Bill Gates and the Pan American Health Organization are both exploring strategies to make highly effective but expensive weight-loss drugs more accessible in lower-income countries, where the majority of people with obesity live. The Microsoft founder and PAHO director Dr. Jarbas Barbosa told Reuters in separate interviews that they recognize the unequal availability of treatments like Novo Nordisk's Wegovy and Eli Lilly's Mounjaro.
About 70% of the roughly one billion people with obesity live in low and middle-income countries, which may struggle to meet the costs of tackling the epidemic and associated health problems like diabetes and heart disease. The World Health Organization estimates that the economic costs of overweight and obesity will reach $3 trillion by 2030 if nothing is done to contain it.
Gates Foundation's Approach to Drug Access
When asked whether his namesake Foundation would help make weight loss treatments more accessible, Gates said "probably." He explained that the Gates Foundation has a track record of taking medicines that are shown to be effective in high-income countries "and figure out how to make it super, super cheap so that it can get to everyone in the world."
The Foundation is currently demonstrating this approach with HIV prevention drugs, working with Indian drug manufacturer Hetero to bring cheaper copies of a new HIV prevention drug to market in lower-income countries for $40 a year.
A Gates Foundation spokesperson revealed that the organization is currently working on early-stage research into the potential for weight-loss drugs to help improve outcomes for women with gestational diabetes. The Foundation could also potentially support clinical trials to test how these medicines affect different populations and provide the data needed to broaden access, Gates said.
PAHO's Bulk Purchasing Strategy
PAHO manages a fund that helps push down medicine prices by guaranteeing bulk orders on behalf of its 35 member states. Using this fund, which is financed by the member states, is an option for weight-loss drugs, Barbosa told Reuters. The fund could also help manufacturers clear regulatory requirements rather than applying in each country for approval.
"We are starting the conversation," Barbosa said, adding that PAHO is developing recommendations for how best to use the drugs and plans to speak to Novo, Lilly and generic drugmakers within the next couple of weeks.
Patent Expiration Opens Door for Generics
From next year, the active ingredient in Novo Nordisk's blockbuster Wegovy drug, semaglutide, comes off patent in countries including China and India. Generic manufacturers are already working on low-cost copies, which could significantly reduce costs compared to brand-name drugs that currently cost hundreds of dollars per month in wealthier countries.
Industry Response and WHO Guidelines
Eli Lilly declined to comment on the accessibility initiatives. Novo Nordisk acknowledged the "unmet need" for its treatments in a statement, saying "We are deeply committed to serving patients around the world."
The World Health Organization recommended in draft guidelines this year using weight-loss drugs as an obesity treatment for adults, but criticized their manufacturers over cost and lack of availability.
New Territory for Global Health
Any entry into obesity would represent a new arena for the Gates Foundation, which remains focused on fighting the deadliest diseases in low-income countries, like malaria. Obesity's role in chronic illness has created a new urgency around addressing rising global rates, although it is still not the biggest problem facing most of the countries where the Foundation operates, Gates said.
