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How the oxygen market works in the world

“Please help my mother,” shouts a man crying at the door of a hospital in New Delhi where they no longer received any more patients with covid-19.

Like him, dozens of people carry their dying relatives while waiting for medical attention. But nobody answers.

Most of the health centers in the Indian capital are saturated and the sick are dying on the streets.

Charanjeev helps cremate the bodies of the victims. “There is no oxygen and people are dying like animals,” he tells the BBC.

In Latin America countries like Brazil, Peru and Mexico have been through the same thing.

At the beginning of this year, Covid-19 patients died from lack of oxygen in hospitals in Manaus, in northern Brazil.

In Lima, Peru, the crisis also reached extreme levels.

Such has been the shortage of oxygen that there is a black market in various regions of Latin America where it is sold for exorbitant prices.

One in five patients requires oxygen

About 20% of COVID-19 patients (one in five patients) require oxygen.

According to the World Health Organization, WHO, 40% of those infected develop a mild illness; another 40% moderate; 15% severe (requiring oxygen support); and 5% critical.

So when cases are triggered in a short period of time, health systems collapse and they do not have a way to respond to the demand for this gas.

Currently low- and middle-income countries require 3,8 millions of cylinders oxygen up to date (equivalent to 26,400,000 cubic meters), according to a gas needs tracker developed by experts working at the nonprofit PATH.

They are part of the Special Oxygen Emergency Corps, in which other international organizations such as the World Health Organization (WHO) also participate, to face the pandemic emergency.

“It is extremely expensive to build an oxygen plant”

Evan Spark-DePass, Director of Market Dynamics at PATH, explains that oxygen shortages are an ongoing problem in many low-income countries.

“It is extremely expensive build a liquid oxygen plant in a country, “he says in a dialogue with BBC Mundo.

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As they are investments made by the private sector, he adds, the company must be certain that there is sufficient demand for its business to be profitable.

It is common for about 90% of a plant’s capacity to be dedicated to industrial oxygen consumption.

Therefore, if there is no industrial demand, “it is very unlikely that someone will build a liquid oxygen plant for medical use only, “notes Spark-DePass.

On the other hand, the production, transportation, distribution and storage system is quite complex.

In most of Europe and the United States, oxygen is delivered by truck and stored in large containers from where it reaches hospital beds.

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But in poor regions that lack this infrastructure, the sick depend on the use of cylinders that often leave families in ruins.

Who makes it?

Globally there are three manufacturers that account for 69% of the market of industrial gas (which includes medical oxygen): Air Liquide, Linde and Air Products, says Jayasree K. Iyer, executive director of the Foundation for Access to Medicines.

Some of the companies that operate in the sector have made some efforts during the pandemic to mitigate the emergency, he explains, but he assures that it is not enough.

“As more patients in poor countries struggle to breathe, the companies that dominate the medical oxygen market have a duty to do more,” he says in conversation with BBC Mundo.

Experts agree that the only way to solve the problem of oxygen starvation, officially regarded as a medicine by WHO, is to promote agreements between the private sector, governments, donors and international organizations.

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One of the largest manufacturers, Air Liquide, a firm that operates in 35 countries, says that during the pandemic it has increased its production of medical oxygen.

The firm maintains that, since it is a drug, its production must comply with very strict production and distribution rules.

“When possible, we work with local authorities to reassign and medically qualify part of our industrial production and assets in the supply chain to supply hospitals, “the company said in response to a request for information made by BBC Mundo.

Emergency solutions

The conversion of industrial oxygen for medicinal use during the pandemic has occurred in several countries in which the authorities have reached agreements with some firms.

In MexicoFor example, demand for oxygen at home increased by 700% nationwide during the first three weeks of January, according to Ricardo Sheffield, director of the Federal Office for Consumer Protection.

Prices quickly skyrocketed on the black market and internet scams proliferated.

To respond to the shortage of the drug, the Mexican government announced in February an agreement with three companies so that 70% of its industrial production would be destined for medical use during the emergency.

The same is happening now in India, although the collapse of the healthcare system is so deep that even last-minute deals have failed to stop the disaster.

“It’s like being in a war zone”is the expression used by Soutik Biswas, a BBC correspondent in India, to describe the situation in that country.

But in the case of countries that do not have industrial oxygen plants, the alternative of converting the gas does not exist.

Another emergency option is to get a larger quantity of concentrators, machines that filter the air and convert it into oxygen, designed for individual patient use. However, concentrators are limited in scope and are not sufficient for critically ill patients.

The other way is to support the transport of oxygen as pressurized gas in cylinders to the most affected areas.

Long-term solutions to face shortages

Liquid oxygen is the best alternative, experts say, but it requires hospitals to have the proper infrastructure to channel it to the patient’s bed.

“You have to increase funding to build that infrastructure,” says Evan Spark-DePass.

“Governments should give it priority within their budgets,” he points out, and generate long-term trade agreements with producers that are negotiated at the country level.

Another option is to evaluate the feasibility of building oxygen plantsAlthough due to their cost and maintenance requirements, they are often beyond the reach of the poorest countries.

And another key point, experts say, is to improve distribution networks of oxygen in cylinders so that when an emergency occurs, the system is better prepared.

Even in a hypothetical scenario in which the COVID-19 pandemic disappears, oxygen therapy can save millions of lives of patients who require the drug when they have severe respiratory complications from other diseases.

Like pneumonia, a disease that kills one child every 39 seconds, according to a study by the United Nations Children’s Fund, Unicef.

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