South Africa has run out of the human insulin pens for people with diabetes as the global pharmaceutical industry shifts production priorities to blockbuster weight-loss drugs that use a similar device for delivery.
Novo Nordisk, which has supplied the country with human insulin in pens for a decade, opted not to renew its contract after it expired last month, and The New York Times reports that no other company has bid on the contract – to supply 14m pens for the next three years, at about $2 per pen.
“Current manufacturing capacity limitations mean that patients in some countries, including South Africa, may have limited access to our human insulins in pens,” said Ambre James-Brown, a spokesperson for Novo Nordisk, who did not reply to questions about which other countries are affected.
Novo Nordisk’s Ozempic and Wegovy – widely prescribed in the US for weight loss – are sold in single-use pens produced by many of the same contracted manufacturers who make the multi-dose insulin pens. A month’s supply of Ozempic in America costs about $1 000, far more than insulin.
Novo Nordisk dominates the global market for insulin in pens and has supplied South Africa since 2014.
Eli Lilly, the other major producer, has said in recent months that it is struggling to keep up with the significant demand for its weight-loss drug Zepbound.
“This is because of the global demand for Ozempic and these drugs,” said Khadija Jamaloodien, the director of sector-wide procurement for the National Department of Health i(NDoH) in South Africa. “They’re shifting the focus to the more profitable line.”
Novo Nordisk is continuing to supply human insulin in vials to South Africa, with its more than 4m diabetics, but pens are considered much easier to use and more precise, than the vial system – which was mostly phased out in the country in 2014.
However, the NDoH has recently instructed clinicians to teach patients how to use vials and syringes of insulin instead of pens.
“Insulin vials and syringes are outdated and difficult to use,” a national association of medical specialists treating diabetes said in a public letter to the government when the switch to vials was announced. “They contribute negatively both to quality of life for people with diabetes, and poor continued medication adherence, which leads to expensive long-term diabetes complications.”
Jamaloodien’s office has instructed clinicians to reserve the remaining small stock of pens for people who will struggle most with using vials and syringes – small children, the elderly and visually impaired people.
Novo said that the company had alerted South Africa last year that it would not be bidding on the next contract for human insulin in pens.
But Jamaloodien said that the company had merely told the government there would be “supply constraint”, not that it was exiting completely. That, she said, did not become clear until the contracting process ended in January.
After that, her department was slow to issue a new tender to try to find another supplier, because of staffing constraints, and has been scrambling to try to fill the gap.
Novo Nordisk started making pens in 1985, and these, or pumps, are the standard of care for Type 1 diabetics in industrialised countries. They are also used by wealthy people in low-income countries.
But South Africa is a rarity among low-resource countries, the only one that has, until now, supplied insulin pens in the public health service.
Eighty percent of people with diabetes live in low- and middle-income countries.
The drugs known as GLP-1s, like Ozempic, which are now routinely being used to treat diabetes in high-income countries, are not included in the WHO’s list of essential medicines or the diabetes treatment guidelines of low- and middle-income countries.
Novo Nordisk has an insulin access policy, under which it supplies insulin for $3 a vial to low-and middle-income countries, and for $2 a vial to humanitarian groups like Médécins Sans Frontières, or MSF.
The company signed an agreement last year with South African drugmaker Aspen Pharmacare to manufacture human insulin there, aiming to produce 60m vials by 2026.
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