South Africa’s public health system is running out of the human insulin pens it supplies to people with diabetes, as the pharmaceutical industry shifts its production priorities toward blockbuster weight-loss drugs that use a delivery device similar.
Novo Nordisk, the company that has supplied South Africa with human insulin in pen form for a decade, has chosen not to renew its contract, which expired last month. No other company bid for the contract to supply 14 million pens for the next three years, at about $2 per pen.
“Current limitations in manufacturing capacity mean that patients in some countries, including South Africa, may have limited access to our human insulins in pens,” said Novo Nordisk spokesperson Ambre James-Brown. The company did not respond to questions about other affected countries.
Novo Nordisk The drugs Ozempic and Wegovy, which are widely prescribed in the United States for weight loss, are sold in single-use pens produced by many of the same contract manufacturers that make multidose insulin pens. In the United States, a month’s supply of Ozempic costs about $1,000, much more than insulin.
Novo Nordisk dominates the global market for insulin pens and has supplied South Africa since 2014. Eli Lilly, the other major producer, has indicated in recent months that it is struggling to meet the significant demand for its weight loss drug Zepbound .
“This is due to the global demand for Ozempic and these medicines,” said Khadija Jamalodien, director of sector procurement for the South African Health Service. “They are now focusing on the most profitable line.”
Novo Nordisk continues to supply human insulin in vials to South Africa, where more than four million people live with diabetes, but the pens are considered much easier to use and more precise.
A pen can be set with a dial to deliver a given amount of insulin, and the tip of its needle can be quickly inserted into the skin. Insulin from a vial must be drawn into a syringe, with the patient or a caregiver confirming the dose, then injecting it.
The vial system was phased out for most South Africans in 2014. But recently, South Africa’s National Department of Health asked clinicians to teach patients to use vials and syringes. insulin instead of pens.
“Insulin vials and syringes are outdated and difficult to use,” a national association of diabetes medical specialists said in a public letter to the government when announcing the switch to vials. “They contribute negatively to both the quality of life of people with diabetes and continued poor medication adherence, leading to costly long-term diabetes-related complications.” »
Muhammed Adnan Malek, 19, a student at Zeeland Normal School in northwest South Africa, has been using public health system insulin pens to treat his type 1 diabetes for nine years.
“I’ve never used it in syringes, so when I heard this news, I asked an 80-year-old man I know who is diabetic what it looks like, and he told me that it was very difficult because it was difficult to give the exact dose,” said M. » Malek said. “With insulin, if you’re one unit higher or lower, it really has an effect. In case of overdose, you suffer from hypoglycemia and this can lead to coma and death.
Ms. Jamalodien’s office has asked clinicians to reserve the small remaining stock of pens for people who will have the most difficulty using the vials and syringes: young children, the elderly and the visually impaired.
When Boitumelo Molema, 22, a student, went to her usual clinic in Mafikeng town a few days ago to collect a monthly supply of five pens, she learned they were out of stock. She visited two other clinics, neither of which had any supplies, before going to a private clinic and purchasing them for the equivalent of $10 each. She will struggle to cover that cost, she said. (Private clinics purchase small volumes from wholesalers who deal with businesses).
Ms James-Brown, a spokeswoman for Novo Nordisk, said the company alerted South Africa last year that it would not bid for the next contract for human insulin in pens.
Ms Jamalodien, of the South African Health Service, said the company had only told the government there would be a “supply constraint”, but not that it would pull out completely. That, she said, didn’t become clear until the contract process concluded in January. After that, her department was slow to put out a new tender to try to find another supplier, due to staffing constraints, and it scrambled to try to fill the void, she said. explain.
Novo Nordisk began manufacturing pens in 1985, and these, or pumps, are the standard of care for type 1 diabetics in industrialized countries. They are also used by wealthy people in low-income countries.
But South Africa is a rare country among low-resource countries, the only one to have so far provided insulin pens to the public health service.
Eighty percent of people with diabetes live in low- and middle-income countries.
Drugs known as GLP-1, such as Ozempic, which are now commonly used to treat diabetes in high-income countries, are not on the World Health Organization’s list of essential medicines or on Diabetes treatment guidelines from low- and middle-income countries. income country.
Novo Nordisk has an insulin access policy, under which it provides insulin for $3 per vial to low- and middle-income countries, and for $2 per vial to humanitarian groups such as Médecins Sans Borders or MSF. The company signed a deal with South African pharmaceutical manufacturer Aspen Pharmacare last year to manufacture human insulin there, aiming to produce 60 million vials by 2026.
MSF also receives testimonies from clinicians in crisis zones, notably in Gaza and Ukraine, where patients who can no longer obtain their usual pens are having difficulty finding their vials and syringes. In the dark, without electricity, it’s not that difficult to measure insulin in a pen, which clicks to indicate the increments it dispenses, said Leena Menghaney, who works with MSF’s Access campaign, but it is much more difficult to confirm a dosage in a syringe. .