-oxygen infrastructures were already presumed to be struggling with an oxygen shortage before the COVID-19 pandemic. With limited supplies, they will need to consider a multistep approach to bolster their systems. 4 4. Kelly MacNamara, “‘Suffering, gasping’: Experts warn of oxygen shortages in poorer virus-threatened nations,” Barron’s, April 21, 2020, barrons.com. There are immediate, intermediate, and longer-term solutions to explore:

Such interventions may not only help close the immediate COVID-19-related shortfall in medical-oxygen supply but also go a long way to eliminating the chronic undersupply of medical oxygen in those countries.

The COVID-19 crisis has brutally exposed the shortage of medical oxygen in many countries, making what was already considered a bad situation worse. If immediate actions are taken with the foresight and commitment to fix systemic deficiencies, investments in medical oxygen to treat COVID-19 have the potential to help reduce the global supply shortage for good.

Mohammad Behnam is a partner in McKinsey’s Vancouver office, Jessica Bernstein is a consultant in the New York office, Tony Gambell is a partner in the Chicago office, and Shyam Karunakaran is an associate partner in the Cleveland office.

The authors wish to thank Matthew Lamontagne, Samantha Mashaal, and Miyu Toyoshima Galliart for their contributions to this article.

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