Botswana’s Bad Batch

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Botswana’s Ministry of Health recalled a batch of tuberculosis (TB) treatment drugs in December after discovering a stunning flaw: They were effectively placebos.

Lab testing revealed the drugs were deficient in rifampicin and ethambutol — two of the four cornerstones of modern TB therapy. The Ministry reported that cases of “treatment failure,” where patients do not improve or remain infectious, had nearly doubled to 40, up from 22 during the same period last year.

But this bad batch is not an isolated quality control error. It’s the latest symptom of a crumbling global supply chain that has left developing nations scrambling for affordable medicine.

In August, the government declared a public health emergency after clinics ran out of essential medicines. The military stepped in to manage emergency distribution. Amid the shortfall, President Duma Boko said drug prices have often spiked “five to ten times.”

In October, the health minister said availability of medicines had improved, but a Global Drug Facility (GDF) document lists typical lead times in months, including a roughly eight-month range for some TB products. And prices remain exorbitant.

The government blamed a global supply shortage that forced it to waive some of the normal checks before the drug’s administration.

“The country was running out of TB drugs and they were very scarce in the international market. Exemptions are common in the health sector when circumstances demand that such an approach be taken,” Ministry of Health spokesperson Christopher Nyanga told Hunterbrook.

The Ministry encouraged the public not to panic and to continue basic precautions to reduce TB transmission through ventilation, avoiding congested settings, and cough etiquette. It also urged anyone with TB symptoms (including cough, unintentional weight loss, fever and night sweats) to seek medical attention.

Medical practitioners in Botswana fear extended repercussions not only for patients but also healthcare workers who are at higher risk of contracting the disease when treating TB-resistant patients. The medical profession is calling on the government to improve their procurement system to avoid buying in a haste and exposing patients to substandard drugs.

“We are very much concerned … because we have now realized an increased number of resistant cases, they are increasing new infections, and this now is becoming widespread. It’s a health hazard to Botswana … otherwise we find ourselves in a very porous situation that does not only risk Batswana, we also risk the region and by risking the region we risk the rest of Africa but transmitting resistant strain of TB and thereby increasing mortality thereof,” said president of the Botswana Doctors Union, Dr. Kefilwe Selema.

Supply chain constraints and shortages have persisted for years, and one big vulnerability has been the supply of rifampicin active pharmaceutical ingredients (APIs). In March 2024, Euroapi announced that it was suspending production of all active pharmaceutical ingredients at its Italy site after an internal audit found quality‑control deficiencies “due to potential local misconduct.” The manufacturer said production would remain suspended until further notice.

The impact of the supply crunch extends far beyond Botswana.

In neighboring South Africa, TB drug shortages were reported to have reached crisis point by March, with supplies for patients at one clinic that sees an average of 20 TB patients a day down to just a week compared to the usual four-month supply. 

In the U.K., a national patient safety alert warned in March that antimicrobial agents used in TB treatment — including rifampicin — would be intermittently available until at least the end of 2025. In October, the Department of Health and Social Care said the supply situation had “significantly improved,” but it still listed packs of rifampicin that remained constrained.

Australia’s database lists shortages through February 2026.

The timing of the scarcity is poor. In March, the World Health Organization warned that U.S. foreign-aid disruptions could undo progress against TB. The WHO noted that the U.S. historically contributes about one quarter of international donor funding for TB programs and that funding withdrawals were damaging services, including drug supply chains. An article from Harvard’s public health school in November noted that U.S. aid cuts have likely already caused hundreds of thousands of deaths.

Without this aid, Botswana has been forced to navigate a hyper-inflated market with a slashed budget. Without potent drugs, hygiene alone cannot stop deadly infectious diseases.

The government maintains that purchasing this ineffective product was an emergency stopgap, as the country faced TB drug shortages and could not wait for the Global Drug Facility’s (GDF) four-to-six-month delivery window. However, the Botswana Doctors Union accuses the ministry of engaging a company that had no history of supplying TB medications.

The supplier of the drugs, India-based Ayesha Biotech, did not respond to Hunterbrook’s inquiry on its experience in supplying TB drugs, but admitted supplying the bad batch to Botswana and pledged to replace the medicine.

“Our company takes full responsibility for this occurrence and we are ready to withdraw the affected batches and replace them at no cost to the government,” Ayesha Biotech said in response to Hunterbrook’s outreach.

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