Investing in Oxygen Access: A Lifeline for Health Resilience in Asia

During the COVID-19 pandemic, access to oxygen made the difference between recovery or death for countless patients. Investments made during COVID-19, through The Global Fund and many others, continue to deliver benefits today in over 100 countries. But despite more than $1 billion in COVID-19 oxygen support, wide gaps in access to oxygen persist.

Closing the global oxygen gap by 2030 will require about $4.4 billion in annual investment. While this figure is large, the impact is transformative as oxygen treats multiple conditions, including newborn complications, pneumonia, tuberculosis, HIV, malaria, chronic respiratory disease, and more. It is also essential for safe surgery.

The Global Oxygen Strategic Framework and Investment Case, commissioned and codeveloped by the Global Oxygen Alliance (GO₂AL), noted that meeting the additional investment needed could save 860,000 lives across the world by 2030, including 331,000 children under five.

Countries are already moving from crisis response to long-term planning to maintain the COVID-19 oxygen supplies and ensure universal access to medical oxygen in their health systems. Examples from Armenia, the Cook Islands, and Fiji were discussed at the ADB INSPIRE Forum:

• Armenia now requires hospitals to have oxygen supply as a condition of licensing.
• In the Cook Islands, a new pressure swing adsorption oxygen generation plant donated during the pandemic was initially placed in a less suitable locale but has since been relocated to Rarotonga, where it now serves as the main hub for oxygen production and distribution to the sister islands.
• Fiji has committed to sustaining the Fiji Oxygen Project, a successful donor-supported initiative that installed solar-powered mobile oxygen concentrators in Fiji hospitals.

Development partners are also strengthening support, such as:

• Japan invested in expanding oxygen access in low-resource settings, including establishing the East African Program on Oxygen Access, a partnership with the governments of Kenya and Tanzania, Unitaid, and the Clinton Health Access Initiative to establish the first Africa-owned liquid oxygen production plant that will increase both medical oxygen supply and lower prices for hospitals across East Africa.
• The Pandemic Fund has awarded $885 million in grants to 75 countries to strengthen system resilience, with more support planned where medical oxygen will hopefully be in scope.
• GO₂AL is supporting countries to develop costed national oxygen plans that cover both capital and operational costs so that donors can invest.

Results from an ADB Capital Health Assets Management Platform 2024 survey underscore that infrastructure alone is not enough. Of 80 health facilities in Nepal, it found that mobile oxygen concentrators accounted for 35% of all uninstalled medical equipment donated during the pandemic. The reason was not lack of demand, but a shortage of biomedical engineers and technicians to install and maintain the machines. This demonstrates that without investments in human capital, vital equipment risks sitting idle.

Governments across Asia are acting on the lessons of COVID-19. Many are beginning to integrate oxygen into health strategies, recognizing it as a vital resource for both everyday care and emergency preparedness. At the same time, GO₂AL members are working with countries to strengthen financing, planning, and workforce development.

Lessons from the pandemic across Asia are informing smart strategies to strengthen national medical oxygen systems, including to:

Integrate oxygen into broader health reforms. Oxygen should not be managed as a temporary or vertical intervention. Embedding it into health financing frameworks, facility licensing requirements, and national universal health care strategies ensure access, affordability, and resilience, including during emergencies.

Prioritize sustainability. Donations during COVID-19 were lifesaving but may be unsustainable. Moving forward, financing mechanisms must include budget, maintenance, and workforce training to prevent equipment from sitting idle.

Strengthen cross-sector partnerships. Oxygen systems depend on energy, infrastructure, transportation, education, and supply chains, not just the health sector. Coordinated investment across ministries and with development partners can maximize reach and efficiency.

Invest in both people and systems. The shortage of biomedical engineers and technicians illustrates that resilient oxygen access requires trained human resources alongside infrastructure. Long-term capacity-building should be a central element of national oxygen strategies.

With Asia facing the greatest burden of premature and pandemic-related deaths, and projections pointing to a high probability of another pandemic within 25 years, there is limited time to translate lessons from COVID-19 into durable reforms.

Institutions such as ADB can play a convening and financing role, helping governments mobilize resources, align partners, and share lessons. Partnerships built around oxygen can serve as a model for other critical areas of health system strengthening.

Note: Examples cited regarding Armenia, the Cook Islands, and Fiji were taken from presentations by Armenia Ministry of Health First Deputy Lena Nanushyan, Cook Islands Health Minister Hon. Vainetutai Rose Toki-Brown, and Fiji Health and Medical Services Hon. Minister Dr. Ratu Atonio Rabici Lalabalavu.

Insights were also taken from the presentations of Priya Basu (The Pandemic Fund Executive Head) and Amanda McClelland (Resolve to Save Lives Senior Vice President, Prevent Epidemics). Ben Coghlan (ADB) and Elena Pantjushenko (PATH) prepared the article. 

Global Oxygen Alliance (GO₂AL).

H. Graham. 2025. Reducing Global Inequities in Medical Oxygen Access: The Lancet Global Health Commission on Medical Oxygen Security. The Lancet Global Health. 13 (3). pp. e528–e584.

Lancet Global Health Oxygen Commission.