An alliance of 70 organisations helping low and middle-income countries (LMICs) to reduce deaths from respiratory-related illnesses such as pneumonia and Covid-19, the Every Breath Counts Coalition (EBCC) is a flagship initiative of JustActions – an organisation launched in 2016 that aims to accelerate the transition to a just society.

Coordinator of EBCC and Founder and CEO of JustActions, Leith Greenslade, spoke to gasworld during the Medical Gases Virtual Event 2022, detailing the organisations’ efforts to increase equitable access to medical oxygen.

A human need 

Over the past two years, the Covid-19 pandemic has triggered oxygen shortages across the globe. Referring to the shortages as a ‘recipe for mass fatality’, Greenslade added that the pandemic has officially claimed more than 6m lives, but the true death toll could be five times higher.

With 80% of the world’s population – 5.7bn – living in Asia and Africa, oxygen shortages and related deaths have skyrocketed across these two regions. 

Lack of oxygen, as seen in South Africa, has been exposed by the ongoing pandemic. 

“And in India, who can ever forget the images of patients lying in the parking lots of hospitals? And on the back seats of cars, suffocating as their loved ones searched frantically for oxygen,” said Greenslade.

All (LMICs) need approximately 4m2 of oxygen every day just to treat Covid patients. Africa and Asia comprise about 70% of that number. 


An online tool developed by NGOs and the Clinton Health Access Initiative and EBCC was built to expose the ‘massive’ daily need for oxygen to treat Covid across LMICs. 

This tool reveals hotspots across the globe where oxygen is most needed. It also uses an algorithm to provide an assumed percentage of the population requiring hospitalisation. 

Areas in most need of additional medical oxygen include southeast Asia, Africa, and Brazil.

“Studies suggested shocking high levels of under treatment of patients needing oxygen across Africa and Asia,” said Greenslade. 

“There is no question that lack of oxygen is one of the reasons pneumonia has been the leading infectious killer in Africa and Asia for so long.” 

With Dr Mike Ryan from the WHO stating that ‘Covid ripped a band aid off an old wound’, questions arose around how it ended up like this. 


Despite comprising 80% of the world’s population, Africa and Asia produce just 28% of the world’s GDP, the buying power that drives markets. 

“With a limited capacity to buy medical oxygen from industry, you have a major public health problem,” said Greenslade. 

“The pandemic has changed all of this. Access to oxygen now has the attention of leading global health agencies and their donor governments.”

The ACT Accelerator Oxygen Emergency Task Force was launched in Feb 2021. Chaired by UNITAID, its members include WHO, UNICEF, the Global Fund, the Africa CDC, the World Bank, the Gates Foundation and others. The group has spent the past year building a system to help LMIC prevent oxygen shortages. 

“In just one year, about $700m has flowed through the task force directly to LMICs.” 

More than 100 LMICs have benefitted from this support, which has led to donations of $500m worth of oxygen related equipment including PSA plants, mobile oxygen concentrators, and other oxygen therapies.


Greenslade praised the MoU’s signed by organisations to increase medical oxygen provision, in addition to the US Government which has announced $75m in additional support, mostly for liquid oxygen. 

“Although this represents the largest amount of international donor financing for medical oxygen ever, still more is needed,” said Greenslade. 

“The task more force is asking 1bn more from donors to close remaining oxygen access gaps.” 

“We need to make sure health systems everywhere have the oxygen they need to address the underlying needs of all patient populations.” 

Three ’asks’ 

Targeted towards the medical gas industry, Greenslade outlined three ‘asks’.

  •  Develop an access to oxygen strategy. Industry must focus on growth markets
  •  Engage public health agencies
  •  Innovate, innovate, innovate. “Invest in new more cost-effective oxygen generation technologies that work in toughest settings,” she added.

“Will we walk away and leave millions of patients to die each year because they can’t get oxygen as if the pandemic didn’t even happen? Let’s not do that. Let’s show the world that by working together on access to medical oxygen, it is possible to achieve both business and public health goals.”