Skinny at all costs? Unravelling the weight loss sensation causing supply chain mayhem for Diabetes Type II patients.
& We're now on Audible and Apple Podcasts!
Dear Friend,
It’s that time of the week. And can you imagine its been a fortnight already.
I write to you from a smouldering 32 degree centigrade Geneva. So much has happened in the world of Global public health in the past fortnight that I hardly knew where to begin. (See: Malaria, tragic cough syrup saga continues (see this; and this), J&J and the IP waiver and Germany putting forth $56mil towards the international AIDS vaccine trial.) Not to mention that this weekend the first case of locally acquired malaria was reported in the US (See: climate change). I couldn’t include everything - so I decided to write a stub on the Ozempic/Wegovy weight loss debacle that is yet unfolding. If any of these headlines interest you - have a look at the Fortnight in Resources below for a few of them.
And, if you have been following the Johnson & Johnson Bedaquilline debacle, you know that I would be seriously remiss not to mention it here. You can catch up on the original story here. But the updates have indeed continued. This situation has rehashed many of the most difficult and important conversations that we have been having since 2020 around Intellectual Property rights around vaccines and therapeutics for diseases of major concern. They say that growth comes during periods of discomfort. Hopefully, this is one of those times.
So let’s start at the beginning. This week’s episode is out! We delve into an interesting dichotomy: Cancer in Africa: The dual burden of disease.
Those who know me well know that I love to read. I am usually reading a few books at a time. Just started ‘Les Fleurs du Mal’ by Baudelaire in paperback (first impression: beautiful melancholy). And I admit that I attracted a few laughs last weekend when I turned up at the beach with what I had not quite registered as an embarrassingly battered and sellotaped copy of the late André Brink’s ‘A Dry White Season’ that I obtained almost 15 years ago at a second hand book store in Johannesburg. Nevertheless, in this modern era, I tend to read most of my books using Audible. Audiobooks got me through many long hours of daily commutes in London in the late 2010s; as well as plane rides, grocery shops and even spring cleaning.
This pre-amble is really all to say how incredibly excited I am to share that Global Health Conversations is now available on Audible and Amazon music. Yay!
Today’s newsletter focusses on the drama surrounding Ozempic and Wegovy - Diabetes treatments currently facing serious supply chain mayhem and endless drama (see: externalities; spillover effects) due to their recent rise as a celebrity and now very mainstream weight loss solution.
This week’s postcard image was taken just over a week before recording the first GHC episode at the Getty center in California. I spent a beautiful time with my family. (But also - watching direct to consumer drug adverts in complete awe, chatting almost endlessly with Miriam from a poolside buffet room and learning about innovative financing mechanisms for generic medicines. V. cool!)
Finally, I would like to express gratitude for all love I received following last week’s episode with Miriam and the previous week’s with Mary. Their details are in the show notes of each of those if you’d like to reach out directly.
As always, I hope you find value in reading and listening. Have a wonderful fortnight and catch you in September!
With love,
Christiana
OUT NOW: This week’s episode 🤩🤩
Episode 8: Cancer in Africa: The Dual Burden of Disease
Across the African continent life expectancies are increasing. Advancements in primary care, strengthening of public health care systems and access to vital medical treatments have resulted in longer, healthier lives across the continent over the past few decades. Nonetheless, living longer makes one susceptible to acquiring an array of non-communicable diseases associated with longer life.
The dual-burden of disease concept deals with the phenomenon of more and more emerging economies dealing with a combination of infectious diseases such as tuberculosis and malaria alongside the rising incidence of non-communicable diseases (NCDs) like cancers, cardiovascular diseases, and diabetes.
“We have seen that if we want to safeguard the health of our people, we need to have the means, the technology and the resources to produce vaccines and treatments for all the diseases that afflict the people of our continent.” - H.E. President Cyril Ramaphosa, President of the Republic of South Africa
This paradigm and its many nuances are demonstrated through a story. Thelma, a fictional character from Tanzania, illustrates the multi-faceted challenges faced by individuals dealing with both infectious and non-communicable diseases that typify the dual-burden of disease issue. And the story weaves itself through the episode.
Efforts to improve access and provide specified care are explored, along with the role of research and innovation in addressing Africa's unique cancer challenges. Touching upon the importance of vaccination initiatives, government programs, and specialized treatment centers in addressing cancer. As well as broadening bio manufacturing capacity in Africa.
So what’s the story with Ozempic & Wegovy? Here’s the STUB story in a series of timelined bullet points. 😉
If you hadn’t heard this story yet - buckle up. This is about to be the perfect inroad to the rabbit hole. 🍵
About a year ago - a major trend took hold. Online communities noticed that a number of major celebrities started losing a lot of weight - fast. Ozempic and Wegovy are the brand names of two semaglutide treatments for Type II Diabetes Mellitus patients with one major side effect: rapid weight loss. Back in 2022, an anonymous Twitter (X??) user asked Elon Musk what he did to lose so much weight and get in shape. He admitted to using Wegovy. This was followed by endless speculation about a number of celebrities including Mindy Kaling. And then, a new social media term was coined: Ozempic face. It would appear that the rapid weight loss experienced by many new Ozempic users to develop a gaunt look due to rapid weight loss. In my personal opinion, this saga has resulted in the kind of major marketing ploy that (respectfully) - any Pharma company could only dream of.
So here’s the story from the beginning:
What is it?
Novo Nordisk’s Ozempic, a semaglutide was first approved by the FDA for use in Diabetes Type II pain December 2017; In June 2021, Novo Nordisk’s Wegovy was granted its FDA approval for chronic weight loss in Diabetic patients. Both drug patents are owned by Novo Nordisk.
So what’s the difference?
Explained here. Minimal. In short, Ozempic was approved for diabetic patients and Wegovy for chronically obese patients. Ozempic acts on the GLP-1 receptor as an agonist, reducing appetite. While Wegovy acts on GLP-1s to improve glycemic control. Their effects are very very similar. And a cynical view might be to infer that Novo Nordisk recognised the opportunity to broaden the market for this medical intervention drastically - beyond Diabetic patients - hence the release of Wegovy four years later with a broader ‘patient’ pool. Moreover, Wegovy is available at a higher dose than Ozempic. But I’m no skeptic. 😏 In fact, I have long felt that they are one of the most innovative, European players in big Pharma. So props to them for finding a viable, profitable gap in the market. Right?
The rise to populatrity:
The problem arose when MANY celebrities were found to have used these treatments to achieve rapid weight loss. And this was followed by many people, the phenomenon initially taking hold in the US before spreading - starting to use these treatments despite not being part of the traditional patient pool. It became a weight loss sensation.
So does Novo Nordisk have the corner on the market share?
Not really. Or at least, not anymore. For now…. there is also Eli Lilly’s Mounjaro (tirzepatide). (This reminds me of my university classes evaluating the factors that set a drug as ‘first in class’; ‘best in class’ and so on. Approved in May 2022, the company has hailed their drug as ‘the first and only GIP and GLP-1 receptor agonist for the treatment of adults with type 2 diabetes’. That said, clinicians online have grouped this drug as part of the same market due to appetite suppression. Some going so far as to suggest that this drug was intended to target the market for weight loss - as much as for diabetes. Nevertheless, these are all very effective and well known drugs. It remains to be seen how trizepitide will impact the market.
The Problem within the Problem: Hoe this became a public health issue
The problem amplified … and this is what makes it a public health issue
The major problem with this phenomenon is the incredible supply chain issues that it has caused for Diabetic patients. The New York Times explains it best. Moreover, prices for these drugs have skyrocketed since their take off in the weight loss market and the subsequent popularisation online through apps such as Tik Tok and Instagram. Type II Diabetes patients who have been using these drugs to manage their chronic disease for years are now faced with a situation where they can no longer access it in some cases and in others, prices have risen significantly. This affects patients. Stat+ explained the high price of these drugs particularly in the US. Describing it as follows:
“ The price of a one-month supply of semaglutide, used in the diabetes drug Ozempic and the weight loss Wegovy, as well as the blood sugar drug tirzepatide, sold as Mounjaro to treat type 2 diabetes and used off-label for obesity. Wegovy topped the list, costing $1,349 in the U.S., four times the price in Germany. A one-month supply of Mounjaro in the U.S. sells for $1,023, more than three times the cost in Japan. Ozempic costs $936 in the U.S., but people in the U.K. and France can buy the drug for $93 and $83, respectively.”
The Fortnight in Resources:
Preventing malaria through the use of monoclonal antibodies - two researchers share their story - Biological therapies for the treatment of infectious diseases is a burgeoning field. Biologics, once almost entirely inaccessible in lower-resourced settings, are being explored for new disease areas due to a variety of factors: including changing market forces, willingness to pay as well as scale-up & manufacturing. Nature explores a recent study in Mali interviewing two immunologists discussing their work first hand.
Open letter: Requesting clarification from J&J on the recent deal for generic bedaquiline supply - An UPDATE to what has probably been the biggest story in infectious diseases of the past two months. In the follow up of the J&J Bedaquiline debacle. TB agencies are seeking clarity from Johnson & Johnson about their ‘Twitter promise’ of intellectual property waivers on Bedaquilline - a vital antibacterial for the treatment of multi-drug resistant TB.
Following the J&J Bedaquilline story - Some good news for the generic manufacturing of this vital antibacterial drug! The TB Alliance has granted Lahore-based Remington Pharmaceuticals a non-exclusive license to manufacture the nonprofit drug developer’s pretomanid as part of the combination BPaL tuberculosis regimen (which includes J&J’s bedaquiline and linezolid).
Indian generics manufacturer hot on the heels of launching a generic Antiretroviral for children with HIV - In other generic news, India’s Aurobindo has announced the launch of its generic version of ViiV’s Triumeq PD (abacavir, lamivudine and dolutegravir) Set to become first generic dispersible tablet formulation of the fixed-dose triple combination therapy for children with HIV - Aurobindo are still seeking regulatory approval in India
The first case of malaria acquired in the US in over 40 years - Malaria has been in the news all fortnight so I had great difficulty deciding what to include here. But this one is a climate change related story that I felt particularly apt. This weekend, Maryland reports first locally acquired malaria case in 40 years
(If I missed any important headlines and you’d like to see them here; feel free to forward them to me in response to this email. :))
There was a bonus episode last week: The Case of a Clinical Trial Catastrophe - the TGN1412 ‘Elephant Men’ Clinical trial
Behind the scenes:
You’ll remember Margareta Rybarikova from Episode 5 when we discussed her CRISPR research, gene therapies and the promise of biotherapeutics for Global Health. Well, I found a few little clips from our recording day. 😉
Recent Episodes: In case you missed them! 💃🏾
Episodes on GHC come out once a fortnight on Sundays!
Episode 4: Revolutionizing Global Health with AI: Exploring Novel Approaches for Enhanced Health Outcomes
Imagine a world in which public health policies were shaped by powerful insights derived from cutting-edge technologies like AI, Machine Learning, and Big Data models. We’ve officially arrived. In this episode, we delve into the transformative potential of predictive and prescriptive analytics, shedding light on how these techniques can revolutionize the way we approach public health challenges.
Episode 5: CRISPR, Gene Editing, Access to Biotherapeutics & On-target approaches to the PhD journey (ft. Margareta Rybarikova)
Margareta Rybarikova is a current PhD candidate with a keen interest in the development of novel therapies for genetic disorders. A friend of the podcast, Margareta discusses her research, gene therapies as a frontier in tackling rare diseases, access to biotherapeutics and balancing life and science and scientific career paths.
Episode 6: Addressing Life Expectancy through Nudges, Financial incentives & Disincentives (ft. Maria Kasimati)
In this episode of Global Health Conversations, I spoke to Maria Myrto Kasimati. We talked about nudges, financial incentives, financial discincentives and using these health economics and policy approaches in addressing the causes affecting reduced life expectancy. It was an interesting talk - an unofficial Part 2 to Episode 3 structured as a discussion.
BONUS: The Case of a Clinical Trial Catastrophe - the TGN1412 ‘Elephant Men’ Clinical trial
In March of 2006, a clinical trial for the drug TGN1412 gathered eight young and healthy men as volunteers. Within a mere 16 hours, all six were urgently transferred to Northwick Park Hospital's intensive care unit due to severe and life-threatening reactions. This ‘true crime’ style bonus episode is cosy-creepy.
Episode 7: Managing a Private Hospital in Nigeria, forming partnerships & addressing health disparities through the private sector (ft Dr Miriambeth Asika)
Dr. Asika Miriam is the Hospital Manager at Zenith Medical and Kidney Center. A medical doctor and a healthcare management consultant with 7+ years of experience in clinical service delivery, healthcare operations management, health policy, planning & financing, strategic planning, and performance improvement; Miriam is passionate about African development and wants to improve healthcare delivery and strengthen the region's healthcare system. We discussed Managing a Private Hospital in Nigeria, forming partnerships & addressing health disparities and the intricate interworking as well as the role of the private sector in a largely private payer system.
Yours,
C