Ozempic generics are coming. But will low-income countries benefit? – Devex

Report on Global Health Challenges and Sustainable Development Goals

Addressing Non-Communicable Diseases and Health Equity

The rise of non-communicable diseases (NCDs) presents a significant challenge to achieving Sustainable Development Goal 3 (Good Health and Well-being). A key area of focus is the management of obesity and diabetes through new pharmaceuticals.

• Semaglutide-based drugs, such as Ozempic and Wegovy, have proven effective for weight loss and managing related health conditions, including diabetes, kidney failure, and cardiovascular disease. These conditions account for 75% of all global deaths, with a majority occurring in low- and middle-income countries (LMICs).
• However, access to these treatments is severely limited by high costs, undermining SDG 10 (Reduced Inequalities). In the Philippines, a monthly course can cost over half of the capital’s monthly minimum wage, creating a significant barrier to health equity.
• The patent expiry for semaglutide in 2026 is anticipated to introduce generic alternatives, potentially reducing prices by up to 80%. This development could substantially improve access and advance progress towards universal health coverage, a key target of SDG 3.
• Concerns remain that generic manufacturers may prioritize profitable private weight-loss markets over public health needs, potentially leaving diabetes patients and populations in LMICs with continued limited access. This highlights the tension between market forces and the public health objectives of the SDGs.

Evolving Global Health Partnerships and Strategies

The “America First” Approach to Global Health Partnerships

Recent U.S. foreign aid strategies reflect a shift in partnership models, impacting SDG 17 (Partnerships for the Goals) and the financing of global health initiatives.

1. Private Sector Engagement and Host Country Co-financing: A $150 million grant to Zipline, an American drone delivery company, aims to expand health supply chain operations in five African countries. This initiative, which supports SDG 9 (Industry, Innovation, and Infrastructure), requires African governments to co-finance the logistics services, shifting greater financial responsibility to partner nations.
2. Focus on Domestic Benefits and Innovation: The strategy aims to support American companies and scale innovations while promoting health security. This model has been praised for fostering direct government-to-government relationships and promoting national ownership of health programs.
3. Data Sovereignty Concerns: The strategy includes requirements for extensive data sharing, raising concerns among African leaders about data sovereignty and the potential for exploitation. This challenges the principle of equitable partnerships central to SDG 17.

Commitment to Multilateral Health Funds

• The United States has pledged $4.6 billion to The Global Fund to Fight AIDS, Tuberculosis and Malaria for the next three years. The Global Fund is a critical partner in achieving the targets of SDG 3.
• This commitment is framed within the “America First” strategy, which praises The Global Fund’s model of requiring co-investments from recipient countries, aligning with the SDG 17 focus on domestic resource mobilization.
• While the pledge is lower than the previous $6 billion commitment, it is considered a strong signal of continued support for multilateral health partnerships, pending the release of nearly $2 billion in previously appropriated funds.

Progress and Challenges in Global Health Initiatives

Advancing Child Health Through Vaccine Accessibility

A multi-stakeholder partnership has achieved a significant milestone in the fight against malaria, directly contributing to the SDG 3 target of ending preventable deaths of children under five.

• An agreement between UNICEF, Gavi, the Vaccine Alliance, and the Serum Institute of India will reduce the price of the R21 malaria vaccine from $3.90 to $2.99 per dose.
• This price reduction is expected to generate up to $90 million in savings, allowing for the purchase of an additional 30 million doses.
• This will enable the vaccination of nearly 7 million more children over five years, primarily in the African region, where malaria caused nearly 600,000 deaths in 2023, with 76% being children under five. This directly addresses health inequalities targeted by SDG 10.

Addressing Gender-Based Violence as a Public Health Crisis

Gender-based violence (GBV) remains a persistent human rights crisis, undermining progress on SDG 5 (Gender Equality) and SDG 3 (Good Health and Well-being).

• An estimated 840 million women globally have experienced physical or sexual violence in their lifetime.
• In South Africa, high rates of femicide and rape prompted large-scale protests, leading the government to declare GBV a national disaster.
• This declaration elevates the issue to the executive level, signaling a commitment to strengthening institutional responses, which is crucial for SDG 16 (Peace, Justice, and Strong Institutions). However, the allocation of additional funding to tackle the crisis remains to be clarified.

Analysis of the Article in Relation to Sustainable Development Goals

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article extensively discusses health issues, including the rise of weight-loss drugs to combat non-communicable diseases (NCDs) like obesity and diabetes, the funding for fighting communicable diseases such as AIDS, tuberculosis, and malaria, and the development and pricing of a new malaria vaccine. It also touches upon health systems and access to medicines in low- and middle-income countries.
2. SDG 5: Gender Equality
   • This goal is directly addressed in the section on South Africa, which highlights the severe problem of gender-based violence (GBV). The article cites statistics on violence against women, femicide, and rape, and discusses the public protests and government response, making a clear connection to the goal of eliminating violence against women and girls.
3. SDG 10: Reduced Inequalities
   • The article points to significant inequalities in access to healthcare. The high cost of weight-loss drugs like Ozempic, which is “more than half of the monthly minimum wage” in the Philippines, illustrates the economic disparity that prevents access for many. The concern that generic versions might prioritize “highly profitable private weight-loss market” over diabetes patients in lower-income countries further emphasizes this inequality.
4. SDG 16: Peace, Justice and Strong Institutions
   • This goal is relevant to the discussion on gender-based violence in South Africa. The article mentions citizens protesting to demand government action (“put a stop to soaring rates of gender-based violence”), leading to the President declaring it a “national disaster.” This reflects the interaction between citizens and state institutions in addressing violence and seeking justice.
5. SDG 17: Partnerships for the Goals
   • The article highlights several partnerships. The “America First” global health strategy, involving the U.S. government, African governments, and a private American company (Zipline), is a form of multi-stakeholder partnership. The U.S. pledge to The Global Fund and the deal between UNICEF, Gavi, and the Serum Institute of India for the malaria vaccine are other prime examples of global partnerships for sustainable development.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3 (Good Health and Well-being):
   • Target 3.2: End preventable deaths of newborns and children under 5 years of age. This is directly relevant to the section on the new malaria vaccine, as the article states that in the African region, 76% of the nearly 600,000 malaria deaths were “children under the age of 5 years old.”
   • Target 3.3: End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases. This target is central to the discussion of the U.S. pledging $4.6 billion to “The Global Fund to Fight AIDS, Tuberculosis and Malaria” and the new agreement to slash the price of the R21 malaria vaccine.
   • Target 3.4: Reduce by one-third premature mortality from non-communicable diseases (NCDs). The article discusses weight-loss drugs that address “obesity and diabetes” and reduce the risk of “kidney failure and cardiovascular disease,” which are major NCDs.
   • Target 3.8: Achieve universal health coverage, including access to affordable essential medicines and vaccines. This is a recurring theme, highlighted by the “steep prices and limited stock” of weight-loss drugs and the price reduction of the malaria vaccine from “$3.90 to $2.99 per dose” to improve access.
2. Under SDG 5 (Gender Equality):
   • Target 5.2: Eliminate all forms of violence against all women and girls. The article’s final section focuses entirely on this, citing that “840 million women globally who have experienced physical or sexual violence” and detailing the crisis in South Africa where “Nearly 120 women report rape cases each day.”
3. Under SDG 16 (Peace, Justice and Strong Institutions):
   • Target 16.1: Significantly reduce all forms of violence and related death rates everywhere. This is supported by the statistics on femicide in South Africa, where “15 women are killed every day” and cases “rose by nearly 34%” between 2022 and 2024.
4. Under SDG 17 (Partnerships for the Goals):
   • Target 17.2: Developed countries to implement fully their official development assistance commitments. The article discusses the U.S. pledge of “$4.6 billion for the work of the Global Fund,” which is a form of official development assistance.
   • Target 17.3: Mobilize additional financial resources for developing countries from multiple sources. The Global Fund replenishment and the Gavi-backed agreement for the malaria vaccine are examples of mobilizing financial resources from public and private sources.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For SDG 3 Targets:
   • Indicator 3.2.1 (Under-5 mortality rate): The article provides data that can be used to track this indicator, stating that 76% of the nearly 600,000 malaria deaths in Africa were children under 5. Reducing these deaths through vaccination would directly impact this indicator.
   • Indicator 3.3.3 (Malaria incidence per 1,000 population): The introduction of a more affordable malaria vaccine, intended to protect “nearly 7 million more children,” directly aims to reduce malaria incidence.
   • Indicator 3.4.1 (Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease): The article implies this indicator by discussing drugs that reduce the risk of cardiovascular disease and help manage diabetes, noting that “Chronic diseases account for 75% of all deaths globally.”
   • Indicator 3.b.1 (Proportion of the population with access to affordable medicines and vaccines): The article provides concrete data points for this indicator. The price of weight-loss drugs ($150 in the Philippines) shows a lack of affordability, while the malaria vaccine price drop (to $2.99) and the potential 80% price slash for generics are measures of progress.
2. For SDG 5 and 16 Targets:
   • Indicator 5.2.1 (Proportion of ever-partnered women and girls subjected to physical, sexual or psychological violence): The article provides a global baseline figure of “840 million women globally who have experienced physical or sexual violence in their lifetime.”
   • Indicator 5.2.2 (Proportion of women and girls subjected to sexual violence by persons other than an intimate partner): The statistic that “Nearly 120 women report rape cases each day” in South Africa is a direct measure related to this indicator.
   • Indicator 16.1.1 (Number of victims of intentional homicide per 100,000 population, by sex): The article provides raw numbers for this indicator, stating that in South Africa “15 women are killed every day” and that “femicide cases rose by nearly 34%.” These figures can be used to calculate the rate of intentional homicide against women.
3. For SDG 17 Targets:
   • Indicator 17.9.1 (Dollar value of financial and technical assistance): The article provides specific dollar values for this indicator, including the “$150 million grant to Zipline” and the “$4.6 billion” U.S. pledge to the Global Fund.

4. Summary Table of SDGs, Targets, and Indicators

Source: devex.com