Lancet Global Health Commission on medical oxygen security (2025)

The report

It appeared in The Lancet Global Health, volume 13, issue 3 (DOI 10.1016/S2214-109X(24)00496-0), and the full text is on PubMed Central. The Commission was launched in 2022 with the aim of synthesising available evidence and producing concrete and actionable recommendations for governments, industry, global health agencies, donors, the health-care workforce and researchers. It was driven by 18 commissioners, supported by a group of 40 advisers from the UN, global health agencies, donors, academic institutions and non-governmental organisations, and it focused on low-income and middle-income countries (LMICs).

Headline findings

• Each year, 374 million people need medical oxygen: 364 million in acute medical and surgical contexts and 9 million with long-term oxygen needs due to chronic obstructive pulmonary disease.
• Patients with acute medical and surgical needs require a minimum of 1.2 billion normal cubic metres (Nm³) of medical oxygen a year.
• More than 5 billion people, more than 60% of the world's population, do not have access to safe, quality and affordable medical oxygen services.
• In LMICs, only 89 million (30%) of the 299 million people who need oxygen for acute medical or surgical conditions receive adequate oxygen therapy: a coverage gap of 70%.
• Closing that acute medical and surgical gap in LMICs would require an additional 6.8 billion US dollars a year.
• Operational costs account for 50 to 80% of total oxygen system costs but have received little investment to date.

What it says about oxygen plants

The Commission notes that PSA and VSA plants are increasingly used in LMICs, given the appeal of a continuous supply without the logistical challenges of procuring medical oxygen, and names their major challenges as running costs, substantial maintenance needs and the need for an uninterrupted power supply. Looking back at the COVID-19 response, it reports that the promise of PSA plants fell short for reasons that include the lack of appropriate infrastructure at facilities, insufficient biomedical engineering capacity to install, run and maintain them, high energy requirements, and confusion surrounding ownership and responsibility for maintenance. It says most health systems and health facilities will benefit from a mixed-source oxygen supply with reliable back-ups.

Recommendations

The report makes 52 recommendations for governments, the oxygen industry, global health actors, advocacy groups, academics and professional bodies to work towards by 2030, and recommends that an independent body assess progress against them in 2027. Among them:

• National medical oxygen plans: fewer than 30 countries had developed one, and the Commission encourages all governments to do so by 2030. See what a national medical oxygen plan is.
• National regulations defining medical oxygen quality and safety aligned with the updated WHO International Pharmacopoeia.
• Pulse oximetry and oxygen services included in universal health coverage schemes.
• Investment in the clinical and engineering workforces.

Context and limits

The report follows the resolution on medical oxygen adopted unanimously by all 194 member states at the 2023 World Health Assembly. Its figures are the Commission's estimates, and it reports huge gaps in data about oxygen coverage. The report was published in 2025, not in 2024.