To help scale-up the undoubtedly critical humanitarian aspect of the medical oxygen supply chain, an unavoidable fact is that business and commercial interests must also be considered. Without investment from public and private stakeholders, the gases and equipment industry would be unable to advance necessary technology innovation, which – as we’ve witnessed – is vital to meet heightened demands for medical oxygen.

Leading USAID’s market access activities at the Centre for Innovation and Impact, Nikki Tyler has helped push the development and implementation of USAID’s oxygen response for Covid-19. 

Before the pandemic, the medical oxygen infrastructure was already underfunded in low and middle income countries (LMICs), according to Tyler. 

50% of healthcare facilities in Africa do not have reliable access to essential oxygen, with fewer than 20% of healthcare workers trained in oxygen therapy. 

“Only in 2017 was oxygen added to the WHO Model List of Essential Medicines,” she revealed. 

Even outside of Covid-19, oxygen is critical for health systems to manage preterm infants, respiratory infections, childbirth and beyond. 

“Lack of oxygen is a global problem, with countries across the world at risk of experiencing shortages.” 

“This includes the US, certain states such as New York and Florida have also experienced these shortages,” said Tyler. 

More than gas 

The oxygen ecosystem needs planning across clinical & engineering/logistics needs. 

The oxygen supply and value chain ranges from supply of equipment, oxygen storage, consumables to clinical support at healthcare facilities, which needs preparation and training. 

Engineering and logistics must be considered, also, to help optimise and maintain oxygen resources. 

USAIDs efforts 

“USAID recognises the importance of oxygen as part of preventing child and maternal deaths, but Covid showed how important oxygen was and how critical it was to health systems and public health architecture.” 

Tyler outlined the efforts conducted by USAD to expand access to oxygen, including investments in PSA/VSA plants, concentrators, and consumables. 

“We also focused on the technical assistance, which again is absolutely critical,” she added. 

“When we went to execute the orders it actually took about a year to buy and to be on the waitlist for these PSA plants, due to the strong demand.” 

Market constraints forced the organisation to adjust its strategy. Rethinking its response, USAID focused on advancing real time, responsive measures to oxygen shortages. 

In March 2021, the organisation pivoted to liquid oxygen as part of its emergency response. 

An additional $75m was provided by the organisation in the summer of 2021 to roll out proof of concepts for oxygen solutions. 

Surges and need 

To help satiate the increased demand in oxygen, USAID responded by leveraging and optimising pre-existing technology. 

“Liquid oxygen can be flipped on very quickly and doesn’t have some of those market constraints of installation delays that other modalities have.” 

PSA plants allow for onsite oxygen generation but with long lead times, the technology has been ‘really inhibited’ their ability to be useful in surges. 

Past efforts 

In addition to supporting Haiti during its oxygen crisis, USAID helped support Nepal’s oxygen shortages during the second wave of Covid-19 infections. 

The USAID-funded EpiC project helped the country procure and install cryogenic tanks and other vital equipment. 


To increase accessibility, markets must be shaped to increase the supply and availability of liquid oxygen (LOX). This can be achieved by securing volumes and overcoming operational burdens, as well as stabilising prices. 

“Another area is expanding capacity, growing the market for bulk LOX by ensuring that more facilities have the capacity to use book bulk LOX to support medical piping and expanding the number of facilities that have access to tanks,” explained Tyler. 

The need for collaboration 

Praising the work conducted by industries partners ranging from health ministries, implementing partners and global donors, Tyler said, “It has been a wonderful collaboration and a testament to how we can work better together.”