GLP-1 therapies in developing markets – a question of scale

A high-burden reality: obesity’s expanding toll

In 2026, obesity is no longer a burden confined to high-income countries. For emerging markets such as South Africa, Mexico, Indonesia, urban India and parts of the Middle East, obesity rates have climbed dramatically, bringing with them a wave of chronic cardiometabolic disease.

South Africa exemplifies this high-burden reality: recent national data indicate that between 67% and 68% of women and 31% of men are overweight or obese.¹ This pattern mirrors broader global trends linking urbanisation, dietary transitions and sedentary lifestyles to the escalation of metabolic disease.

Crucially, obesity is not a cosmetic or lifestyle nuisance; it’s a disease multiplier. Excess adipose tissue increases the risk of type 2 diabetes, cardiovascular disease, hypertension and chronic kidney disease – conditions that drive the majority of healthcare expenditures in both private and public systems. In South Africa, this burden is intensifying pressure on constrained medical scheme reserves and under-resourced public health facilities.

Glucagon-like peptide-1 (peptide hormone)
 

Source: Pain & Inflammation Specialists

GLP-1 therapies: a clinical breakthrough confronts economic barriers

Glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as some of the most impactful therapies in modern endocrinology. Initially approved for glycaemic control in type 2 diabetes, GLP-1s such as semaglutide and tirzepatide have demonstrated sustained weight loss of 15-25% in randomised clinical trials, effects that rival those of bariatric surgery in magnitude.²

Unfortunately, despite their clinical promise, GLP-1 therapies remain largely inaccessible across developing markets due to cost and reimbursement gaps:

• In South Africa in early 2026, branded GLP-1 therapies can cost between US$65 and US$380 per month (approx. R1,000 to R6,000), with much of this paid out of pocket.³
• Most medical schemes do not reimburse GLP-1s for obesity alone, restricting coverage to diabetes indications and leaving patients to shoulder the expense.³

This creates a paradox: obesity prevalence is (ironically) highest among food-insecure households, where families often rely on inexpensive, energy-dense, nutrient-poor diets. For these groups, GLP-1 therapies remain unattainable despite being medically essential for preventing costly chronic disease. Data from nutrition research consistently show that low-income status correlates with both higher obesity rates and lower access to quality healthcare, entrenching a vicious cycle of disease and expense.⁴

From an investment perspective, the large unmet demand created by affordability constraints represents a latent market that could unlock substantial growth if pricing and reimbursement were to evolve.

Aspen Pharmacare’s strategic inflection point

A potential game changer for the African market is Aspen Pharmacare’s entry into the GLP-1 segment. With multiple global patents for leading GLP-1 molecules set to expire later this decade, Aspen is positioning itself to manufacture and market locally produced, more affordable formulations by late 2026.

Local manufacturing matters for three reasons:

1. It can significantly reduce the cost of goods and supply chain inefficiencies compared to imported biologics.
2. It enables participation in government procurement programmes, potentially expanding access beyond affluent private purchasers.
3. It accelerates the shift from niche, high-margin use to high-volume, essential-medicine status, particularly after inclusion on national formularies.

This potential trajectory bears a historical resemblance to the scaling of antiretroviral (ARV) therapy in South Africa. Two decades ago, ARVs were prohibitively expensive, limiting access to a minority of patients. Through a combination of local production, international support and progressive policy, ARVs became affordable and widely distributed, contributing materially to gains in life expectancy and reductions in HIV-related mortality.⁵

The emerging class of oral GLP-1s (anticipated later this decade) could further accelerate access by easing administration logistics in low-resource settings.

Investment architecture: beyond the drug molecule

For investors, the GLP-1 opportunity extends beyond the originators and into the infrastructure that enables scale:

• Eli Lilly and Novo Nordisk remain core exposures for broader obesity and cardiometabolic category growth, given their deep pipelines, manufacturing scale and strong clinical evidence bases.
• Danaher stands out for its exposure to bioprocessing, fill/finish and quality control technologies that are indispensable for global biologics production and scale. As volumes increase, demand for analytical instruments and manufacturing systems grows disproportionately.
• Roche/Zealand Pharma represent high-potential optionality in next-generation incretin combinations and differentiated profiles.
• Fill-finish and contract development and manufacturing organisation (CDMO) players, often overlooked, could capture outsized benefits as capacity shortages emerge and regionalisation of supply chains accelerates.

Importantly, scaling GLP-1s also intersects with adjacent sectors. The need for nutrition support services, behavioural health platforms, remote monitoring and outpatient care infrastructure creates investable opportunities in healthtech and service delivery models that complement pharmacotherapy.

Policy shifts: essential medicines and reimbursement logic

A major policy milestone occurred in late 2025 when the World Health Organization added GLP-1 therapies to its essential medicines list for obesity and related metabolic diseases.⁶ This designation is not merely symbolic: it signals a shift toward global recognition of obesity as a chronic disease requiring broad access to effective treatment.

For governments and insurers, this raises pressure to reevaluate coverage models. In South Africa, the economic case for reimbursement is straightforward: preventing diabetes and its complications could reduce downstream cost burdens on both private schemes and the public sector.

Integrating GLP-1 therapies into the continuum of care requires more than drug access. It demands wraparound services, including dietary counselling, behavioural therapy, digital adherence tools, and longitudinal monitoring, thereby creating fertile ground for investment in innovative care models tailored to emerging markets.

Second-order impacts: food systems and carbon footprints

Widespread adoption of effective weight-management therapies is likely to alter consumption patterns. Early real-world evidence from developed markets suggests reduced demand for ultra-processed, energy-dense foods as metabolic health improves. This could put pressure on margins for high-carbon, resource-intensive food producers, particularly those specialised in high-sugar, high-fat product portfolios.

Conversely, demand may shift toward nutrient-dense foods and sustainable agriculture, reshaping local food ecosystems in ways that align with broader environmental and public health goals.

Conclusion: a structural opportunity in developing markets

The scaling of GLP-1 therapies in emerging markets is a structural healthcare opportunity, not a cyclical trend. With obesity driving escalating chronic disease burdens and innovations converging on affordability and access, the case for investment spans molecules, manufacturing, policy evolution and adjacent care platforms.

Much like the ARV revolution of the early 2000s, GLP-1 therapies have the potential to redefine population health outcomes, provided stakeholders align on affordability, infrastructure and coverage. From an investment standpoint, this convergence creates durable, multi-sector opportunities.

Sources

1. National health and nutrition surveys (South Africa): obesity prevalence by sex.
2. Semaglutide and tirzepatide phase 3 weight-loss data (NEJM, Lancet publications).
3. South African GLP-1 pricing and coverage analysis (local pharmaceutical pricing reports).
4. Household food insecurity and obesity correlation studies (public health journals).
5. Impact of ARVs on South African life expectancy (peer-reviewed epidemiology studies).
6. WHO Essential Medicines List update (2025 GLP-1 inclusion announcement).