The Last Bottle of Halothane: Why Africa Cannot Wait

Africa , Featured , Headlines , Health , Human Rights , Humanitarian Emergencies , Sustainable Development Goals , TerraViva United Nations Opinion

Dr Elizabeth Igaga in one of the operating rooms at Smile Train partner, CORSU hospital, Uganda during a partner visit. Credit: Smile Train

KAMPALA Uganda, Jun 16 2026 (IPS) - Global health has a habit of mobilizing around the visible and the dramatic. Ebola, malaria, and Mpox have all dominated headlines related to Africa in recent years, and understandably so. But nobody is talking about one of the most consequential regional health crises waiting to happen.

When a child needs surgery, the first challenge is not the procedure itself. It is getting them safely to sleep. For decades, hospitals across sub-Saharan Africa have relied on a drug called halothane to do that. It has a faintly sweet smell, which means children breathe it in calmly, without distress or resistance. It’s affordable, stable in warm climates, and it works. Although there are anesthetics with fewer side effects that have been used for decades in higher-income countries, in low-resource settings with limited options, it has been indispensable.

Dr. Elizabeth Igaga, Senior Director of Program Safety, Smile Train

In 2023, the sole global manufacturer of halothane abruptly and permanently shut down production . There was very little warning time, no wind-down period, and no coordinated plan for the countries most dependent on the drug. What remains is the stock that was already distributed across global markets. That stock will not last much longer. Based on what we know about consumption patterns, it is very likely that by the end of 2026 or in early 2027, the last bottle of halothane in Africa will be gone.

I am an anesthesiologist and perioperative patient safety specialist based in Uganda. I work with hospitals across low and middle-income countries to ensure that children who need surgical care receive it safely. Safe anesthesia is not a luxury. It is a foundation of surgical care. What I see on the ground makes the halothane shortage one of the most pressing and underacknowledged patient safety problems in global health today.

The obvious alternative is a drug called sevoflurane. As a more modern anesthetic, it’s safer and more effective than halothane. But in Uganda, sevoflurane costs approximately ten times more than halothane. In settings where health budgets are already stretched, this is not a simple swap.

This matters on an enormous scale. Research published in The Lancet shows that outcomes for children undergoing surgery in Africa are already significantly worse than those in high-income countries, including African mortality rates that are approximately 11 times higher. Remove access to the one anesthetic drug that most African pediatric facilities currently rely on, and those numbers will get worse.

The demographic stakes make this more urgent still. Africa is projected to be home to roughly 40 percent of the world’s children by 2050 . The continent already carries an enormous burden of conditions that can only be treated with surgery, much of it in pediatric populations, not to mention a child hit by a car, diagnosed with cancer, or rushed to the hospital with a ruptured appendix. All of these children face the same anesthesia infrastructure as everyone else, and when that infrastructure fails, what would have been a survivable crisis becomes something far worse.

What is often misunderstood about the transition away from halothane is that it is not simply a matter of substituting one drug for another. It is a systems problem with at least four distinct components that all need to move at the same time.

The first is government procurement. Halothane is currently embedded in national drug budgets across the continent at a price point that sevoflurane cannot match. Ministers of health and national procurement authorities must make an active decision to fund the difference and begin revising their drug budgets now, before shortages force their hand under emergency conditions. Market dynamics mean dwindling supplies will make halothane increasingly expensive, another component that could put essential surgeries out of reach.

The second is equipment. Many anesthesia machines currently in use across African hospitals are not compatible with sevoflurane without modification or outright replacement. That requires hospital-by-hospital assessment to understand what is needed before a single bottle of the new drug is ordered. Committing to a new anesthetic without first confirming that the infrastructure can deliver it safely is not a transition plan; it is a different kind of crisis.

The third is the supply chain. Sevoflurane needs to be formally incorporated into national essential medicines lists and procurement frameworks so that it reaches facilities reliably and at negotiated prices, rather than arriving sporadically through fragmented channels.

The fourth is workforce tra…