GLP-1 patents and Africa: The COVID-19 lessons we still have not learned

Weight loss drugs promise a diabetes breakthrough in Africa, but patent barriers stall access. What does COVID-19 tell us about how to solve the continent’s silent crisis? Asks Sofia Araújo of Inventa.

Some debates appear new, yet from an intellectual property perspective, they follow a familiar pattern. Whenever a pharmaceutical breakthrough fundamentally changes the treatment of a widespread disease, the same question inevitably arises: how should the law balance the protection of innovation against the need to ensure access to essential medicines?

Africa is no stranger to this dilemma. The COVID-19 pandemic exposed the practical limitations of the international intellectual property framework when patent rights collided with public health imperatives.

Despite the flexibilities embedded in the TRIPS Agreement and reaffirmed by the Doha Declaration, timely access to vaccines and treatments remained profoundly unequal.

The emergence of GLP-1 medicines has reopened many of the same questions, this time in the context of chronic disease rather than a global pandemic.

Type 2 diabetes and obesity may not generate the urgency of a global pandemic, but they are becoming major public health challenges across the African continent. At the same time, the most effective therapies currently available remain protected by extensive patent portfolios held primarily by Novo Nordisk and Eli Lilly.

The GLP-1 revolution: Patent challenges

GLP-1 receptor agonists represent one of the most significant pharmaceutical innovations of recent decades. Semaglutide, marketed under the Ozempic and Wegovy brands, and tirzepatide, commercialised by Eli Lilly, have fundamentally reshaped the treatment landscape for type 2 diabetes and obesity, delivering clinical outcomes that were difficult to achieve with previous therapies.

Protection extends far beyond the active pharmaceutical ingredient itself. As is often the case in the pharmaceutical industry, the relevant patent landscape includes claims relating to formulations, methods of administration, dosage regimes and specific therapeutic indications. This strategy, commonly described as evergreening, continues to fuel debate over whether secondary patents strike an appropriate balance between rewarding innovation and delaying generic competition.

In many jurisdictions where semaglutide is available, the monthly cost of treatment remains well beyond the reach of most African health systems and, inevitably, most patients.

Innovation is no longer the question—access is.

Africa's silent diabetes crisis

According to the International Diabetes Federation, Sub-Saharan Africa is expected to experience the highest proportional increase in diabetes cases worldwide by 2045.

Rapid urbanisation, changing dietary habits and increasingly sedentary lifestyles are transforming what was once an underdiagnosed condition into one of the continent's most pressing public health concerns.

Unlike infectious diseases, diabetes rarely generates images that mobilise international attention. Instead, it progresses quietly, contributing to cardiovascular diseases, kidney failure, amputations and mounting pressure on already fragile healthcare systems.

Against this background, access to innovative therapies should not be viewed merely as a question of improving quality of life. It is equally a matter of strengthening public health systems and preventing complications that, in the medium and long term, impose far greater human and economic costs.

Compulsory licensing: A rarely used legal tool

International intellectual property law is not indifferent to public health concerns. Article 31 of the TRIPS Agreement allows WTO Members to authorise the use of patented inventions without the consent of the patent holder, provided that certain conditions are met and adequate remuneration is paid.

The Doha Declaration on the TRIPS Agreement and Public Health reinforced this principle by confirming that Members are free to determine what constitutes a national emergency or other circumstances of extreme urgency and to adopt measures necessary to protect public health.

The 2003 WTO General Council Decision, later incorporated into Article 31bis of TRIPS, further expanded these flexibilities by enabling countries with insufficient pharmaceutical manufacturing capacity to import generic medicines produced under a compulsory license.

On paper, therefore, the legal framework appears robust.

In practice, however, compulsory licensing has remained the exception rather than the rule across much of Africa. Political pressure, trade considerations and concerns about foreign investment have often discouraged governments from relying on these mechanisms, even where significant public health interests are at stake.

More fundamentally, compulsory licensing is only part of the answer.

The manufacture of peptide-based medicines such as semaglutide and tirzepatide requires sophisticated technology, specialised expertise and complex supply chains that many African countries are still developing.

Without technology transfer and increased regional manufacturing capacity, the practical impact of compulsory licenses remains limited.

The debate, therefore, extends beyond patents alone. It is equally about industrial policy, regulatory cooperation and long-term pharmaceutical resilience.

The COVID-19 lesson that risks being forgotten

The COVID-19 pandemic was widely expected to reshape the relationship between intellectual property and public health.

In October 2020, South Africa and India proposed a temporary waiver of certain TRIPS obligations covering vaccines, diagnostics and treatments, arguing that existing intellectual property rules could become a barrier to equitable access during a global health emergency.

The negotiations that followed demonstrated just how difficult it remains to reconcile commercial interests with public health priorities. After almost two years of discussions, WTO Members agreed on a compromise that applied only to vaccines and was accompanied by operational limitations that significantly reduced its practical effect.

The debate surrounding GLP-1 medicines presents a remarkably similar challenge, but in a less visible context. Diabetes and obesity do not overwhelm hospitals overnight, nor do they generate the political urgency associated with a pandemic. Their impact is gradual, cumulative and, for that very reason, easier to postpone.

That may also make the legal response more difficult.

The absence of an immediate emergency creates the illusion that there is still time to act, even as the number of patients requiring long-term treatment continues to grow.

What should Africa do next?

The conversation should not be reduced to whether compulsory licenses ought to be granted.

A more comprehensive strategy is required.

From a legal perspective, countries with greater institutional capacity - such as South Africa, Egypt, Morocco and Nigeria—could play a leading role in testing and implementing the TRIPS flexibilities available for essential medicines, creating practical precedents for the rest of the continent.

At the regional level, the African Continental Free Trade Area (AfCFTA) provides an opportunity to strengthen regulatory cooperation and coordinate procurement strategies, ultimately increasing Africa's collective bargaining power.

At the same time, policymakers should continue to scrutinise the growing use of secondary pharmaceutical patents and consider whether current patent practices strike the appropriate balance between rewarding innovation and facilitating timely generic entry.

Yet perhaps the most important lesson lies elsewhere.

Without sustained investment in local pharmaceutical manufacturing, research capacity and technology transfer, access debates will continue to focus on legal rights rather than practical solutions.

The post-COVID initiatives aimed at expanding vaccine production across Africa demonstrate that industrial capacity can be developed when political will and international cooperation converge. Similar efforts may now be required for non-communicable diseases.

Conclusion

The discussion surrounding GLP-1 medicines illustrates that the real legacy of COVID-19 is not simply the reaffirmation of the TRIPS flexibilities. Rather, it is the recognition that legal mechanisms alone cannot guarantee access to essential medicines.

Compulsory licensing remains an important instrument, but its effectiveness depends on manufacturing capacity, technology transfer, regulatory coordination and political commitment. Patent law is only one part of a much broader equation.

The growing burden of diabetes across Africa provides an opportunity to rethink how intellectual property, public health and industrial policy interact before the continent faces another access crisis.

The legal tools already exist.

The more difficult question is whether governments are prepared to use them and whether the international community is willing to support a model of pharmaceutical innovation that rewards research while recognising that access to essential medicines is, ultimately, a matter of public interest.

Sofia Araújo is an attorney at law at Inventa, and can be contacted at saraujo@inventa.com