Oxygen on the Move: How India Mobilised Medical Oxygen Logistics in the 2021 Second Wave, and the Lesson for Critical Health Infrastructure

B.A.P-I Retrospective, 2020 to 2024. This paper looks back at 2021 and the lesson it holds for the protection of India's critical infrastructure.

1. Introduction

For a few weeks in the spring of 2021, the most important supply chain in India was the one that carried liquid medical oxygen (LMO) from production plants to hospital storage tanks. The second wave of COVID-19 drove demand for medical oxygen to nearly 9,000 MT, against 3,095 MT during the first wave, as the Union Health Ministry later told the Rajya Sabha (Deccan Herald, 2021, Jul. 20). India met that surge through a national logistics mobilisation.

Five years on, the episode deserves to be read as a case study in critical health logistics. What comes through from the record is that the decisive task was less the quantity of oxygen the country could make than the speed with which it could be moved, allocated and accounted for, and that India's institutions, from the Railways to the armed forces, rose to that task. This paper reconstructs the record and draws the lesson for the protection of India's health infrastructure.

2. Scaling Production and Transport Together

On 15 April 2021 the Union Government stated that the country's daily production capacity for medical oxygen was 7,127 MT against a consumption of 3,842 MT, that a national stock of 50,000 MT was available, and that it would nonetheless import 50,000 MT to secure supplies to the states (The Tribune, 2021, Apr. 16). An empowered group of officers had begun mapping oxygen sources for 12 high-burden states. As demand climbed, the Government expanded supply at speed. Daily LMO production rose from 5,700 MT in August 2020 to 9,446 MT in May 2021, the tanker fleet grew from 1,040 to 1,681 with capacity rising from 12,480 MT to 23,056 MT, and 408 of 1,105 nitrogen and argon tankers were converted to carry oxygen (Indian Chemical News, 2021, May 11).

The central challenge was geography. Production was concentrated in the eastern industrial belt, few hospitals had in-house generation, and there were too few cryogenic tankers to carry the surge to where it was needed (Gandham et al., 2022, Jan. 5). By late April, the Government itself described cryogenic transport as a bottleneck in bringing LMO from the eastern part of the country to other regions, and imported 20 cryogenic ISO containers of 10 MT and 20 MT capacity to relieve it (Deccan Herald, 2021, Apr. 27). A World Bank assessment later concluded that the emergency stemmed less from an absolute shortage than from the need to scale distribution to the surge (Gandham et al., 2022, Jan. 5). One finds here, keeping this into consideration, an infrastructure lesson of general value: aggregate capacity must be matched by transport assets and by buffers placed close to demand.

3. Commanding the Molecule: Orders under the Disaster Management Act

The Union Government's first instrument was legal. On 22 April 2021 the Union Home Secretary, as chairperson of the National Executive Committee under the Disaster Management Act, 2005, directed that there should be "no restriction on the movement of medical oxygen between the states", that oxygen vehicles should enter cities without restriction of timings, that manufacturers could not be confined to supplying hospitals in their own state, and that supply of oxygen for industrial purposes would cease, except for nine specified industries (ETV Bharat, 2021, Apr. 22). District magistrates and superintendents of police were made personally responsible for implementation, and states were bound to follow the supply plan of Empowered Group-I.

Three days later a further MHA order prohibited the use of liquid oxygen for any non-medical purpose and required all stocks to be made available to the Government for medical use (Morung Express, 2021, Apr. 25). The orders turned oxygen, for the period of the emergency, into a nationally directed resource, ensuring that supply followed need across state boundaries. They showed the Disaster Management Act to be a flexible and effective instrument in the hands of the Union. The reform that follows is to place such arrangements in a standing framework for critical medical inputs, so that they can be activated on the first day of a future surge.

4. Rails, Wings and Ships: Moving Liquid Oxygen Across India

Indian Railways supplied the backbone of the long-haul solution. Oxygen Express deliveries began on 24 April 2021 with 126 MT to Maharashtra (PIB, 2021, Jun. 19). By 5 May, 34 Oxygen Expresses had delivered about 2,067 MT in 137 tankers, including 707 MT to Delhi and 641 MT to Uttar Pradesh (PIB, 2021, May 5). By 19 June, 448 trains had completed their journeys, delivering nearly 32,464 MT in more than 1,854 tankers to 15 states (PIB, 2021, Jun. 19). Rail did what roads could not: it moved large volumes over long distances at speed, and on a schedule that the network could control.

The armed forces shortened that cycle further. By 7 May the Indian Air Force had flown 351 domestic sorties airlifting 252 oxygen tankers with a total capacity of 4,904 MT, and 59 international sorties bringing in 72 cryogenic containers with a capacity of 1,233 MT along with 1,252 empty cylinders (PIB, 2021, May 7). The Navy deployed ships including INS Talwar, INS Kolkata, INS Airavat and INS Jalashwa to ferry oxygen containers, cylinders and concentrators (PIB, 2021, May 7). Argon and nitrogen tankers were converted to carry oxygen, and real-time tracking of tankers was set up (Gandham et al., 2022, Jan. 5). Together these responses formed a genuinely national effort, joining the Railways, the Air Force, the Navy and civilian agencies in a single supply chain. They also point to the reform agenda: a dedicated surge reserve within the civilian medical gas logistics chain, so that the capacity India mobilised in 2021 is available by design in future.

5. The National Task Force and Scientific Allocation

Allocation required as much care as transport. The Supreme Court ordered 700 MT a day for Delhi, while Delhi opposed a suggestion from the Centre for an audit of its use (Deccan Herald, 2021, May 8). On 6 May 2021, in Union of India v. Rakesh Malhotra, a bench of Justices D. Y. Chandrachud and M. R. Shah constituted a 12-member National Task Force, with the Cabinet Secretary as convenor, to devise a methodology for the allocation of medical oxygen to the states and Union Territories on a scientific, rational and equitable basis, and to facilitate audits by sub-groups in each state (LiveLaw, 2021, May 8). The Court described the purpose as "to facilitate a public health response to the pandemic based on scientific and specialised domain knowledge" (LiveLaw, 2021, May 8).

The Task Force held many meetings and submitted its report to the Union Government, and the Court directed the Union to file an Action Taken Report on its recommendations (LiveLaw, 2021, Aug. 9). A sub-group's audit of Delhi was reported to have found that the Delhi government had used "exaggerated claims and wrong formula" to project its needs, though the Centre noted that only an interim report on Delhi had been filed (LiveLaw, 2021, Aug. 9). The lasting value of this work is the principle it established: allocation of a scarce medical resource should rest on an agreed, evidence-based method of estimating need. Embedding such a method in advance is a clear reform priority.

6. After the Wave: India Builds Distributed Oxygen Capacity

India built substantial capacity afterwards. By July 2022 the Union Health Ministry reported that 1,225 Pressure Swing Adsorption (PSA) oxygen plants funded through PM CARES had been installed and commissioned in districts across the country (Lok Sabha, 2022, Jul. 29). This decentralised on-site generation directly addresses the dependence of district hospitals on long-haul LMO. The World Bank recommended that these gains be sustained through annual maintenance contracts across the whole chain, trained technicians, strategically placed buffer storage, multimodal transport and digitised cylinder tracking, noting that the PM CARES plants came with five-year annual maintenance contracts (Gandham et al., 2022, Jan. 5). Sustaining that maintenance discipline, with regular operation and trained staff, is the way to keep this national investment ready for use.

7. Designating Medical Oxygen as Critical Health Infrastructure: A Recommendation

The lesson of 2021 is that medical oxygen is not merely a pharmaceutical commodity; it is a lifeline system with production, storage, transport and allocation layers, each of which must be kept ready. India should, accordingly, designate the medical oxygen chain as critical health infrastructure, with a standing reserve of cryogenic tankers and ISO containers held under contract for emergencies, regional buffer storage near major demand centres, a national tracking platform kept live in ordinary times, and an allocation formula agreed with the states in advance and published, so that a future surge can be met on day one. Readiness should be measured and reported, in the manner this author has proposed for continuity-ready infrastructure through the Bharat National Resilience Index (Dash, 2025, Oct. 28), through annual drills that test whether PSA plants run, whether tankers can be mobilised and whether oxygen reaches district hospitals within a fixed time. The Oxygen Expresses, aircraft and ships of 2021 showed what India can achieve when its institutions act together. A standing framework would make that achievement the starting point for the next emergency.