Transforming On-Demand Medical Oxygen Infrastructure to Improve Access and Mortality Rates
概括
尽管世界卫生组织（WHO）在2017年将医用氧气称为必不可少的医学，但在所有护理环境中仍未始终使用氧气。医用氧气的短缺对于手术，肺炎，创伤和其他低氧疾病至关重要，存在于弱势群体中prior to the COVID-19 pandemic and persist today. By one estimate, pre-pandemic, only20% of patients在低收入和中等收入国家（LMIC）中，需要医疗氧气就会接受。大流行极大地增加了对氧气的需求，随着氧气成为必不可少的治疗，进一步的复合进入问题。金博宝正规网址在大流行的高峰期，由于患者潮流影响已经脆弱的基础设施，数十个国家面临严重的氧气短缺。
这一挑战的核心驱动力不是缺乏资金和国际关注，而是缺乏购买氧气的基础设施，而不仅仅是设备。尽管组织，Bill＆Melinda Gates Foundation，Clinton Health Access倡议，联合国儿童基金会，他和美国国际发展机构（USAID）优先考虑医疗氧气的资金和规定，许多国家仍然面临重大短缺，但仍面临严重的短缺。甚至更少的LMIC，例如巴西，真正的氧气自给自足。在设计阶段，无意间的全球氧递送基础设施无意间排除了低收入和农村地区代表。此外，当前的交付基础设施由许多个人资助者以及私人和公共利益相关者组成，他们不以协调的方式工作，因为没有全球管理机构来建立全球政策，标准和监督；识别浪费和冗余；并确保自给自足的途径。As a result, LMICs are at the mercy of other nations and entities who may withhold oxygen during a crisis or fail to adequately distribute supply. It is time for aid organizations and governments to become more efficient and effective at solving this systemic problem by establishing global governance and investing in and enabling LMICs to become self-sufficient by establishing national infrastructure for oxygen generation, distribution, and delivery.
We propose transforming current interventions by centering the concept known asOxygen as a Utility（OAAU）从根本上重新构想了一个国家的医疗氧基础设施作为公共公用事业，并由私人投资和稳定的价格支持，以创建一个可行，公平的市场，以实现必要的公共卫生。随着白宫的共同响应团队在未来几个月内关闭，美国国际开发署的全球卫生局has a unique opportunity to take a global leadership role in spearheading the development of an accessible, affordable oxygen marketplace. USAID should convene a global public-private partnership and governing coalition called the Universal Oxygen Coalition (UOC), pilot the OaaU model in at least two target LMICs (Tanzania and Uttar Pradesh, India), and launch a Medical Oxygen Grand Challenge to enable necessary technological and infrastructure innovation.
挑战和机会
没有医学替代品的氧气，该氧气用于治疗多种急性呼吸窘迫综合征，例如新生儿中的肺炎和肺炎，以及非传染性疾病，例如哮喘，心力衰竭，心力衰竭和COVID-19。仅肺炎是世界上最大的成人和儿童传染病杀手，夺走了250万人的生命，包括2019年740180儿童,。COVID-19的大流行使对氧气的需求加剧了，并暴露了缺乏氧气的需求，因此世界各地的死亡人数增加。
For every COVID-19 patient who needs oxygen, there are at least five other patients who also need it, including the 7.2 million children with pneumonia who enter LMIC hospitals each year. [Ehsanur et al, 2021]. Where it is available, there are often improperly balanced oxygen distribution networks, such as high-density areas being overstocked while rural areas or tertiary care settings go underserved. OnlyLMICS中10％的医院有能力获得脉搏血氧仪和氧气治疗，这些资源更好的医院往往在更接近现有的氧气递送提供者的较大城市中。
This widespread lack of access to medical oxygen in LMICs threatens health outcomes and well-being, particularly for rural and low-income populations. The primary obstacle to equitable oxygen access is lack of the necessary digital infrastructure in-country. Digital infrastructure provides insights that enable health system managers and policymakers to effectively establish policy, manage the supply of oxygen to meet needs, and coordinate work across a complex supply chain composed of various independent providers.在建立可复制且负担得起的数字基础设施之前，LMIC将没有必要的资源来管理国家氧气输送系统，预测需求，计划适当的氧气生产和采购，保障公平分配并确保可持续消费。
氧气可以以多种形式（VIA集中器，汽缸，植物或液体）交付，全球市场包括许多在多个国家出售的制造商和分销商。大多数氧气提供商是营利性组织，尽管有良好的意图，但并未在商业上激励他们合作以实现同等的氧气获取。这些相同的制造商中的许多人还出售医疗设备来调节或向患者提供氧气，但在分布式网络上维护设备仍然是一个挑战。这些设备很复杂且昂贵，而且通常很少有训练有素的专家来维修破损的设备。医疗保健提供者通常不用回收或维修设备，而是被迫丢弃破损的设备并购买新的设备，这有助于更大的垃圾填埋场废物，并为住在附近的人们带来更加复杂的健康问题。
Common contributing causes for fragmented oxygen delivery systems in LMICs include:
- No national digital infrastructure连接，跟踪和监视医疗氧气供应和利用，例如预测需求并确保提供可靠的服务提供的电力。
- No centralized way to monitor manufacturers, distributors,以及各种交付提供商，以确保协调和遵守当地政策。
- In many cases,没有建立氧气和医疗保健法规的地方政策or no means to enforce local policy.
- Lack of purchasing optionsfor healthcare providers, who are often forced to buy whichever oxygen devices are available versus the type of source oxygen that best fits their needs (i.e., concentrator or liquid) due to cumbersome tender systems and lack of coordination across markets.
- 缺乏训练有素的专家来维护和维修设备，including limited national standardized certification programs, resulting in the premature disposal of costly medical devices contributing to waste issues. Further, lack of maintenance fuels the vicious cycle of LMICs requiring more regular funding to buy oxygen devices, which can increase reliance on third parties to sustain oxygen needs rather than domestic demand and marketplaces.
医用氧气投资是实现全球健康成果和本地化政策目标的独特机会。美国国际开发署投资5,000万美元以扩大医疗氧气通道通过其global COVID-19 response for LMIC partners, but this investment only scratches the surface of what is needed to deliver self-sustainment. In response to oxygen shortages during the peaks of the pandemic, the WHO, UNICEF, the World Bank, and other donors shipped hundreds of thousands of oxygen concentrators to help LMICs deal with the rise in oxygen needs. This influx of resources addressed the interim need but did not solve the persisting healthcare system and underlying oxygen infrastructure problems. In 2021, the World Bank made emergency loans available to LMICs to help them shore up production and infrastructure capabilities, but not enough countries applied for these loans, as the barriers to solve these infrastructure issues are complex, difficult to identify without proper data and digital infrastructure to identify supply chain gaps, and hard to solve with a single cash loan.
尽管非常关注LMIC中的氧气获取问题，但目前的支出远远不足以在LMIC中建立可持续的氧气系统。主要的访问和权益差距仍然存在。简而言之，单独提供资金而没有凝聚力，综合的工业策略无法解决医疗氧不平等的根源问题。
美国国际开发署最近宣布an expanded commitmentin Africa and Asia to expand medical oxygen access, including market-shaping activities and partnerships. Since the pandemic began, USAID has directed $112 million in funding for medical oxygen to 50 countries and is the largest donor to The Global Fund, which has provided the largest international sums of money (more than $600 million) to increase medical oxygen access in over 80 countries. In response to the pandemic’s impacts on LMICs, theACT-ACCELERATOR（ACAT-A）氧气紧急工作队，由Unitaid和Wellcome Trust共同主持，已提供7亿美元氧气供应供应75多个国家，并催化大型氧气供应商和非政府组织领导者支持LMIC和国家医疗部。这个工作队汇集了行业，慈善事业，非政府组织和学术领导者。尽管美国国际开发署不是直接合作伙伴，但全球基金是工作队的主要捐助者。
但是，如果没有政策的变化，LMIC将继续缺乏充分诊断国家氧气供应系统瓶颈和障碍所需的支持，建立国家监管政策，部署数字基础设施，变更采购方法，启用必要的治理变化，并培训- 国家专家，以确保持续，公平的氧气供应链。为了帮助LMIC变得自给自足，我们需要从提供零碎的方法（捐赠金钱和氧气供应）转变为一种整体方法，其中包括访问一群专家，用于氧气数字基础设施的资金资金，帮助制定国家政策以及治理机制，并支持建立专业培训和认证计划，以便LMIC可以自我管理自己的医疗氧供应链。这样的发展政策计划依靠氧气作为公用事业框架，该框架着重于为医疗氧作为必要的公共物品创建功能，公平的市场。成功实现的情况下，OAAU促进了一个国家内部的端到端分配的公平率，例如其他公用事业，例如水和电力。
在国民经济中，充分实现的OAAU模型将整合和简化氧气输送的大多数方面，从产量到分配氧气和分配其设备的分配，再到何时培训员工何时管理氧气，如何使用设备，以及如何使用设备，以及设备维修。这项新模型将协调行业合作伙伴，资助者和国家领导人，将重点放在端到端的医疗氧气上，作为一种负担得起的，可访问的公用事业，而不是实物发展。OAAU将参与创建可持续LMIC医用氧供应链的每个利益相关者的可预测性，可负担性和效率中心。OAAU以行业合作伙伴和本地参与者的价格提供了所有类型的氧气，从而提高了访问和可靠性。这种新的业务模式将通过收取订阅和按下费用为私营部门提供商的投资提供可持续性，每个商业模式都会由健康部谈判，以使他们能够管理自己的国家的氧气需求。这种新模式将将每个利益相关者纳入LMIC的医疗保健系统中，并促进开放的，基于市场的谈判，以实现负担得起的自给自足的医疗氧气供应链。
需要初始投资来在每个LMIC中创建永久性氧基础架构，以将招标系统从设备和服务或实物辅助模型转变为购买氧气作为实用工具模型。该规模的行业业务模型转型将需要多方利益相关者的努力来包括国内协调。当前的氧气输送基础设施由许多不以协调方式工作的个人资助者以及许多个人资助者和公共利益相关者组成。在这项关键的医疗氧气供应时，美国国际开发署的召集能力，捐助者的支持和专业知识应得到利用，以更好地指导这笔支出以创造创新的机会。这普遍的氧气将建立全球联盟policy, standards, and oversight; identify waste and redundancy; and ensure viable paths to oxygen self-sufficiency in LMICs. The UOC will act similarly to electric cooperatives, which aggregate supplies to meet electricity demand, ensuring every patient has access to oxygen, on demand, at the point of care, no matter where in the world they live.
Plan of Action
为了使管家和催化OAAU，美国国际开发署应利用其全球平台来召集资助者，供应商，制造商，分销商，卫生系统，金融合作伙伴，慈善事业和非政府组织，并发起呼吁采取行动以动员资源并引起医疗氧气不平等。美国国际开发署全球卫生局, along with the its私营部门的联系点，以及国务院的Office of Global Partnershipsshould spearhead the UOC coalition. Using USAID’s Private Sector Engagement Strategy andEDGE fundas a model, USAID can serve as a connector, catalyzer, and lead implementer in reforming the global medical oxygen marketplace. The Bureau for Global Health should organize the initial summit, calls to action, and burgeoning UOC coalition because of its expertise and connections in the field. We anticipate that the UOC would require staff time and resources, which could be funded by a combination of private and philanthropic funding from UOC members in addition to some USAID resources.
To achieve the UOC vision, multiple sources of funding could be leveraged in addition to Congressional appropriation. In 2022, State Department and USAID funding for global health programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.8 billion, an increase of $634 million above the FY21 enacted level. In combination with USAID’s leading investments in The Global Fund, USAID could deploy existing authorities and funding from发展创新企业（DIV）and leverage Grand Challenge models like出生时挽救生命to create innovation incentive awards already authorized by Congress, or the newly announced边缘基金专注于灵活的公私部门合作伙伴关系，将资源指向所有人获得公平的氧气获取。这些变革性投资还将为诸如本地化之类的美国国际开发署政策优先事项提供服务。UOC将与美国国际开发署和每一个呼吸计数通过将基本的参与者（卫生系统，氧气供应商，制造商和/或分销商以及金融合作伙伴）带入统一的整体方法来确保可靠的氧气提供和可持续的基础设施支持来重新构想这个持久的问题。
Recommendation 1. USAID’s Bureau for Global Health should convene the Universal Oxygen Coalition Summit to issue an OaaU co-financing call to action and establish a global governing body.
全球卫生局应组织峰会，召集UOC联盟，并发出呼吁为OAAU的国家飞行员提供诉讼。UOC联盟应将LMIC政府召集在一起；地方，区域和全球私营部门医疗氧提供者；本地服务和维护公司；设备制造商和分销商；卫生系统；私人与发展金融；慈善组织；全球健康非政府组织社区；卫生部； and in-country faith-based organizations.
一旦完全建立,UOC大学会邀请印度河try coalition members to join to ensure equal and fair representation across the medical oxygen delivery care continuum. Potential industry members include Air Liquide, Linde, Philips, CHART, Praxair, Gulf Cryo, Air Products, International Futures, AFROX, SAROS, and GCE. Public and multilateral institutions should include the World Bank, World Health Organization, UNICEF, USAID country missions and leaders from the Bureau for Global Health, and selected country Ministries of Health. Funders such as Rockefeller Foundation, Unitaid, Bill & Melinda Gates Foundation, Clinton Health Access Initiative, and Wellcome Trust, as well as leading social enterprises and experts in the oxygen field such as Hewatele and PATH, should also be included.
UOC members would engage and interact with USAID through its Private Sector Engagement Points of Contact, which are within each regional and technical bureau. USAID should designate at least two points of contact from a regional and technical bureau, respectively, to lead engagement with UOC members and country-level partners. While dedicated funds to support the UOC and its management would be required in the long term either from Congress or private finance, USAID may be able to deploy staff from existing budgets to support the initial stand-up process of the coalition.
Progress and commitments already exist to launch the UOC, with Rockefeller Philanthropy Advisors planning to bring fiscal sponsorship as well as strategy and planning for the formation of the global coalition to the UOC with PATH providing additional strategic and technical functions for partners. The purpose of the UOC through its fiscal sponsor is to act as the global governing body by establishing global policy, standards, oversight controls, funding coordination, identifying waste & redundancy, setting priorities, acting as advisor and intermediary when needed to ensure LMIC paths to self-sufficiency are available. UOC would oversee and manage country selection, raising funding, and coordination with local Ministries of Health, funders, and private sector providers.
UOC的其他职责可能包括：
- 发出可行性研究，以评估目标国家的技术差距。这项研究将为未来的挑战，合同，优先次序，设计和专注。
- Advise LMICs on identifying barriers and knowing best next steps.
- 为OAAU建立官方框架，其中包括成功和可复制模型的核心指标。
第一次UOC峰会将发出行动呼吁，以从开发银行，慈善机构和援助机构中做出新的重要承诺，以共同提供OAAU飞行员计划，在目标LMIC中建立买入，并从事市场塑造活动和基础设施对医用氧气供应链的投资。这Summit could occur on the sidelines of the Global COVID-19 Summit or the United Nations General Assembly. Summit activities and outcomes should include:
- 金融commitmen宣布启动和安全ts from public and private funds for piloting OaaU in at least one national context.
- Identify and prioritize criteria for selecting pilot locations (regions or nations) for OaaU and select the initial country(s) for holistic oxygen self-sufficiency investment.
- Create the UOC Board representing manufacturers, global health experts, LMIC leaders, funders, multilateral institutions, and health providers who are empowered to identify geographic areas most in need of oxygen investment, issue market-specific grants and open innovation competitions, and leverage pooled public and private funds.
- Research, prioritize, and select at least two models of OaaU within a national marketplace to focus attention of all stakeholders on fixing the oxygen marketplace.
建议2. UOC应根据需求和准备就绪，并直接筹集资金对试点计划建立国家优先级。
USAID shouldco-finance an OaaU pilot model through investments in domestic supply chain streamlining and leverage matched funds from development bank, private, and philanthropic dollars. This fund should be used to invest in the development of a holistic oxygen ecosystem starting in Tanzania and in Uttar Pradesh, India, so that these regions are prepared to deliver reliable oxygen supply, catalyzing broad demand, business activity, and economic development.
这objective is to deliver a replicable global reference model for streamlining the supply chain and logistics, eventually leading to equitable oxygen catering to the healthcare needs that can be rolled out in other LMICs and improve lives for the deprived. The above sites are prioritized based on their readiness and need as determined by the2020路径市场研究supported by the Bill and Melinda Gates Foundation. We estimate that $495 million for the pilots in both nations would provide oxygen for 270 million people, which equates to less than $2 per person. The UOC should:
- Invest in local providers:这将产生经济发展和高薪工作，在整个供应链中。
- 刺激局部创新和数字化转型：促进国内和区域系统集成商在本地驱动的创新，尤其是在氧气产生，分销和交付的数字化转换方面。解决方案应包括新的数字工具，用于汇总供求，以及实时命令和控制，以从需求从根本上改善获得医用氧气的机会。
- Create an in-country deployment coalition for each pilot country:由于氧气市场在每种情况下都是独特的，因此在每个国家 /地区都有一个基于市场的部署联盟，涉及私人，公共和社会部门合作伙伴对于协调资源的部署和维持实施工作至关重要。部署联盟可以由美国国际开发署国家任务执行或监督。
- 提供试点模型资金to enable Ministries of Health and the deployment coalition to streamline and fix supply chains.
- 发行采取行动电话for interested parties and stakeholders to submit plans to address both the immediate medical oxygen needs in the country of choice and the long-term infrastructure barriers. These plans could help inform strategy for deploying resources and making oxygen infrastructure investments.
这项工作将导致LMIC的可持续氧网格通过订阅和每次使用模式产生收入，从而减少对援助组织或捐助者采购投资的需求。为了创造OAAU的条件，UOC将需要进行一次性投资，以创建基础设施，以提供一个国家需要成为氧气自给自足的国家所需的氧气。这项投资应由世界银行通过数量使用来支持，保证了每个国家 /地区的电量的数量使用保证。结果将把范式从购买设备转移到购买氧气。
Recommendation 3. The UOC and partner agencies should launch the Oxygen Access Grand Challenge to invest in innovations to reduce costs, improve maintenance, and enhance supply chain competition in target countries.
We envision the creation of a replicable solution for a self-sustaining infrastructure that can then serve as a global reference model for how best to streamline the oxygen supply chain through improved infrastructure, digital transformation, and logistics coordination. Open innovation would be well-suited to priming this potential market for digital and infrastructure tools that do not yet exist. UOC should aim to catalyze a more inclusive, dynamic, and sustainable oxygen ecosystem of public- and private-sector stakeholders.
这Grand Challenge platform could leverage philanthropic and private sector resources and investment. However, we also recommend that USAID deploy some capital ($20 million over four years) for the prize purse focused on outcomes-based technologies that could be deployed in LMICs and new ideas from a diverse global pool of applicants. We recommend the Challenge focus on the creation of digital public goods that will be the digital “command and control” backbone of a OaaU in-country. This would allow a country’s government and healthcare system to know their own status of oxygen supply per a country grid and which clinic used how much oxygen in real time and bill accordingly. Such tools do not yet exist at affordable, accessible levels in LMICs. However, USAID and its UOC partners should scope and validate the challenge’s core criteria and problems, as they may differ depending on the target countries selected.
Activities to support the Challenge should include:
- Assessing technology and cost gaps在医疗保健基础设施的目标伙伴国家中，特别关注供应链和氧气提供。这项研究将为挑战设计和重点提供介绍。
- 与LMIC建立合作伙伴关系在飞行员中实施有希望的创新，并从医疗部，私营部门以及多边或私人融资中获得高级市场承诺，以确保可行的解决方案规模途径。
- Establishing an official framework of best practicesfor OaaU that includes core metrics of success and replicable models that interested healthcare ministries could use to develop a system in their own nations.
Conclusion
USAID can play a catalytic role in spearheading the creation and sustainment of medical oxygen through a public utility model. Investing in new digital tools for aggregation of supply and demand and real-time command and control to radically improve access to medical oxygen on demand in LMICs can unlock better health outcomes and improve health system performance. By piloting the OaaU model, USAID can prove the sustainability and scalability of a solution that can be a global reference model for streamlining medical oxygen supply chain and logistics. USAID and its partners can begin to create sustained change and truly equitable oxygen access. Through enhancing existing public-private partnerships, USAID can also cement a resilient medical oxygen system better prepared for the next pandemic and better equipped to deliver improved health outcomes.
参考
- Pneumonia in Children Statistics – UNICEF DATA
- Ann Danaiya Usher (2021). Medical oxygen crisis: a belated COVID-19 response. The
Lancet, World Report. - Lam F., Stegmuller A.,Chouz V.B., Grahma H.R. (2021). Oxygen systems strengthening as
an intervention to prevent childhood deaths due to pneumonia in low-resource settings:
系统评价，荟萃分析和成本效益。BMJ全球健康期刊 - AD Usher: Medical Oxygen crisis: a belated COVID-19 response (2021) The Lancet Global
Health. - Nair H, Simoes EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JS et al.
（2013）严重急性下呼吸道的全球和区域招生负担
infections in young children in 2010: a systematic analysis. Lancet 381: 1380–90.
10.1016/S0140-6736（12）61901-1 - Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE et al. (2012) Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 2151–61. 10.1016/S0140-6736(12)60560-1
- UNEP报告。非洲废物管理前景。（2018）
- T Duke, SM Gramham, NN Cherian, AS Ginsburg, M English, S Howie, D Peel, PM Enarson,
IH Wilson和W是，联合氧气系统工作组（2010）氧气是一种
essential medicine: A call for international action. - Unitaid press release. COVID-19 emergency impacting more than half a million people in low-
随着需求激增（2021年），每天中等收入国家 /地区国家
OAAU方法整合并简化了氧气输送的大多数方面，就像通过政府投资和公私合作伙伴关系建立在技术发展以管理它们的情况下，综合电网逐渐发展成为公用事业。采用OAAU方法，将在氧气数字网格设计，建立，互操作连接之间进行投资，员工培训，纵向可持续计划的需求预测和开发。通过这种模型，增加数量的氧气供应商将通过旨在降低成本的拍卖来竞争。政府将获得较低的固定价格，以换取提供坚定的承诺，以购买预先建立的氧气，服务和设备，以长期提供氧气。金融合作伙伴保证了这些承诺的价值，以减少各国违约的付款风险，以鼓励增加竞争的增加，从而使这种新机制的车轮变化。提供更高质量的较低成本的获得医用氧气将是LMIC的一种缓解。此外，我们预计政府将在监管和监督中发挥更大的作用，这将为市场提供价格稳定，负担能力和适当的供应，就像电力的监管方式一样。
首先，氧气是一种复杂的产物，可以由浓度器，圆柱体，植物和液体氧气形式产生。为了使一个国家成为氧气自给自足，它需要所有类型的氧气，并且每个国家都基于医疗保健系统，人口需求和现有的身体基础设施，都有自己独特的需求组合。如果一个国家拥有出色的运输系统，那么氧气的递送是更好的选择。但是，如果一个国家的农村人口更高，没有主要高速公路，那么交货就不是一个可行的解决方案。
这oxygen market is competitive and consists of many manufacturers, each of which bring added variations to the way oxygen is delivered. While WHO-UNICEF published minimal technical specifications and guidance for oxygen therapy devices in 2019, there remains variation in how these devices are delivered and the type of data produced in the process. Additionally, oxygen delivery requires an entire system to ensure it safely reaches patients. In most cases, these systems are decentralized and independently run, which further contributes to service and performance variation. Due to layers of complexity, access to oxygen includes multiple challenges in availability, quality, affordability, management, supply, human resources capacity, and safety. National oversight through a digital oxygen utility infrastructure that requires the coordination and participation of the various oxygen delivery stakeholders would address oxygen access issues and enable country self-sustainment.
鉴于氧气提供了每个残疾调整的生活年份返还50美元，医疗氧气投资是开发银行，外国援助机构和影响投资者的有意义的机会。OAAU业务模型转换将是LMIC中氧气按需的氧气可用性迈出的重要一步。可靠，负担得起的医疗氧气可以增强医疗基础设施并改善健康结果。最近的估计表明，每年约有1.20-1.56亿例急性下呼吸道感染发生在5岁以下儿童中，大约140万例导致死亡。这些死亡中有95％以上发生在低收入和中等收入国家（Nair, 2013; Lui, 2012).
Unlike prior approaches, OaaU is a business model transformation from partial solutions to integrated solutions with all types of oxygen, just like the electricity sector transformed into an integrated grid of all types of electricity supply. From there, the medical facilities will buy oxygen, not equipment—just like you buy amounts of electricity, not a nuclear power plant.
Investing in oxygen as a utility through on-demand infrastructure can improve access and mortality rates globally. Healthcare experts propose how an international coalition led by USAID can transform the medical oxygen marketplaces of low- and middle-income countries to ensure every patient has the oxygen they need.
在一个火灾季节转向火年的环境中，北美各地的夏季天空充满了远至另一个海岸的野火烟雾，对科学准确的野外火灾政策的需求从未如此大。在过去的几个月中，Compass Science Communication一直与[…]合作合作
科学，证据和土著观点可以更好地了解美国对野外火灾的反应。
At the beginning of April, the Congressional Research Service (CRS) released a landmark report outlining the scope of federal investments in regional ecosystems, something we have written about at FAS in the past. This CRS report, ‘Regional Innovation: Federal Programs and Issues for Consideration,’ does an excellent job covering the scope and scale of our massive federal investment […]