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The havoc that the second wave of the pandemic has wreaked across India is not only due to the disease’s high rates of transmission but also and possibly more importantly, on account of a scarcity of life-saving tools. Particularly, oxygen, which we have always taken for granted.

At the time of writing this article, India had a production capacity of about 7200 MT of oxygen. However, processing capacity is not uniformly distributed. Maharashtra, Gujarat, Jharkhand, Odisha, Tamil Nadu, Karnataka, Kerala, and West Bengal account for nearly 80% of the total oxygen produced in India. Liquefaction and fractional distillation are the most common methods for extracting oxygen from air. With the daily active cases count hovering around the 3.5 lakh mark, the country is in need of medical oxygen for a growing pool of patients.

 What has led to the crisis?

According to epidemiologist Archisman Mohapatra, Executive Director of the Generating Research Insights for Development (GRID) Council, the UK variant or the Indianized version of the virus that is sweeping India spreads faster, causing whole communities to fall ill and putting severe pressure on the local infrastructure.

As experts have pointed out, India produces enough oxygen to meet the needs of 1.3 billion per day. Mostly, it is for industrial use, but can be diverted for medical purposes. The bottlenecks are in transport and storage. This delay is because of a stretched distribution network. Cryogenic tankers transport liquid oxygen at extremely low temperatures to distributors, who then turn it to gas for filling cylinders. However, India has a shortage of cryogenic tankers. And, for safety purposes, such special tankers must be transported by road rather than by air after they have been filled.

India does not have enough cryogenic tankers to ensure 24×7 road transport of medical oxygen. Now when oxygen is being transported from one state to another, the travel time it takes from the manufacturer to a patient’s bed has increased from 3-5 days to 6-8 days, according to Indian Council of Medical Research (ICMR). The more remote the location of the patient, the worse is the case. Smaller suppliers have also expressed concern about a lack of jumbo and dura cylinders to maintain a steady flow. Such increase in the logistic costs have fuelled up the cost of refilling cylinders roughly between `500 - `2000, slowing down the movements further. Other logistical issues like that at the Goa Medical College where lack of trained drivers who could manoeuvre the oxygen cylinders quickly during the process of changeover of cylinders led to oxygen supply dips which in turn led to more than 30 deaths between May12 - May 15, 2021 have added to the woes.

Most of the oxygen producing units are in eastern India, while the soaring demand is coming from cities in the western and northern India, especially Maharashtra, Gujarat, Madhya Pradesh, Uttar Pradesh, Delhi, followed by Chhattisgarh, Punjab and Rajasthan. As per a report in India Today, before the acute shortage, the hospitals had a daily requirement of 300-500 litres, but now the overall demand has reached 5,000 metric tonnes per day in the second wave. Amidst all this, the blame game continues as local officials in some states are blocking oxygen tankers meant for other states in a bid to ensure supplies for themselves.

Many hospitals still do not have on-site oxygen plants, often because of poor infrastructure and high costs. However, it needs to be noted that setting up of new oxygen manufacturing plants or expanding existing ones is not feasible right away. In the last one year, INOX started two plants in West Bengal and UP to produce 200 and 150 tonnes oxygen respectively per day. The process of building one plant took 24 months. INOX says that they have plans to come up with plants in MP, UP, Tamil Nadu and West Bengal.

Meanwhile, the Sterlite plant in Thoothukudi, Tamil Nadu, which can produce 1,050 MT of oxygen per day, stayed shut as India looked outside for help. Its owners requested that the gates be opened, but the state government took a long time to agree. As it stands, it is the distribution and policy management, not the production, that is the more serious issue.

Attempts to resolve the crisis

UK, France, Germany, US, Australia, Russia, Ireland and many others have announced their aid packages; Bhutan, forever the recipient, has committed to providing 40 metric tonnes of liquid oxygen every day. By serving as a logistics centre for supplying oxygen cryogenic tanks and cylinders to bridge the country’s immediate oxygen shortage, Singapore has truly demonstrated its commitment to India.

The central government has ordered a ban on industry use of oxygen but with exceptions like medical, pharmaceutical and defence. It has asked the Indian Railways to move multiple tankers from refilling plants to where they are most needed. The government has issued orders to convert argon and nitrogen tankers into oxygen ones. In the meantime, the Indian Air Force rushed to transport emergency oxygen from Singapore, Bangkok, and Dubai, and courier the same to different states across the country. The government is also using the Air Force cargo planes to fly empty tankers to production centres, in collaboration with industrial gas major Linde India and others. The Defence Research & Development Organisation (DRDO) is working with several private and public sector agencies to produce over 700 Pressure Swing Adsorption (PSA) plants, which use technology developed for India’s LCA Tejas light fighter aircraft. 

The industry has also come forward and pledged their support. Tata Steel has increased its daily oxygen supply limit to 800 tonnes per day to health centres for the treatment of Covid-19 patients. The government has ordered a total of 500 on-site oxygen generator units and a major chunk has gone to the Tata group. Tata Group also imported 1,000 cryogenic containers to transport liquid oxygen, supplying 900 tonnes of oxygen every day to state government hospitals. Mukesh Ambani’s Reliance Industries tweaked manufacturing at its oil refineries to produce over 1,000 tonnes of medical grade liquid oxygen per day - i.e. slightly over 11% of India’s total production. Reliance has also airlifted 24 ISO containers for transporting medical-grade liquid oxygen. The Adani Group has purchased 48 cryogenic tanks from leading manufacturers in Saudi Arabia, Thailand, Singapore, Taiwan, and the United Arab Emirates (UAE) to support the nation. Microsoft is working with India to provide 25,000 oxygen concentration devices. The Walmart Foundation has pledged to supply 20 oxygen generator plants and an equivalent number of cryogenic containers. It is also worth mentioning the efforts of NGOs like Delhi based Hemkunt Foundation, United Way Delhi and Kolkata based Covid Care Network (CCN), among others.

Also, another positive development is that the Supreme Court on May 8, 2021 has constituted a 12-member National Task Force (NTF) to streamline and ensure the “effective and transparent” allocation of liquid medical oxygen on a “scientific, rational and equitable basis” to states and Union Territories fighting Covid-19. The Supreme Court’s primary term of reference for the task force is to assess and recommend the availability and distribution of medical oxygen across the country, to work out a methodology for its equitable distribution, to recommend ways to supplement the oxygen supply based on current and expected demands, to encourage audits on whether supply is reaching its destination in the states, and to evaluate the effectiveness of the Task Force’s recommendations — is indeed a welcome move.

Summing Up

The clamour for something so basic to life has overshadowed India’s massive vaccination drive and brought widespread criticism of how things are being handled; more so, because, some policymakers declared that the coronavirus was defeated months ago, despite warnings of highly contagious variants. The coming days are likely to be worse; a third wave is a distinct possibility even a fourth. We should not repeat the same mistakes and be caught napping again.