New WHO designation for Oxygen

PATH hailed a landmark decision by the World Health Organization (WHO) to include a new indication for oxygen in its Model List of Essential Medicines (EML) and List of Essential Medicines for Children (EMLc), identifying oxygen as a medicine essential for the management of hypoxemia. Hypoxemia, or dangerously low levels of oxygen in the blood, can be fatal without oxygen therapy. Without oxygen, it would be next to impossible to treat hypoxemia resulting from conditions such as pneumonia, which is the leading cause of mortality in children under five. The WHO action could reduce child deaths from pneumonia by 35 percent annually in high-burden settings.

This action follows a global campaign led by PATH, an international global health nonprofit organization, to make oxygen more accessible in low- and middle-income countries. This effort is designed to reduce preventable newborn, child, and maternal deaths and accelerate progress toward the Sustainable Development Goals laid out by the United Nations in 2015. Previously, oxygen was listed only for use as an inhalational medicine in general anesthesia in the EML and EMLc. PATH reviewed the national essential medicines lists of 105 countries and found that approximately a third (31 percent) did not include oxygen and roughly half (48 percent) listed oxygen only by anesthetic indication.

PATH and medical experts petitioned the WHO EML secretariat to include an additional listing of oxygen as a medical gas, extending its use for the management of hypoxemia. This change clarifies oxygen’s importance as a medical treatment that should be widely available in health facilities everywhere. Oxygen therapy can save lives, especially for those most vulnerable: newborns, children, and pregnant women. Oxygen is needed for the 1.5 to 2.7 million young children worldwide needing care for severe or very severe pneumonia each year.

"Oxygen therapy is an essential component of comprehensive pneumonia treatment for children and now is the time to invest in expanding access to pulse oximetry and oxygen," said Dr. Keith Klugman, director of the pneumonia team at the Bill & Melinda Gates Foundation. "This welcome update to global policy provides an ideal time to reflect on what is needed at national and subnational levels to ensure equitable access to oxygen for all sick children."

Oxygen is an essential part of a complete health care system, and is a required treatment for a range of conditions across disciplines and age groups. However, its availability varies widely by level of health facility and region in low- and middle-income countries, and is often hindered by inadequate provider training and a scarcity of necessary equipment and supplies. In particular, facilities often lack pulse oximeters to diagnose and monitor hypoxemia; oxygen sources such as concentrators and cylinders; and devices to deliver therapy, such as cannulas (or small tubing), ventilators, and continuous positive airway pressure equipment.

"Accessing oxygen therapy for childhood pneumonia and other indications should not be a matter of location or luck," said Carolyn Reynolds, vice president for Policy and Advocacy at PATH. "We applaud WHO’s decision to elevate oxygen as an essential commodity for newborn, child, and maternal health. Now is the time for countries around the world to act on this evidence, which can save thousands of children’s and women’s lives each year."

"The updated EML and EMLc emphasize oxygen’s lifesaving role and support UNICEF’s ongoing work to ensure access to oxygen and pulse oximetry in countries with a high burden of child mortality, such as Kenya," says Dr. Hayalnesh Tarekegn, child health program officer, UNICEF. "It is imperative for countries to align their policies with the latest WHO guidance and implement broader oxygen access for the thousands of children in health facilities that need oxygen to survive."