Johannesburg – 26 February 2025: The Health Justice Initiative (HJI), Treatment Action Campaign (TAC), and Doctors Without Borders (MSF) welcome the South African Competition Commission's announcement, on Friday, 21 February 2025, initiating a formal investigation into pharmaceutical corporations Novo Nordisk (Pty) Ltd and Sanofi-Aventis South Africa (Pty) Ltd regarding potential anti-competitive practices in the insulin pens market.]
The investigation will examine whether multiple device patents and proprietary designs are being used to exclude competition and prevent the entry of alternative suppliers.
The investigation stems from Novo Nordisk's October 2023 decision to cease tendering for insulin pens to the National Department of Health, instead offering only insulin vials. This change left South Africa's public healthcare sector without a contracted supplier of insulin pens for 2024, potentially affecting thousands of diabetes patients.
Response to the South African Competition Commission's announcement by Civil society and HIV activists:
HJI, TAC and MSF are committed to supporting the Commission's investigation by contributing detailed submissions and are also calling for a comprehensive regulatory investigation into potential anti-competitive practices across South Africa's entire insulin market.
Despite their advantages, insulin pens remain largely unavailable and unaffordable in low- and middle-income countries (LMICs). Ahead of World Diabetes Day, HJI, TAC and MSF called on pharmaceutical corporations Eli Lilly, Novo Nordisk, Sanofi, and other insulin manufacturers to make all insulin pen devices (human and analogue) available at US$1 per pen in all LMICs, based on data published by MSF estimating that insulin pens could cost as little as $0.94 per pen, including a profit.
South Africa, one of the first LMICs to provide human insulin in pen devices (in 2014), faced a major setback in diabetes care as the three major corporations (Novo Nordisk, Sanofi and Eli Lily) refused to respond to the government tender issued in 2023. With no other option left, the South African government began procuring expensive analogue pens from Sanofi at a much higher price, ranging between $2,24 for long-acting analogue pens and $4,26 for ultra-fast acting analogue pens. Diabetes is considered a major public health crisis in South Africa, where it is now the number one cause of death for women and second leading cause of death for men. Just under 5 million people are estimated to have diabetes in South Africa.
In 2023, Novo Nordisk signed a deal with South African manufacturer Aspen Pharmacare to supply human insulin in vials for Africa. However, the detailed conditions of this agreement have not been made public, but it appears that Novo is preventing Aspen from producing human insulin in pens, which is what is primarily needed in South Africa to keep treatment mechanisms constant for people who transitioned to pens in 2014.
The lack of access to insulin pens in South Africa has been further worsened by Novo Nordisk's recent decision to entirely discontinue the production of human insulin in pen devices. Instead, the corporation is prioritising the production and marketing of more lucrative medicines in pens, such as GLP-1s like brands Ozempic and Wegovy, used for diabetes and weight loss, which are marketed and sold at extremely high prices in high-income countries.
Sibongile Tshabalala, Treatment Action Campaign: “It is outrageous that people with diabetes in South Africa are being forced to revert to more painful syringes and vials to administer their insulin, while a big pharmaceutical corporation continues to make outrageous profits t by selling easier-to-use, more practical insulin pens in wealthier nations. Novo Nordisk’s decision to discontinue insulin pens in South Africa is a blatant act of health apartheid, enforcing unequal standards of care. Everyone living with diabetes deserves equal access to the highest standard of treatment and care without any compromises.”
Candice Sehoma, Advocacy Advisor, MSF Access Campaign: “For decades, pharmaceutical corporations have prioritised their profits over people’s health and lives. The global withdrawal of easier-to-use human insulin pens is severely impacting people with diabetes in resource-limited settings, creating a system where access to quality care depends on where people live and how much money they have. We welcome the Competition Commission’s investigation, which comes at a crucial time as the South African government struggles to afford costlier alternatives to address the challenges on the ground amidst an already strained health budget. It’s time to end profiteering on insulin, a lifesaving medicine that was discovered over a century ago.”
About the Organisations
Doctors Without Borders (MSF) is an international, independent medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters, and exclusion from healthcare.
Treatment Action Campaign (TAC) is a South African HIV/AIDS activists organisation that was founded to fight for access to treatment for people living with HIV and presently continue to represent users of the public healthcare system in South Africa, and to campaign and litigate on critical issues related to the quality of and access to healthcare.
Health Justice Initiative (HJI) is a South African public health and law initiative focusing on addressing inequality in healthcare access and advocating for equitable and fair access to healthcare.
