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The latest HPforGH blog from Dr Liz Hardman

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Take a Deep Breath:
The Oxygen Crisis in Zambia

Pipeline pressure zero bar, no available oxygen cylinders, overwhelming numbers of patients and staff feeling exhausted both by the current situation and the lack of end in sight.  In the UK we felt some of these things last April, but as the restrictions near an end and a somewhat normal life starts to return in both the UK and many other parts of the world, we hope that this desperate situation is behind us.  But in other parts of the world the pandemic goes on, and where strict elimination strategies are not possible to enforce or vaccination rates are low this will continue to affect our anaesthetic colleagues and friends around the world.

In February 2020, I had the privilege of working in Zambia with anaesthetists in training as part of the Zambian Anaesthetic Development Program (ZADP). Although my time in Zambia was cut short due to the outbreak of COVID-19, I remained in touch with friends and colleagues I had met there and continued to deliver teaching remotely on Zoom for the rest of the year.  As Zambia experiences it’s third wave of COVID-19 cases, hospitals have been increasingly overwhelmed this time, and even in the tertiary hospitals there are shortages of everything: oxygen, consumables, space, staff.  Whilst the first and second wave did not have the predicted impact on many African countries (1), the Delta variant has meant that the third wave has rapidly overwhelmed healthcare services.


In May, we saw terrible scenes in India of people desperately sourcing oxygen for their relatives who could not access hospital care and difficulty coping with the numbers of dead patients. This was widely reported in the global news, as it should have been, but even though that wave of cases in India has subsided, similar scenes are occurring all over the world, particularly in countries with even fewer resources. This map of oxygen shortage risk is from the Every Breath Counts Coalition who are calling for oxygen to be recognised as an essential medicine (2).

In July, Zambia saw a huge surge in COVID-19 cases throughout the continent with a record death rate at the beginning of August (3).  Oxygen supplies were under severe strain and in many instances completely exhausted – even for the emergency C-section under general anaesthesia – and though case numbers from this wave are now falling, this pattern is destined to repeat itself unless something changes.


World leaders and international organisations have stated that no one is safe until everyone is safe (4). We can support our colleagues in Zambia by sending equipment, supplies and moral support.  Ultimately, the way out of this situation is to focus on vaccination: currently in Zambia 1.6% of the population are fully vaccinated (5).  As a global community we need to urgently address vaccine inequity by prioritising vaccinating healthcare workers, funding and supporting global vaccination projects such as COVAX, protect supply chains and stop surplus vaccines being thrown away(6). In June, just 245,000 doses were sent from the COVAX project to the entire continent, and whilst vaccination shipments have been ramping up, there is still an incredibly long way to go (7). 

The Zambian Anaesthetic Development Partnership are raising money to provide basic equipment such as oxygen saturation monitors and oxygen concentrators and training to Zambian health facilities (8).  They have also co-ordinated a letter to the UK government from 13 anaesthetic organisations to advocate for global vaccine equity and the reversal of decisions to cut UK aid (9).


Fatigue from hearing news, reports and statistics about COVID-19 is real and affecting everyone in the world at the moment, but working towards a safe and secure future for everybody, regardless of where you live, is only possible by supporting each other. Follow this link to find out more about how you can help to support the oxygen crisis in Zambia.


Dr Elizabeth Hardman

Health Professionals for Global Health        

@drlizhardman @HPforGH

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  1. Wamai, G.R. et al. (2021) What Could Explain the Lower COVID-19 Burden in Africa despite Considerable Circulation of the SARS-CoV-2 Virus? International Journal of Environmental  Research and Public Health 2021, 18(16), 8638;

  2. Every breath counts Coalition. Available from:

  3. Record weekly COVID-19 deaths in Africa. WHO Africa, 5th August 2021. Available from:

  4. No-one is safe until everyone is safe – why we need a global response to COVID-19. UNICEF, 24 May 2021. Available from:

  5. COVID-19 Vaccination Rates. Our World In Data. Available from:

  6. Dyer O. Covid-19: Vaccine doses expire in US as uptake falls by 68% BMJ 2021; 373 :n1536 doi:10.1136/bmj.n1536

  7. COVID-19 vaccine shipments boost for Africa. UN News, 29th July 2021. Available from:

  8. Supporting the oxygen crisis in Zambia, Global Anaesthetic Development Partnership, 2021. Justgiving. Available from:

  9. Global Anaesthetic Development Program. Available from:

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