Doctors Without Borders calls on big pharma to continue supply of insulin pens as contract ends

2 Jul 2024

The scramble for semaglutide-containing injectables as an aid to weight loss means manufacturers are prioritising them over insulin pens.

People with diabetes who rely on state healthcare will have to be taught to use insulin in vials and syringes again as the long-term supplier of insulin pens to the Department of Health will no longer provide these devices.

Pharmaceutical company Novo Nordisk will not be tendering again for the contract.

Globally, big pharmaceutical companies have turned their attention to the manufacture of semaglutide-containing weight-loss injectables instead of insulin pens. Ozempic is the best known of them, but Novo Nordisk makes an alternative called Wegovy.

The International Diabetes Federation estimates that 4.2 million adult South Africans are living with diabetes and only about 16% of them have access to private healthcare.

“Both people with type 1 and type 2 diabetes are prescribed premixed insulin pens,” said Dr Patrick Ngassa Piotie, project manager of the School of Health Systems and Public Health at the University of Pretoria, and chairperson of the Diabetes Alliance. “Indeed, individuals with type 1 diabetes need to inject insulin from the time of diagnosis.

“People living with type 2 diabetes start insulin injections when oral medications are no longer sufficient to control their blood glucose levels.”

Piotie said there are estimates of the number of people with type 1 and type 2 diabetes in South Africa, but it is not really known how many people have it.

He said, of the 4.2 million estimated to have a form of diabetes, about 10% to 15% are living with type 1 diabetes.

“Of those with type 2 diabetes, up to 50% will eventually need insulin.

“During the implementation of the Tshwane Insulin Project at primary care level, we found that 25% to 50% of patients with type 2 diabetes should be prescribed insulin.”

A step backwards

Piotie said that compelling diabetes patients to return to syringes and vials of insulin is like compelling phone users to go back to using landlines.

“Just think how that would impact your life,” he said. “Except that we are talking about a life-saving medication here.

“I truly believe that only people living with diabetes can tell us how that backward move will affect their lives.

“I cannot speak on behalf of the 75-year-old woman who has arthritis and failing eyesight, and who has been using insulin pens for years and relies on the sound the pen makes to ensure that she is injecting the right dose.

“Her arthritis makes it difficult or even impossible for her to operate a syringe and a vial,” Piotie said.

“I cannot speak for the seven-year-old or the teenager who got used to the convenience of using a pen. With the pain, they didn’t have to confront their fear of needles and now they are expected to carry syringes and vials and to operate those with the same dexterity of a professional nurse.

“In terms of danger, first you have the dosage errors as the risk of incorrect dosing is higher with syringes and vials.

“Injecting more insulin or less insulin is dangerous as hypoglycaemia or hyperglycaemia threatens the patient’s life. Insulin pens are therefore much safer than syringes and vials.

“We can also mention the issue of convenience, which is closely related to better adherence. Poor adherence will result in suboptimal glucose control, exposing the person living with diabetes to complications,” Piotie said.

He led research that was published earlier this year in the Journal of Endocrinology, Metabolism and Diabetes of South Africa, which indicated that patient data collected in 23 public health facilities showed that control targets were already not being met.

Médecins Sans Frontières (MSF) Southern Africa has described the latest development as a major setback for people with diabetes.

Previously, Novo Nordisk has been the primary supplier of human insulin pens to the Department of Health and supplied more than 14 million to South Africa over the past three years.

In May, the department issued a circular to health facilities predicting a shortage of stock. It asked for existing stock to be used sparingly, and for the elderly, children and the visually impaired to be prioritised when distributing the pens.

“It is, however, important to highlight the global shortage of insulin pen sets, which is likely due to an increased demand of more profitable products requiring similar production needs as insulin pen sets, and manufacturers prioritising this production,” the circular explained.

The department also cautioned: “Where insulin vials are prescribed and dispensed, enhanced counselling and adherence monitoring is required to ensure appropriate administration and use.”

Neglecting responsibility

MSF warned in a statement that transitioning people with diabetes to vials and syringes in the absence of insulin pens could present major consequences for many of them.

It has called on Novo Nordisk and other manufacturers of insulin pens to acknowledge their responsibility and take immediate action to ensure a continuous supply of insulin pens to South Africa, where it is sorely needed. “Forcing tens of thousands of people with diabetes to switch from pens to vials and syringes on short notice is unacceptable and will have very serious consequences.

“We are astonished by the thoughtless irresponsibility of insulin manufacturers who didn’t consider warning the government in advance about their decision to no longer sell insulin pens in South Africa.

“We urge Novo Nordisk and other insulin makers to recognise their responsibility towards people with diabetes in South Africa and globally, while they continue to reap exorbitant profits on their products from high-income markets, and take immediate steps to continue supplying pen devices, which are essential for quality diabetes care,” said Camren McAravey, country operational representative for MSF in South Africa. DM

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This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R35.

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A step backwards

Neglecting responsibility