Canada is in a unique position, as it’s the only G7 country where patent protection on semaglutide is about to lapse.Tom Little/Reuters
Peter Singer is professor emeritus at the University of Toronto, co-founder of Grand Challenges Canada, and former special adviser to the director-general of the World Health Organization. He owns shares in GLP-1 companies. Natasha Loder is the health editor of The Economist.
In just four months, the patent for semaglutide, a key weight loss medication which goes under the brand names Ozempic and Wegovy, will expire in countries like India, China, Brazil – and also in Canada. This could mark a historic turning point for global public health. With more than a billion people living with obesity worldwide, the potential for generic, affordable semaglutide to transform the management of obesity, diabetes, and related metabolic disease is so mind-bogglingly large, we think the time is ripe for governments – including in Canada – to start to plan for how to maximize their potential.
While American patients who pay for semaglutide themselves spend US$499 a month, Indian manufacturers are gearing up to produce biosimilar versions at a manufacturing cost of less than US$6 a month. Indian manufacturers work on a high-volume, low-cost model. This makes it likely that the cost of generic semaglutide will be a fraction of what it is today. This would make lifesaving treatment accessible on a massive scale.
Just how big a deal would widening availability be? Some sense of the scale of the impact can be found in work by one of us. In a preprint estimate in collaboration with David Brook, Dr. Singer modelled the effects of global access to these GLP-1 medicines. Their most recent estimate finds that 2.1 million to 3.1 million lives per year could be saved in patients with diabetes and/or obesity.
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These drugs can lower the risk of diseases that cause premature death and disability not only by reducing obesity, but also by reducing systemic inflammation, improving blood sugar control, exerting direct protective effects on the heart and blood vessels, and even working on the brain pathways involved in addiction. No wonder when The Economist wrote about the widening array of indications for GLP-1 drugs, they were described on the cover as “the everything drugs.” While affordable access isn’t the only issue – side effects can deter patients, and the full long-term effects on the body aren’t yet known – the potential is massive.
The opportunity is bigger than health. Estimates in Britain show that GLP-1 use could increase annual GDP growth by 0.3 per cent at five years and 0.55 per cent at 10 years through lower health care costs and improved productivity.
When a new drug arrives in a market it is understandable that governments will want to limit the effect on drug budgets by restricting access. But the opportunity to save so many lives is unprecedented, and governments need to think about innovative finance methods that might help introduce these drugs sooner, allowing for the rewards of prevention to be garnered immediately.
One option is pooled purchasing. Canada could purchase biosimilar semaglutide for provincial drug programs. Either bulk purchasing of large quantities of the drug, or population-scale deals with manufacturers, can dramatically reduce the cost of treating each patient. Population-scale arrangements are structured to ensure access to everyone who qualifies for treatment. Lower costs would allow semaglutide to be prescribed for a wider range of conditions and with lower BMI (body mass index) limits for patients
Canada is in a unique position as the only G7 country with patent protection lapsing. It could lead a consortium of countries – including populous middle-income ones like Nigeria and Indonesia – in a pooled-purchasing mechanism. This would increase access and lower costs for all. Broadening access to this medication would be fitting for a country where Banting and Best discovered insulin a century ago and given that Canadian scientist Daniel Drucker played a key role in the discovery of GLP-1 drugs.
Semaglutide, or Ozempic, reduces symptoms of feared diabetes complication, study finds
Another option is pay-for-results schemes. The European and Islamic development banks, alongside the Gates Foundation, have used this model for polio eradication. Those funding the rollout of a medical intervention pay for outcomes. Adapting this for semaglutide delivery could mean paying implementers when agreed public health outcomes are met – something that could incentivize innovation in delivery. This might be particularly useful in small-island developing states where obesity rates run as high as 70 per cent.
Foundations could play a catalytic role. The Novo Nordisk Foundation has become wealthy due to its controlling shareholding in Novo Nordisk, which sells semaglutide (Ozempic, Wegovy) in high-income countries. Given the Foundation’s commitment to improving health, it could consider innovative approaches to support wider access to semaglutide.
The World Health Organization is convening a meeting of heads of government on non-communicable diseases at the UN General Assembly this month. Astonishingly, there is no mention of GLP-1 drugs, and this is a major oversight. Earlier this month the WHO listed GLP-1 drugs on its essential medicines list for people with diabetes who also have heart or kidney disease or obesity, but not for obesity on its own. WHO could further speed up availability with its clinical guidelines and pre-qualification approval of manufacturers. Our leaders need to ensure this breakthrough benefits millions – both in Canada and around the world.