South Africa’s public healthcare system has run out of insulin pens for diabetics as the pharmaceutical industry shifts production focus to blockbuster weight loss drugs that use similar devices to deliver the drug.
Novo Nordisk has supplied insulin pens to South Africa for a decade, but the company chose not to renew the contract, which expired last month. No other company bid for the contract – to supply 14 million insulin pens over the next three years at a price of about $2 each.
“Limited production capacity currently means that patients in some countries, including South Africa, may not be able to access human insulin in our pens,” said Ambre James-Brown, a spokeswoman for Novo Nordisk. The company did not respond to questions about which other countries were affected.
Novo Nordisk In the United States, the widely used weight loss drugs Ozempic and Wegovy are sold in disposable pens that are inserted by Many of the same contract manufacturers A company that makes multi-dose insulin pens. In the United States, a month’s supply of Ozempic costs about $1,000, much more than insulin.
Novo Nordisk, which dominates the global insulin pen market, has been supplying insulin to South Africa since 2014. Eli Lilly, another major manufacturer, In recent months The company is struggling to meet the huge demand for its weight loss drug Zepbound.
“This is because there is a huge global demand for Ozempic and these drugs,” said Khadija Jamaloodien, head of industry-wide procurement at South Africa’s health service. “They are shifting their focus to more profitable product lines.”
Novo Nordisk is continuing to supply vials of human insulin to South Africa, which has more than four million diabetics, but the pens are considered easier to use and more precise.
The pen has a dial that dispenses a set amount of insulin, and its needle quickly pierces the skin. The patient or caregiver must draw insulin from the vial into a syringe, confirm the dose, and then inject it.
Most South Africans stopped using insulin vial injection systems in 2014, but recently the country’s Department of Health instructed clinicians that they should teach patients how to use insulin vials and syringes instead of insulin pens.
In announcing the switch to insulin vials, the National Association of Medical Specialists Treating Diabetes said in an open letter to the government: “Insulin vials and syringes are outdated and difficult to use. Not only do they have a negative impact on the quality of life of people with diabetes, but patients are less likely to take their medications, which can lead to costly long-term diabetes complications.”
For nine years, Mohamed Adnan Malik, 19, a teacher training college student in the town of Zeeland in northwestern South Africa, has been using insulin pens provided by the public health system to treat his type 1 diabetes.
“I’ve never injected insulin with a syringe, so when I heard about this, I asked an 80-year-old diabetic and he said it was difficult because it’s hard to give an accurate dose,” Mr Malik said. “The dose of insulin, if it’s one unit higher or one unit lower, it will have an impact. If you overdose, you’ll have hypoglycemia and it can lead to coma and death.”
Ms. Jamaluddin’s office has instructed clinicians to reserve the few remaining pens for those who have the most difficulty using vials and syringes — small children, the elderly and the visually impaired.
A few days ago, Boitumelo Molema, a 22-year-old university student, went to her regular clinic in Mafeking town to pick up her monthly supply of five pens, only to find that they were out of stock. She went to two more clinics, which were out of stock, and then went to a private clinic to buy the pens for $10 each. She said she could hardly afford the cost. (Private clinics buy small quantities of pens through wholesalers that deal with the company).
Ms James Brown, a spokeswoman for Novo Nordisk, said the company had informed South Africa last year that it would not bid for the next contract for human insulin in injection pens.
Ms. Jamaludin of the South African Health Service said the company had only told the government there would be “supply constraints” but had not indicated it would withdraw entirely. She said that was not clear until the contracting process was concluded in January. Since then, her department has not issued a new tender to find another supplier because of staffing constraints and has been struggling to fill the gap, she said.
Novo Nordisk began producing the pen in 1985, and the pen or pump is the standard of care for people with type 1 diabetes in industrialized countries. It is also used by wealthy people in low-income countries.
But South Africa is a rarity among resource-poor countries, being the only one so far to offer insulin pens as part of its public health service.
80% of people with diabetes live in low- and middle-income countries.
Currently, GLP-1 drugs (such as Ozempic) are routinely used to treat diabetes in high-income countries, but these drugs are not included in the World Health Organization’s essential medicines list or diabetes treatment guidelines for low- and middle-income countries.
Novo Nordisk owns Insulin Access PolicyUnder the agreement, the company supplies insulin to low- and middle-income countries at $3 per vial and to humanitarian organizations such as Doctors Without Borders (MSF) at $2 per vial. The company signed an agreement with South African drugmaker Aspen Pharmacare last year to produce human insulin in South Africa, with the goal of producing 60 million vials by 2026.
MSF has also heard from clinicians in crisis areas such as Gaza and Ukraine, where patients no longer have access to the usual pens and are struggling to revert to vials and syringes. Leena Menghaney, a staff member at MSF’s Access campaign, said that in the dark without electricity, measuring insulin in a pen is not difficult – the pen makes a click to indicate the injection increment – but confirming the dose in the syringe is much more difficult.
