The silent epidemic no one is talking about enough

Every morning, before the sun clears the acacia trees, millions of people around the world swallow pills they will take for the rest of their lives. Insulin for diabetes. Statins for a stubborn lipid panel. Blood-pressure tablets that have become as routine as coffee. Antiretrovirals and chemotherapy agents that reorder the body’s chemistry in ways both lifesaving and unpredictable.

They are the patients of the noncommunicable-disease era – and their numbers are swelling. NCDs, a catch-all term for conditions like diabetes, hypertension, cardiovascular disease, and cancer, now account for roughly three-quarters of all deaths globally, according to the World Health Organization. In low- and middle-income countries, where health systems were long oriented toward infectious disease, the shift has been seismic.

But here is the part that gets less attention: surviving an NCD diagnosis is only half the battle. The other half – the quieter, more dangerous half – is navigating decades of treatment without being harmed by the very system designed to save you.

On September 17, 2026, as landmarks from Gaborone to Geneva glow orange for World Patient Safety Day, a coalition of regulators, clinicians, and patient advocates is trying to force that second half into the light.

This year’s global theme – “Safe care for noncommunicable diseases” – and its accompanying slogan, “Safe care for life!” – cut to the heart of a paradox that the healthcare world has been slow to reckon with: the longer you need care, the more chances there are for something to go wrong.

A Lifetime of Touchpoints, a Lifetime of Risks

Consider what treating a chronic illness actually entails. A patient diagnosed with type 2 diabetes at 45 may spend the next three decades cycling through primary-care visits, specialist referrals, pharmacy pickups, lab draws, dosage adjustments, and hospitalizations; each one a handoff, each one a potential failure point.

A prescription written for the wrong dose. A drug interaction missed because the patient sees three doctors who never compare notes. An adverse reaction dismissed as “just part of the disease.” A falsified medication purchased from an unlicensed outlet because the licensed one ran out of stock – or because it was cheaper.

These are not hypotheticals. They are the documented, daily friction of chronic-disease care, and they inflict a toll that is both enormous and, paradoxically, invisible.

The WHO estimates that unsafe care contributes to as many as 2.6 million deaths annually worldwide. In the context of NCDs, where patients may interact with the health system hundreds of times over a lifetime, the cumulative risk of medication errors, diagnostic delays, and adverse drug reactions multiplies in ways that acute-care models were never designed to handle.

“Managing a long-term condition requires a partnership between the patient, healthcare provider and regulator,” said Dr. Seima Dijeng, Chief Executive Officer of the Botswana Medicines Regulatory Authority, or BoMRA. “We encourage people living with noncommunicable diseases to follow their prescribed treatment plans, obtain medicines from licensed facilities and ask questions whenever they are unsure.”

The Regulator’s Role – More than a rubber stamp

In many countries, the word “regulator” conjures images of bureaucratic gatekeeping – a slow-moving agency that stamps approval on drugs and moves on. In Botswana, BoMRA is trying to reframe the role as something more dynamic: a sentinel that watches over the patient not just at the pharmacy counter, but across the entire arc of treatment.

The authority’s mandate spans product registration, licensing, pre-market evaluation, and post-market surveillance; the last of which is where much of the real work on NCDs happens. A medicine may sail through clinical trials with flying colors, only to reveal unexpected side effects when prescribed to a 58-year-old with hypertension, a thyroid disorder, and a regimen of five other drugs. Real-world data is where safety is truly tested, and it is where regulators like BoMRA say they are investing more attention and resources.

“From the registration of medicines used to manage chronic conditions to monitoring their safety in real-world use, BoMRA remains committed to creating a safe environment where Batswana can access quality-assured healthcare products with confidence,” Dr. Dijeng said.

That commitment extends to pharmacovigilance – the science of detecting, assessing, and preventing adverse effects. BoMRA operates dedicated reporting channels for both the public and healthcare professionals to flag suspected adverse drug reactions and substandard or falsified medical products. The challenge, as in many countries, is getting people to use them.

The Patient Who Doesn’t Speak Up

There is a quiet crisis in patient safety, and it lives in the space between what patients experience and what they report. Studies across sub-Saharan Africa have consistently shown low rates of adverse-event reporting, driven by a combination of factors: patients who don’t know they can report, patients who assume their side effects are normal, patients who fear that complaining will jeopardize their care, and clinicians who are too overburdened to file reports themselves.

Dr. Dijeng’s message is direct: patients should report any expected, unexpected, or unusual side effects associated with their medicines. The emphasis on “expected” is deliberate – even well-documented side effects, when aggregated across thousands of patients, can reveal patterns that improve care for everyone.

But reporting is only useful if it leads to action, and that is where the regulatory feedback loop becomes critical. A single report of a substandard drug may be an anomaly. Twelve reports from the same district in the same month is a signal – and it is the regulator’s job to act on it before harm compounds.

The Social Determinants We Can’t Prescribe Away

The 2026 World Patient Safety Day campaign explicitly acknowledges something that the medical community has been slow to integrate into safety frameworks: the social determinants of harm.

A patient who cannot afford consistent transport to a clinic will default on appointments. A patient who lives in a food desert cannot simply “eat healthier” to complement a diabetes regimen, no matter how earnestly a clinician advises it. A patient who purchases medicines from an informal market because the formal supply chain is broken is not being reckless – they are being resourceful in a system that has failed them.

The campaign’s emphasis on a primary health care approach is not accidental. Strengthening the first point of contact – the community clinic, the neighborhood pharmacist, the outreach worker – is the most cost-effective way to reduce the cascade of errors that accumulate when patients fall through the cracks of a fragmented system.

Dr. Dijeng echoed this when he urged patients to complement medical interventions with healthy eating and regular exercise – practical counsel, but counsel that lands differently depending on whether you live in a gated community in Gaborone or a remote village where the nearest fresh produce is a three-hour drive away.

Orange Light, Urgent Signal

On the evening of September 17, landmarks and public spaces around the world will be bathed in orange; the color of World Patient Safety Day. It is a symbolic gesture, and symbolism matters. Orange does not heal a medication error. It does not reverse a diagnostic delay. But it does something that quiet competence alone cannot: it makes the invisible visible.

For the millions of people living with NCDs, the risks embedded in their long care journeys are often silent – a wrong dosage, a missed interaction, a substandard pill that looks identical to the real thing. These harms do not announce themselves with sirens or flashing lights. They accumulate in the margins of routine.

In Botswana, BoMRA’s commemoration will include public education campaigns and stakeholder engagement activities; an effort to move the conversation about patient safety from the corridors of regulatory offices into the places where people actually live and receive care. The goal is not merely awareness; it is behavioral change; a shift toward a culture where asking questions is not seen as defiance but as due diligence, and where reporting a problem is not an inconvenience but an act of civic participation.

The Long Game

Noncommunicable diseases are called “noncommunicable” because you cannot catch them from your neighbor. But in another sense, the conditions that produce unsafe care – underfunded systems, fragmented record-keeping, weak supply chains, silent patients – are deeply contagious. They spread through institutions, through communities, through the slow erosion of trust between people and the systems meant to protect them.

“Safe care for life” is not a slogan that can be fulfilled with a single regulation or a single day of awareness. It demands the kind of persistent, unglamorous vigilance that regulators like BoMRA are built for – and the kind of active, informed engagement that patients are only beginning to be asked for.

The NCD epidemic will not be solved by a vaccine. It will be managed, day by day, pill by pill, appointment by appointment, over decades. The question the orange lights are asking is a simple one, even if the answer is anything but: After you survive the diagnosis, who is making sure the treatment doesn’t hurt you?

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