Pulse oximetry—from Apple Watch to equitable access

Pulse oximetry is having a moment. The COVID-19 pandemic has raised the profile of this medical tool for good reason—it can offer an early warning to those severely affected by SARS-CoV-2. But the basic technology behind it is far from cutting edge.

Oximeters—devices that use light to measure blood oxygen levels—were first conceived in the 1800s and significantly improved during World War II. The pulse oximeters used today owe their accuracy and simplicity to Takuo Aoyagi, a Japanese electrical engineer who figured out how to account for the changes created by pulsation in the 1970s.

Now that Apple Watch has joined other wearables in offering pulse oximetry, this powerful tool will be available to more people than ever before.

But if “modern” pulse oximeters were commercialized in the 1980s—and wearables manufacturers can fit the tech inside a watch—why aren’t these critical tools available everywhere? And how can we make them more accessible?

Dykki Settle is PATH’s chief digital officer and director of the Center of Digital and Data Excellence. He says that, “Like all technological advances, high-cost wearables with pulse oximetry will briefly deepen the digital health divide. But, in the long run, these advances will benefit everyone.”

Wealthy countries are often the ones to advance technology because those customers can afford to pay top dollar, allowing companies to recoup the high costs of research and development.

“What we need to do as a global community—and what PATH works to do every day,” Dykki says, “is to accelerate the dissemination of new technology once advances have been made.”

When it comes to medical oxygen and its associated tools (including pulse oximeters), scaling up access is a multifaceted challenge that cuts across health areas and requires technical, financial, and political solutions.

“That’s why we take a multifaceted approach,” says Lisa Smith, senior market dynamics officer at PATH and director of the COVID-19 Respiratory Care Response Coordination project. “We’re responding to the COVID-19 pandemic, improving global and national policies, and strengthening markets and implementation.”

To respond to the pandemic, PATH and a coalition of partners are supporting countries in the development and execution of comprehensive respiratory care plans to respond to COVID-19. Despite the challenges that come with pandemic response, Lisa says there are also opportunities.

“We have a real chance to advance oxygen solutions for the long-term,” she says. “With evidence-based approaches, we can facilitate a rapid response to the pandemic and build sustainable oxygen therapy platforms that save lives for generations to come.”

To improve global and national policy, PATH partners with global bodies, countries, and communities to advocate for policies that increase access to lifesaving oxygen.

For example, at the global level, PATH played a central role in the World Health Organization’s landmark decision to indicate oxygen for treating hypoxemia in its Model List of Essential Medicines (EML) and in its List of Essential Medicines for Children (EMLc) in 2017—an action that could reduce child pneumonia deaths by as much as 35 percent in high-burden settings.

To strengthen markets and implementation, PATH develops resources like the Oxygen Delivery Toolkit for decision-makers and facilitates the scale up of essential tools through initiatives like Tools for Integrated Management of Childhood Illness (TIMCI), which is funded by Unitaid.

Over the next three years, TIMCI will equip frontline health workers in more than 360 primary health care facilities across five countries with the tools they need to detect a range of severe diseases impacting children in those communities.

TIMCI project director Michael Ruffo says, “By expanding access to these tools, and collecting data on their implementation and impact, we’re taking an important step toward ending preventable child deaths and realizing more integrated health systems.”

“Just think of the smartphone,” Dykki says. That’s how he likes to convey the dissemination of innovation—and to point out that it’s getting faster. “In a little over ten years, it’s gone from an exclusive tool of the wealthy, to an essential tool for many of the world’s professional health workers.”

He says that’s exactly the kind of global progress PATH is working to accelerate—but with oxygen therapy, with clinical decision support algorithms, with digital and data systems, and more.

The ultimate goal? Realizing a world where everyone can benefit from technological advances in health.