Global demand for medical oxygen to treat patients with Covid-19 has risen sharply in recent months, fast outstripping supplies and raising concerns that thousands of patients in low and middle-income countries will not receive life-saving treatment.

Demand has increased by more than a fifth in the past three months, with many countries experiencing larger rises. Manufacturers have been diverting oxygen from industrial uses such as welding to healthcare, but funding and focus have been limited, and capacity in hospitals and clinics is insufficient to cope with the jump in intensive-care patients, companies and health experts say.

“Supplies are super tight everywhere. In Africa, Europe and North America, needs have gone through the roof with this second wave. The issue is not so much the availability of molecules as the people, logistics [and] connecting to hospital networks and facilities,” Jean-Marc de Royere, a senior vice-president at France’s Air Liquide, one of the world’s largest producers, said.

NGOs and medical workers are calling for more support and action on the issue from multilateral organisations, companies and donors, urging them to step up oxygen production and delivery alongside rolling out vaccines and medicines.

Lollipop chart showing low and middle-income countries with high and rapidly rising needs for oxygen to treat Covid-19 patients in daily number of thousands of large ‘J’ size oxygen cylinders

“The international community and many governments have been appallingly slow to respond. Until Covid-19 vaccines become available, oxygen is the most important life-save weapon in the medical armoury. We are drifting into a region-wide humanitarian crisis,” Kevin Watkins, head of charity Save the Children UK, said.

Estimates from the Covid-19 Oxygen Needs Tracker, compiled by a group of health charities, suggest that middle and lower-income nations need more than 10.2m cubic metres of oxygen a day — up from 8.5m cubic metres a day in November — with demand surging in countries including Brazil, Nigeria and Peru.

One problem is that the global market for oxygen production is complex and fragmented — split between large manufacturers such as Air Liquide and British-based Linde, and local hospital production — while data on medical capacity and use are limited.

Janet Diaz, lead for clinical care at the World Health Organization, said: “The challenges are very serious. Oxygen is a molecule that is free in the air, but to use as medical oxygen you need technology.”

Many smaller and poor countries have become increasingly desperate. In Malawi, where two cabinet ministers and other senior officials have died from infections in recent weeks, and the president has turned to local banks and online crowdfunding to buy oxygen cylinders.

In Manaus in Brazil, doctors have resorted to manual ventilation due to cylinder shortages. Oxygen cylinders are being brought to the remote city by the air force, while celebrities have paid for shipments and Venezuela has also sent supplies.

Babajide Sanwo-Olu, governor of Lagos state, the centre of Nigeria’s pandemic, said demand for oxygen had jumped fivefold in recent weeks at the main hospital treating Covid patients and would be likely to double again soon. “That itself is a huge logistical [burden],” he said.

Richer countries including the US and most of Europe are focused on gaining access to scarce supplies of vaccines to protect their populations, but these are unlikely to be available at any scale in lower-income countries for many months.

A growing number of political leaders and doctors in Latin America and Africa are warning they will be unable to provide sufficient oxygen for patients overwhelming hospitals, without which life-saving treatments such as the cheap steroid dexamethasone will have little effect.

Line chart showing new Covid-19 cases and oxygen needs per day in millions of cubic metres for 2020

“Vaccines alone are not going to do this. We could do a better job in saving lives by providing more of what we can currently deliver. In many places, the constraint is oxygen,” Peter Sands, head of the Global Fund to Fight Aids, Tuberculosis and Malaria, the multilateral agency, said.

Leith Greenslade, co-ordinator of the Every Breath Counts Coalition, which advocates for improved provision of oxygen, said the response of the World Bank and donors had been fragmented and inadequate. “The quantity of oxygen needed by Covid-19 patients is so large that bigger emergency solutions are now needed.”

The World Bank has so far disbursed just half of a $6bn coronavirus grant and low-interest loans programme for pandemic response established last year. It says few countries have formally requested support for oxygen and it is stepping up work to co-ordinate greater funding.

Lack of co-ordination is exacerbating the problem, with individual health systems buying their own supplies and suppliers worried about non-payment from stretched authorities. “The market is disorganised,” said Zachary Katz, a vice-president of Chai, a health charity.

Oxygen provision is complicated by the difficulties of transport, production, safety supervision and regular maintenance of equipment. Even before the pandemic, supplies were limited in much of the developing world.

Muhammad Pate, global director for health, nutrition and population at the World Bank, said: “The countries with the weakest health systems are bearing the brunt of this crisis.”