The first signs of the summer’s groundbreaking new medical oxygen agreements in progress have been demonstrated in Zambia, where the Clinton Health Access Initiative (CHAI) has been working with Afrox to maximise access to oxygen for all.

Unitaid and CHAI announced unprecedented agreements with Air Liquide and Linde, respectively, for improved access to medical oxygen on 16th June.

A major development for both society and the industrial gases industry, the agreements provide a pathway to increased access to medical oxygen in low and middle-income countries (LMICs) during the continuing Covid-19 pandemic and beyond.

Read more: Air Liquide and Linde agree unprecedented oxygen cooperation

The agreements are made in the form of a non-binding Memoranda of Understanding (MoU) and have been entered into on a non-exclusive basis.

The announcement came following intense engagement with 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.

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 and Melinda Gates Foundation, and Access to Medicine Foundation.

Whilst agreements with other medical oxygen suppliers are still actively being pursued, the first case study of the MoU’s in action has now been documented in Zambia, by CHAI.

Utilising the MoU, CHAI has been working with Linde (through Afrox Zambia) and other partners to move the work forward. The CHAI team in Zambia worked with CHAI’s Essential Medicines team, alongside the government, partners and Afrox, to set up a functional system to optimise the use of available medical oxygen.

That included the readiness and delivery of medical oxygen cylinders and, with the country’s Lusaka and Copperbelt provinces representing just over 60% of all Covid cases in the nation, the project partners went to work immediately to increase access to medical oxygen in the top seven facilities from the two provinces.

“This work stabilised oxygen supply in the seven initial hospitals and efforts are now being undertaken to ensure that additional hospitals equally have sufficient oxygen for patient care,” a CHAI statement explained.

“Recognising that any delay in action could cost lives, partners spent sleepless nights to ensure that oxygen would be available at health centres to meet demand.”

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Aerial shot of Lusaka, capital city of Zambia.

Devasting waves

In the words of CHAI, Zambia has experienced devastating waves of the pandemic. The third and most recent wave has led to an unprecedented number of infections, placing a serious strain on the health system, and increasing hospitalizations and deaths.

It has also impacted gains in reaching universal health coverage.

This has been affirmed in recent months with repeated warnings of a ‘brutal’ third wave of Covid-19 across Africa, including in Zambia. The World Health Organization (WHO) announced on 25th June that the pandemic was resurging in 12 African countries, while the highly contagious Delta variant of the coronavirus, first identified in India, had been detected in 14 African countries.

The WHO also admitted that this third wave came as Africa was experiencing a vaccine shortage. At that time, slightly more than 1% of Africans had been fully vaccinated.

Read more: Covid – Africa ‘losing battle’ with third wave

Underlining the sheer need for greater access to medical oxygen in a country like Zambia, data correct as of 28th June – within just says of that WHO warning – suggested the nation had a need for 121,732 cubic metres of oxygen per day, up from a baseline of almost zero need on 1st June.

“More patients reaching hospitals need advanced support in intensive care units and emergency wards. Optimal use of hospital infrastructure including beds, drugs, patient monitoring devices, and medical oxygen has become a top priority for Zambia’s Covid-19 response team,” the CHAI statement continued to explain.

“The situation in Zambia is typical of one that is desperate, requiring team effort from all players in the healthcare system. At any given time, more than 70% of Covid admissions require oxygen therapy. This demand is higher than what can be met by the current public production capacity in the country.”

PSA oxygen generators in the hospital

Exhausting traditional capacity

Putting that case study into further numbers, CHAI described how Zambia’s health facilities have traditionally relied on pressure swing adsorption (PSA) plants for oxygen supply.

Many of the PSA plants being used in Zambia were designed for normal patient volumes, however, producing around 30,000 litres of oxygen per hour. In contrast, Covid-19 patients require up to 3,600 litres of oxygen per patient in an hour – which would mean exhausting the capacity of many smaller plants with less than 10 patients.

In fact, CHAI explains that over 75% of patients hospitalised with Covid-19 in Zambia require production rates of up to 60 litres per minute. As a result, the existing supply solutions alone have not been able to meet the current demand.

This therefore represents a compelling case in point of the need for greater access for all to vital medical oxygen, a call to action that is now being heard and delivered against by the powerful new agreements and the Covid-19 Oxygen Emergency Taskforce.

As gasworld has previously reported, however, it is not just about the imperative short-term objectives in oxygen supply – the aim is to create a lasting pathway in access to medical oxygen, as CHAI alluded to in its statement.

“In addition to helping facilitate equitable access to oxygen to meet the emergency needs of the Covid-19 pandemic, the collaboration also aims to build a framework for local contractual agreements – in line with standard public procurement practices – which could form the basis of longer-term purchasing deals by governments and global agencies that fund access to medical oxygen to avoid supply shortages.”

“As part of the long-term conversation, we are looking to assist with strengthening the technical capacity of Zambia’s Ministry of Health to manage the engineering side of medical oxygen production and help make long-term investments in bulk oxygen storage tanks that would permanently resolve the oxygen crisis, regardless of the severity of the pandemic.”

“This level of investment entails zero reliance on oxygen cylinders and would be sufficient in ensuring gains post-Covid for the management of other illnesses that need oxygen.”