How COVID-19 unleashed a wave of medical oxygen innovation

As waves of COVID-19 swept across the globe in June 2020, John Graf, an engineer at NASA, found himself confronting a challenge far removed from NASA’s usual focus on space exploration. He was considering how a technology originally designed to produce oxygen for space suits could be repurposed to meet the urgent needs of underserved countries desperate for respiratory care solutions. Graf was not alone in this endeavor. Innovators from around the world were grappling with a long-neglected question: How can we ensure that patients, particularly those in remote locations, have access to medical oxygen?

There was a time during the COVID-19 pandemic when it seemed that nearly everyone with an engineering degree and a garage was working on this issue. Car manufacturers like Ford and GM shifted to building ventilators, while Mercedes transitioned from producing Formula 1 engines to manufacturing continuous positive airway pressure (CPAP) machines. In sub-Saharan African countries like Kenya and Senegal, companies responded by developing 3D-printed respiratory care equipment designed to be more affordable and faster to produce than imported alternatives.

If necessity is the mother of invention, then decades of underinvestment in oxygen technologies culminated in 2020 with a sudden collective realization: low-and middle-income countries were facing COVID-19 with few oxygen products suited to their needs and contexts. This sparked a wave of investment and innovation.

When the pandemic began, much was already known about the limitations of oxygen concentrators — devices that generate oxygen at a patient’s bedside but that were originally invented for well-resourced hospitals. These devices often struggled to perform under challenging environmental conditions. The surging demand for oxygen exposed these limitations, opening the door for a collaboration between UNICEF, Oxygen CoLab and manufacturers to innovate and tailor products to the needs of remote and underserved populations. The result was the PulmO2 from Drive DeVilbiss and Sanrai International, the world’s first fit-for-purpose oxygen concentrator specifically designed for energy efficiency, ease of use and repair and resilience in hot, humid and dusty environments.

Dr. Thomas Burke, a professor at Harvard Medical School, had been prototyping bubble CPAP machines long before 2020. These devices, which were developed to provide a simple and non-invasive way to ventilate newborns struggling to breathe, could be expensive and required consistent electricity. Dr. Burke recognized that the pandemic presented a rare opportunity to rapidly support the health and well-being of infants and young children worldwide by deploying an improved bubble CPAP device designed to overcome the hurdles of cost and electricity supply. His organization, Vayu Global Health, developed a device that is ultra-low-cost, portable and electricity-free. Their bubble CPAP device has already proven invaluable in low-resource settings, including war zones like Ukraine, where pediatricians are now using it.

The pandemic also spurred unprecedented applications for existing respiratory care technologies, even in unlikely settings within high-income countries. For example, when New York City was overwhelmed with COVID-19 cases in 2020, a field hospital was set up in Central Park to manage overflow patients. MediTrac, a flexible medical gas piping product, developed by OmegaFlex, was used to quickly equip the facility, connecting patient bedsides directly to oxygen sources. Observing this efficient deployment, the global health community is now exploring opportunities to adapt this same approach for use in sub-Saharan Africa, where rigid copper piping systems can be time-consuming to install and potentially hazardous if not installed correctly.

The urgency of the early 2020s also shone a light on long-standing disparities in oxygen care products, prompting redesigns. Studies published during the pandemic revealed that traditional pulse oximeters, used to detect low levels of oxygen in the blood, are less effective at diagnosing patients with darker skin tones. Next-generation pulse oximeters currently in research and development aim to correct this flaw; another silver lining from the pandemic era.

It's now possible to reflect on the magnitude of oxygen product innovation that has taken place since 2020. A recent report from Unitaid, The Medical Oxygen Innovation Landscape, examines this topic. The report finds that products developed in just the last few years have the potential to revolutionize access to oxygen in low- and middle-income countries and reverse decades of neglect.

However, these innovations are not a panacea. Some are significantly more expensive than the products they are intended to replace. Others have yet to be tested in low-resource settings, where challenges may differ greatly from those in high-income contexts or lab settings. Moreover, these next-generation technologies must be integrated into under-resourced and overstretched health systems. Ultimately, not every oxygen-related technology developed during the pandemic will reach scale.

The next step is to rigorously test the cost-effectiveness and feasibility of promising products and, based on the findings, iteratively evolve the product pipeline to meet the needs of resource-constrained health systems. Maintaining the momentum and resources that originally inspired and enabled these products to be developed will be critical.

The vast reimagining of the health sector during the COVID-19 pandemic presents opportunities to leapfrog decades of technological stagnation for oxygen products in low-resource settings. Herculean efforts to redesign these technologies could translate into durable changes in how oxygen is delivered around the world – but that will only be possible with continued, urgent efforts.

Unitaid funds Vayu Global Health Innovations, an organization discussed in this article. Mention of any technologies does not suggest endorsement or commitment to fund in the future.