In mid-April, as the second wave of the coronavirus pandemic took a deadly turn in India, many middle-class people found themselves confronted with a problem they didn’t know existed – loved ones dying from a lack of oxygen as state-of-the-art private hospitals ran out of supplies.

Obtaining this life-saving gas had never before been a problem for well-off Indians. But for poor India – dependent on government-run hospitals – access to oxygen is often a matter of life and death. Timely access to medical oxygen could prevent a large chunk of neonatal and maternal deaths in the country.

When it comes to pneumonia, the leading cause of childhood deaths, India accounts for 20 per cent of young lives lost globally to the disease. In 2017, 60 children died in a government hospital in Uttar Pradesh, allegedly owing to an oxygen shortage, although this was officially denied.

Access to oxygen remains inequitable in many parts of the world, not just India. Health facilities serving poor people especially struggle to provide a safe and reliable supply. ‘This is one of the factors sustaining the high death rates, especially in neonatal intensive care units, paediatric and maternity wards, in so many low- and middle-income countries,’ according to the United4Oxygen Alliance. ‘By closing oxygen access gaps, India can make progress not only on reducing maternal, newborn and child deaths, but also deaths from communicable and non-communicable diseases and road traffic accidents.’

In 2018, the India chapter of Path, a global public health non-profit, released a report that brought into focus how in the states of Bihar and Uttar Pradesh, where poverty levels are particularly high, there is a corresponding higher burden of pneumonia deaths which could be brought down with proper supply of medical oxygen. In these two states, oxygen was available in bigger hospitals in the cities, but in the rural areas, while some primary healthcare centres had oxygen concentrators, they were often in a state of disuse or faulty. India’s big challenge was not the commercial availability of oxygen, the report concluded, but rather ‘ensuring functional availability and rational use’ and improving safe access.

The gas is on the World Health Organization’s list of essential medicines for managing hypoxemia or dangerously low levels of oxygen in the blood, a condition encountered consistently in Covid-19 patients who have taken a turn for the worse.

Faced with an unprecedented tragedy in April and May of this year, when oxygen shortages killed so many, including in private hospitals, the Indian government announced plans to increase supply by setting up over 1,500 new oxygen plants. There have been numerous private philanthropic efforts, too. Under the banner of the Oxygen for India initiative, Ramanan Laxminarayan, an epidemiologist and director of the Washington DC-based Center for Disease Dynamics, Economics & Policy, is working with oxygen manufacturers and local non-profits to improve access, getting supplies to hospitals or directly to the patients. The initiative also has plans to set up a national oxygen grid which will connect around 200 hospitals to oxygen plants.

The wheels are beginning to turn. It only took us a once-in-a-century pandemic to start talking about the oxygen gap.