It was great to see the announcement of a major breakthrough in medical oxygen supply in the last few weeks and all those involved, including Air Liquide and Linde, are rightly being commended for their commitments – but where are the announcements of other major names in oxygen?

That is one of so many questions this poses, but perhaps the most pressing right now.

For anyone that missed it, it was revealed that a Covid-19 Oxygen Emergency Taskforce led by Unitaid and Wellcome under the ACT-Accelerator Therapeutics pillar, has been working together over the past four months to address the global oxygen crisis.

Comprised of the World Health Organization (WHO) and the biomedical consortium it coordinates, as well as Unicef, The Global Fund, the World Bank, the Every Breath Counts coalition, the Clinton Health Access Initiative (CHAI), and The Bill & Melinda Gates Foundation among others, the taskforce strives to overcome fundamental issues such as unstable funding commitments and insufficient infrastructure, which have limited the availability of medical oxygen in low and middle-income countries (LMICs).

After a period of ‘intense engagement’ with the world’s major oxygen suppliers, the taskfroce announced last week that both Air Liquide and Linde have committed to unprecedented collaboration in the form of non-binding Memoranda of Understanding (MoU) to provide a pathway to increased access to medical oxygen in LMICs during the continuing Covid-19 pandemic.

This is a major development not just for our industry but for wider society and, as I understand it, this could be the dawn of a whole new era in medical oxygen. An era where the liquid oxygen supply chain really is held in the same high regard and public importance as vaccines and other medical treatments.

Indeed, in an interview I had the pleasure of conducting earlier this week for gasworld with Leith Greenslade, Coordinator of the Every Breath Counts Coalition, she described how she believes “the oxygen industry now needs to accept that it’s part of the public health architecture of the world.”

If that’s the case, and it’s hard not to agree when we have seen the critical role of oxygen so publicly highlighted over the past 15 months and it continues to be high on the global health agenda of today and tomorrow, then clearly there is plenty for our industry to consider, and urgently.

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One could envisage a whole new approach to the business of medical oxygen as a result.

Oxygen providers big and small may need to consider new ways of resourcing and strategising oxygen supply internally. We could see the emergence of access teams, philanthropic arms of the business, and stakeholders devoted solely to oxygen concerns. In essence, if oxygen is becoming part of the public health architecture, then it’s feasible to see an architecture of its own evolve within our industry, such is the expected demand in the years ahead.

Which brings us to the business case as well as the benevolence. Clearly, a significant market exists both now and in the years ahead where medical oxygen is concerned – a future market that is surely worth sitting up and taking notice of?

Greenslade herself observed that “the medical gas business is going to be a much bigger part of the industry moving forward – and that’s a good thing for everyone.” She was also patently clear in our discussions of the ‘equal seat at the table’ for industry in these partnerships, and of the business needs to be served in terms of revenue and profit.

With the humanitarian need so obvious to us all, and the business case also stated, I can’t help thinking, what are we waiting for here? Doesn’t this beg the question as to why we have not seen other big names in oxygen production and supply announced yet?

It was made clear in the announcement that the agreements struck are entered into on a non-exclusive basis; agreements with other medical oxygen suppliers are still being pursued. As I understand it, this is very much the case and there is fervent hope that more headline announcements can be made soon. I know that the taskforce is keen to work with Air Products, the Taiyo Nippon Sanso (TNS) group of companies, Messer, SOL and many others; none of these names would be a surprise given their respective statures, oxygen capabilities and footprints. Yet those commitments still do not appear to be forthcoming at the time of writing…

Decentralisation

I’ve enjoyed a lot of conversations recently – on camera and off it – about Covid-19 and oxygen supply, with different stakeholders in the industry and those connected to it externally. I’ve been fortunate to take in a range of different views on the matter.

Indeed, I wrote several weeks ago about the balancing act between preparedness and sheer unpredictability and, informed by conversations within the industry, paid deference to the challenges the industry faces in being ready for such scenarios at any given moment. It can be difficult to ‘simply’ adapt to such situations when there is no insight into the scale, duration and to an extent the paymaster for such supply. There are almost too many unknowns.

Whilst still applicable, with the news this month of those groundbreaking new agreements and the backstory to how those agreements came to be, it strikes me that we are looking at exactly that point I had previously sympathised with – a balancing of preparedness and the business case to match. These are funded, coordinated and measured agreements.

It seems fitting too, that my reflections this week have come at a time when I’ve just had the honour of hosting a webinar where decentralisation and reformation of business models and supply chains was a recurring theme. In looking for the positives from a pandemic, we heard how there has been re-evaluation of processes and mindsets; a reformation of accepted business models; and how the acceleration of digital technologies is challenging our strategic thinking.

Against this backdrop, there is also a trend of decentralisation emerging across the industry. The decentralisation of traditional supply chains like helium and carbon dioxide; the decentralisation of energy and its traditional geographic powerhouses; and yes, perhaps, there is also a decentralised medical oxygen market underway with the second coming of PSA generators and oxygen concentrators, and now wider access to liquid product too.

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Questions to answer

Does this create new challenges? I’ve heard the view that there could be issues ahead with the sheer quantity of standalone oxygen generation equipment installed in crisis-hit regions; whilst it serves an immediate, human need, the question put to me was, does this also create a new infrastructure of essentially dormant/vacant technology in the years ahead?

But surely, just as we try to seek out the positives in a pandemic that has changed our way of living and working, we also need to challenge the idea that an equipment glut could be an issue. After all, our industry is continually turning challenges into opportunities.

Should we not take that and rather than see it as a problem, view it simply as an opportunity for a second or third phase of this project? An added business case for servicing, maintenance and upgrading, perhaps?

Another theoretical question put to me is whether this matter and those breakthrough agreements could throw any unwanted ‘sunlight’ onto the current structure of the supply chain in certain regions. Without the kind of further insight and explanation required for such a question, that’s not something I could ponder.

There are still wider questions to be answered, of course. In my view, chief among them are:

  • Why has it taken so long, and the ‘intense’ work of a taskforce to put oxygen on its rightful pedestal during this pandemic?
  • What does our industry need to do internally if oxygen really is now part of the public health architecture?
  • What direction does our industry and its innovative protagonists wish to take with medical oxygen? If we are at a fork in the road right now, what path will we take?

What I do know is, our industry has already been firmly on the frontline during this pandemic and its worst peaks, working day and night to provide medical oxygen and in some cases, even engineer the solutions that will ensure it is delivered as required to the hospital and patient. It has delivered against all odds, breaking its own records for speed and ingenuity of installations.

Now it has the opportunity to go a big step further; the door is wide open to a whole new era in access to medical oxygen that works for all involved – from the patient through to procurement and supplier. That is surely a cause and business case worth fighting for.