African hospitals face a severe crisis as stocks of halothane, the primary anaesthetic for child surgeries, are expected to run out by the end of 2027, according to a charity warning. The last halothane manufacturer shut down its production line in India in 2023, leading to rapidly depleting supplies across sub-Saharan Africa.
Halothane Shortage Threatens Pediatric Surgeries
Halothane is still widely used in the region because it is seven to ten times cheaper than the alternative, sevoflurane. Elizabeth Igaga, an anaesthesiologist in Uganda and senior director for program safety at Smile Train, stated, "We don't know exactly when, but I don't think we will have any halothane left by the end of 2027." Smile Train performs over 100,000 surgeries annually for cleft lips and palates, 90 percent of them on children.
The transition to sevoflurane is a major challenge. While high-end hospitals have already switched, they represent a tiny fraction of health facilities in sub-Saharan Africa. Many hospitals are discovering that their anaesthesia machines need replacement at a cost of tens of thousands of dollars each.
Panic and Catch-Up in Zambia
The announcement that halothane was no longer being produced "set off nationwide panic" in Zambia, said Sompwe Mwansa, president of the country's Society of Anaesthetists. "We're playing catch-up on equipment needs and training needs," she told AFP. "It's really been quite a challenging transition period for us, especially for centers that are away from sort of the urban centers." Across much of Africa, anaesthetics are administered by health workers who are not doctors and will require fresh training for new drugs to avoid expensive wastage, Mwansa added.
Urgent Call for Government Action
The World Federation of Societies of Anaesthesiologists called in 2024 for African governments to urgently budget for the transition. Smile Train noted, "Unfortunately, that call has not received the response that the timeline requires." Ugandan and Zambian authorities have responded positively, according to doctors, but the transition adds millions of dollars to already stretched health budgets, compounded by massive cuts to aid subsidies from Western countries over the past 18 months.
Potential Reduction in Surgical Capacity
Mwansa warned, "It may very realistically lead to a reduction in our surgical capacity. Already anaesthesia was a hidden corner of the budget... with many competing interests. It's very concerning." Africa hosts the world's youngest population, with the UN predicting that by 2050, one in four children globally will reside in Africa, while infant mortality rates remain high. Smile Train is helping with the transition but wants African governments to take ownership. Igaga said, "We are happy to support, but we also need them to take responsibility."
