Six out of every ten people globally lack access to safe medical oxygen, resulting in hundreds of thousands of preventable deaths each year and reducing quality of life for millions more, an international report co-authored by the University of Auckland has found.

Associate Professor Stephen Howie from the University’s Faculty of Medical and Health Sciences (FMHS) was an adviser to the Lancet Global Health Commission on Medical Oxygen Security and co-author of its report Reducing global inequities in medical oxygen access released 18 February.

A key finding shows global access to medical oxygen is highly inequitable. Five billion people, mostly from low and middle-income countries don’t have access to safe, quality, affordable medical oxygen.

Associate Professor Howie, child health researcher and a specialist paediatrician says he hopes further lives will be saved because of this work, and that children and adults will not only survive but thrive.

The Auckland University team are leading the field to improve access to medical oxygen. Howie recently gave a plenary address  at the World Lung Health Conference in Bali, spelling out the challenges and opportunities to tackle the global issue.

“I have been working in the area of oxygen treatment for oxygen-starved (hypoxic) illnesses for two decades, particularly in Africa and the Pacific. My first priority was children (naturally, as a paediatrician) but we learnt soon enough that solving the problem has to involve catering for all ages.

“It is such an obvious need. I saw it at the hospitals I worked at in Africa where needless death from diseases like pneumonia happened because oxygen supplies were short, and this hit families and staff very hard. It was at that time that we made it our goal that ‘no child should die for lack of oxygen’ and this applies to adults too.” 

Fiji was particularly hard hit when the first waves of the COVID-19 pandemic arrived, at one point it had the highest rate of COVID-19 in the world. A close partnership between the Fiji Ministry of Health, the University of Auckland, Cure Kids and Fiji National University, funded by New Zealand MFAT and other donors, played an important role in supporting the pandemic response says Howie. 

Dr Sainimere Boladuadua is Lancet Commission’s Western Pacific Region ambassador 

On the ground during that time was Dr Sainimere Boladuadua, a public health medicine specialist, now a doctoral student at the University of Auckland and currently undertaking a Fulbright fellowship at Johns Hopkins University in Baltimore. 

Boladuadua (Somosomo, Cakaudrove, vasu i Levuka-i-Yale, Kadavu/Fiji) also has the honour of being the Lancet Commission’s Western Pacific Region ambassador and will spearhead advocacy for improving access to medical oxygen in the region. 

“I remember those days, the adrenalin was pumping and it was scary. It was very difficult before the vaccine arrived. We had very little sleep trying to get everything set up,” she says recalling the period of the country organising itself and the national response which included setting up field hospitals. 

Boladuadua met Howie in Fiji where he helped to lead the Fiji Oxygen Project, supporting the vital work of health leaders like Dr Luke Nasedra and Dr Eric Rafai. 

“The project was just doing exactly this, trying to improve and ensure that all the health facilities had access to medical oxygen, facilities to deliver them. That no child or adult should die for lack of oxygen, and it's such a simple medical therapy that you expect to be available but often it isn't, says Boladuadua. 

“The reality was rural health facilities sometimes had to ration the oxygen. You have a limited supply, the cylinders that come in every month you have your quota, and if you run out then sometimes you have to prioritize who gets it, who doesn't. Which is just so heartbreaking.” 

The Fiji Ministry of Health, supported by the project, was in the midst of covering those gaps when COVID hit, and Boladuadua says the one silver lining was that it shone a light on the gaps, putting the issue on the radar. 

“You saw the images around the world, hospitals running out of oxygen in India, family members hauling oxygen cylinders on motorcycles. I guess that made it really come up to the forefront.” 

This was the entry point for Boladudua to start work on her doctoral studies at the University with Howie as her primary academic supervisor, and unsurprisingly her PhD has a focus closely related to her previous work. 

“My research question is how to improve access to care for children with acute respiratory infections in Fiji and obviously links to the supply of oxygen as well.” 

She says respiratory conditions are rising and pneumonia is still one of the leading causes of death and disease particularly in under five year-olds across the Pacific and even in New Zealand. 

“Within New Zealand, our Pacific children experience a larger acute respiratory burden than children of any other ethnic group.” 

Boladuadua says she’s grateful to Professor Cameron Grant, Head of Paediatrics, Child & Youth Health at FMHS who encouraged her to apply for the Fulbright Scholarship. As well as support from her friends, doctoral candidates Alehandrea Manuel (who has since completed her PhD) and Ashlea Gillon. 

“Professor Grant was a Fulbright scholar 30 years ago and he said it would be life changing, and it has been in so many ways,” she says of working closely with the team at Johns Hopkins and the opportunities presented such as the lecture she’s been asked to present next month at the School of Public Health: ‘Decolonising Global Health – a Pacific perspective’.

“What appealed to me was they had a Centre for Indigenous Health that worked very closely with Native American communities. And although Johns Hopkins is in Baltimore, their work is very much within the communities themselves, in the tribal lands of the Navajo and White Mountain Apache peoples in the Southwest of the US. 

“They've got sites in all these communities and the staff - data collectors, researchers, the research nurses and everyone in those teams, the majority are Native American. So it's about responding to their health needs and also building local capacity.” 

Learning how the Indian Health System has accommodated traditional medicine has inspired Boladuadua and she’s brimming with ideas that she’s eager to bring back to Aotearoa later this year when she returns. 

“I wanted to see how you can use traditional knowledge and practices with western knowledge, I wanted to learn how that happened. They're just doing it so beautifully here. I am learning so much and it has been life changing with all the different perspectives, exposure and the incredible people I’m able to work with.”