Africa is reportedly ‘losing the battle’ with a brutal third wave of Covid-19 as the Delta variant of the virus sweeps across the continent and shortages in its oxygen supply chain are seriously exposed.

The World Health Organisation (WHO) announced on 25th June that the pandemic is resurging in 12 African countries.

Meanwhile, the highly contagious Delta variant of the coronavirus, first identified in India, has been detected in 14 African countries.

“Africa is facing a fast-surging third wave of Covid-19 pandemic, with cases spreading more rapidly and projected to soon overtake the peak of the second wave the continent witnessed at the start of 2021,” affirmed a statement from the WHO’s regional office in Africa.

Dr. Matshidiso Moeti, WHO Regional Director for Africa, added that with rapidly rising case numbers and increasing reports of serious illness, “the latest surge threatens to be Africa’s worst yet.”

Various reports in the days since continue to carry this message of plight, with both Reuters and local publication The East African describing this third wave as ‘brutal’. The latter reported that Africa is ‘losing the battle’ against coronavirus.

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Unprepared

The WHO admits this third wave comes as Africa is experiencing a vaccine shortage. It says just slightly more than 1% of Africans have been fully vaccinated.

There have been many previous warnings that Africa is unprepared for a resurgence in Covid-19 cases, both from a vaccination and oxygen supply perspective.

BBC World Service reported on 16th June that many African countries were facing a ‘growing crisis’ of severe oxygen shortages which is leading to preventable deaths.

Every Breath Counts, a public-private coalition of global health organisations, has been warning of life-threatening oxygen shortages in low and middle-income countries (LMICs) across Africa, Asia and Latin America for years.

Coalition members had been striving to coordinate greater access to oxygen in LMICs as far back as 2013 and had identified this as a risk to life in the global south, where there were already many hospitals without any kind of oxygen – liquid, plants or concentrators – and a large number of fatalities in those regions were among children (with pneumonia for example) that were simply not getting access to oxygen.

When the Covid-19 pandemic hit, this risk was escalated to tragedy and pulled the question of oxygen supply sharply into focus.

“We knew this was going to be a nightmare [with oxygen]. We just knew and we were watching,” said Leith Greenslade, Founder and CEO of JustActions and Coordinator of the Every Breath Counts Coalition, in an interview with gasworld.

“We watched as international agencies all mobilised around the subject of vaccine. It was clearly critical: we needed a vaccine and they put so much effort into that. And we thought well that’s good, but what about oxygen?”

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“If you don’t put the same amount of effort into oxygen and you have countries waiting for vaccines for a long time, this is a recipe for mass fatalities - and that is tragically how it’s played out.”

“We needed an equal focus on vaccines, diagnostic tests and treatments from the get-go, equal money going into each, equal partnerships with industry – and we didn’t have that. We had a kind of one-legged stool, which was vaccine-focused, and they’re now just realising the error of their ways as Africa is dealing with a third wave and has a 3% one-dose vaccine coverage rate. 97% of Africa is not vaccinated, and they don’t have oxygen either.”

Every Breath Counts says as many as 50 LMICs are currently dealing with oxygen shortages or are at risk of facing the crisis, with clusters in southern, eastern and west Africa.

‘Lighting up’

The COVID-19 Oxygen Needs Tracker from PATH, the Clinton Health Access Initiative (CHAI) and Every Breath Counts, affirms the severely sharpening need for oxygen across various African countries. An interactive tool to help advocates, decision-makers, and implementers communicate the urgency of investing in access to medical oxygen and related technologies in LMICs, it provides daily-updated estimates on a country-by-country basis.

Data correct as of 28th June (2021), suggests the Democratic Republic of Congo (DRC), for example, has a current need for 16,138 cubic metres of oxygen per day – up from well below 5,000 cubic metres per day on 1st June.

There are far more extreme examples. Zambia has a current need for 121,732 cubic metres of oxygen per day, up from a baseline of almost zero need on 1st June; Tunisia, 134,301 cubic metres of oxygen per day; Uganda, 50,259 cubic metres of oxygen per day; South Africa, a huge 620,769 cubic metres of oxygen per day.

In all of these cases, the data demonstrates a significant surge in the last 3-4 weeks.

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“It’s happening,” Greenslade affirmed to gasworld. “This Delta variant is just making its way through Africa.”

“We monitor and track 50 countries that are either in or are about to be in an oxygen crisis, and it’s pretty much most of Latin America, parts of Asia, and Africa that are lighting up at the moment.”

“In Sub-Saharan Africa it’s South Africa, Zambia, Namibia, Uganda, Kenya, Rwanda, Zimbabwe, Democratic Republic of Congo (DRC), Mozambique, Ethiopia, Angola, Eritrea, and Malawi – transmission is exploding with this variant.”

Oxygen agreements

Groundbreaking new agreements were announced earlier this month that see both Air Liquide and Linde plc commit to providing greater access to medical oxygen in low and middle-income countries (LMICs).

Estimates from PATH suggest that around one million critically-ill Covid-19 patients in low and middle-income countries need two million oxygen cylinders (14.2 million cubic metres) per day at present.

Unprecedented agreements – in the form of non-binding and non-exclusive Memoranda of Understanding (MoU) – are now in place with Air Liquide and Linde after months of intense engagement with many of the world’s major oxygen suppliers by the Covid-19 Oxygen Emergency Taskforce, a group of partners led by Unitaid and Wellcome under the ACT-Accelerator Therapeutics pillar.

Read more: Pioneering oxygen agreements: What do they constitute?

The taskforce also includes the WHO and the biomedical consortium it coordinates, as well as Unicef, The Global Fund, the World Bank, UNOPS, the Every Breath Counts Coalition, CHAI, PATH, Save the Children, The Bill & Melinda Gates Foundation, and the Access to Medicine Foundation.

It is suggested that these new agreements could usher in a new era for the medical oxygen business. Greenslade told gasworld that not only was the Covid-19 pandemic response handicapped by a predominant focus on vaccines at a time when there needed to be an equal focus on vaccine tests and oxygen, but that the oxygen industry now needs to accept that it’s part of the public health architecture of the world.

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