The $6 revolution. How generic weight loss drugs could save millions of lives.

The arrival of generic semaglutide is an unheard of opportunity for global public health

This article was jointly written and jointly published on Global Health Insights, a Substack by the professor and commentator Peter Singer.

In about five months the patent for a key weight loss medication, semaglutide, will lapse in a large number of countries around the world including India, China, Brazil, and Canada —although not in the most lucrative markets. The wider availability of this drug is likely to herald the beginning of a step change in the global treatment of obesity and metabolic diseases. It is a big deal. Obesity alone has risen relentlessly over past decades, more than doubling in adults since 1990. Over a billion people live with obesity, and its health consequences, worldwide.

The potential for generic and cheaper semaglutide for wide use in the treatment of obesity, diabetes, and a range of other conditions is so mind-boggingly large, we think the time is ripe for many governments to start to plan for how to maximise their potential. Firms in China and India, in particular, have been preparing for the expiry of the patent in their territories by developing the capacity to deliver large quantities of what will be cheaper, generic, i.e. biosimilar, versions of this drug. Reports suggest that drugs which today cost over $1,000 a month* in America will be manufactured in India for less than $6 a month. Although the price of these drugs is unknown, Indian manufacturers typically work high-volume and low costs. Demand will be global. (Although individuals in countries where the patent has not expired, such as America, UK, Europe, Japan, and Australia, will not be able to buy these generic medicines legally).

For those living in countries where semaglutide (sold under the brand names Ozempic and Wegovy) patents are expiring, as prices tumble, so too will waistlines as demand is expected to soar. Countries could transform the treatment of diabetes, obesity and overweight, along with better outcomes in those with cardiovascular health, poor metabolic health, liver and kidney disease. There is growing evidence that these drugs have an impact on addiction, lowering the desire to consume alcohol or gambling, and there are positive signals with regards to reduction in dementia from the use of anti-obesity medications, and even in all-cause mortality. No wonder when The Economist wrote about the widening array of indications for GLP drugs, they were described on the cover as, “The everything drugs”.

Just how big a deal would widening availability be? Some sense of the scale of the impact can be found in work by one of us. Singer and Brook tried to model the effects of global access to GLP medicines. Their most recent estimate, published in August 2025 as a preprint, finds that 2.1m to 3.1m lives per year could be saved in patients with diabetes and/or obesity (the larger number includes all patients with obesity whether or not they have cardiovascular disease). But these numbers do not include the large numbers of people who, with better access to these medicines, can live happier, healthier and more economically productive lives. Nor do they include the as-yet-to-be confirmed benefits in addiction, or dementia reduction, or even cardiovascular disease without diabetes or obesity.

How should we think about the path forward in terms of maximising the gains from these innovations? One path is for governments to consider bargain basement population-scale deals with generic manufacturers. Another path will come from better future drugs–although these will be more expensive and protected by patents for longer. Nonetheless, semaglutide and similar first generation drugs have flaws, they don’t work for everyone, many struggle to persist with these drugs, and they cause too much muscle loss. Moreover, when they are discontinued weight rebound occurs (which is mostly fat) — although stopping blood pressure medicines also causes a return of hypertension. As they are injectable drugs, they are inconvenient to take and store. There are also concerns about adverse events such as pancreatitis (which in rare cases have caused deaths) or optic neuropathy (which can lead to vision loss). A third path for these medicines is to expand the indications that GLP-1 medicines can be used for. If Singer and Brook’s model is expanded to include cardiovascular disease without obesity or diabetes, the lives saved increases to 3.9m.

Yet even if generic semaglutide is extremely cheap, it is not free. It may need to be taken for a lifetime, and there are overheads that come with delivering it at scale. Governments may restrict access to certain groups in order to tame health budgets and to balance the need to pay for other health interventions. Private markets are also likely to play an important role in the availability of this drug–such is the demand for it–but that will not necessarily address those in greatest health need.

When a new drug arrives in a market it is understandable that governments will want to limit the impact on drug budgets by restricting access. But the opportunity to save so many lives is unprecedented, and governments need to think about innovative finance methods that might help introduce these drugs sooner–allowing for the financial rewards of prevention to be garnered immediately.

One approach is a capital stack, which layers different types of capital such as grants, low-interest loans and public-private investments to fund large-scale health initiatives. A recent example is the ExCITD platform launched by the Asian Development Bank to finance dengue elimination using technology that stops mosquitoes from transmitting the disease.

Another option is pay-for-results schemes. The European and Islamic development banks have used this model for polio eradication. Those funding the rollout of a medical intervention pay for outcomes. Adapting this for semaglutide delivery could mean paying implementers when agreed public health outcomes are met–something that could incentivise innovation in delivery.

These sorts of ideas would help to ensure that large-scale access can be targeted to those who would most benefit (rather than those who are easiest to reach) — whether in populous countries (where the largest health gains are to be found) or countries with extremely high rates of obesity like small island developing states (where the most transformative changes in disease prevalence could be achieved).

Foundations can also play an important role–not just by supporting innovative finance but by creating the right environment for novel medical innovations to spread. It is traditional to look to medical charities such as the Gates Foundation or the Wellcome Trust for health-related initiatives. However, a new player in global health is the Novo Nordisk Foundation, which has become wealthy on the back of the drug semaglutide. The foundation is a controlling shareholder of the pharma firm Novo Nordisk but nonetheless has always had clear health and humanitarian goals.

In most rich countries semaglutide is still covered by patent protection at least until 2030 and possibly longer–which means the foundation will be placed in the interesting position whereby its future wealth will be increasingly derived from the company it owns fighting patent battles in rich countries, and thereby limiting access to a life-saving drug.

It is unlikely that the foundation will use its heft as a controlling shareholder to influence the firm’s defense of its remaining patents. As an industrial foundation it could argue that it is also responsible for the commercial viability of the firm’s business. So what could it do? Morally, it ought to use its largess to try and save more lives.

One way to do this would be for the Foundation to tackle some of the downsides of the patent defense. As semaglutide moves into generic territory, the firm Novo Nordisk may show waning interest in research into indication expansions, or how the drug works in genetically diverse populations or on its implementation in poorer countries where no patent is held. Research into the best use, along with tools to minimise harms like muscle loss, would be valuable. An increase in the global use of this drug will, inevitably, lead to larger numbers of adverse events along with misuse and discontinuation.

Critics may argue if the foundation funds innovative access models or research into semaglutide it could create a private benefit for the firm Novo Nordisk. This is also the position of tax rules governing foundations. One novel approach that we would like to suggest would be to grant exemptions to company foundations from this restriction on a case-by-case basis for initiatives that produce massive public benefit, much as the US Food and Drug Administration grants priority review vouchers for orphan drugs.

We would also argue that the overarching public health benefits from expanding access to and knowledge about semaglutide far outweigh any possible private competitive gains. This is particularly the case given the dynamic and competitive nature of the commercial market for weight-loss drugs in rich countries. Indeed, arguably more evidence for the benefits of semaglutide might compel other firms to conduct similar research to bolster the case for their own drugs. Openly published research into dosing, side effects and long term safety creates knowledge that can be useful across the industry.

The world has long been off track to meet its goals on obesity and 2026 could be the start of a new era in the fight against this condition. In its recent proclamations on obesity the World Health Organisation has emphasised prevention and management of obesity–such as multidisciplinary obesity care models-and has developed a sound action plan. But no mention has been made — including, astonishingly, in the upcoming UN meeting on noncommunicable disease—of GLP-1 drugs, which are easily as important a health intervention as statins, and seem likely to turn out to be the most consequential medical innovation since vaccines. That is a gap that needs to be rectified lickity split, as each month of delay could cost 250,000 lives.

New GLP-1 guidelines are now expected in mid-September (previously expected in July). But what is needed is a clear position from WHO on the place of these new drugs, alongside prevention efforts, a decision on whether they are essential medicines, and gearing up to approve specific generic manufacturers. In this rapidly moving landscape a position on these issues that fully considers the unprecedented scope and scale of the global public health benefits is now overdue. Governments, too, need to start thinking today about how to bring to their citizens the massive gains from this new and promising health technology.

Natasha Loder is the Health Editor at The Economist.

Peter Singer is Professor Emeritus at University of Toronto, board member, blogger and skier; he was co-founder of University of Toronto Joint Centre for Bioethics and Grand Challenges Canada, and former Special Advisor to the WHO Director General.

Disclosure: Peter Singer owns shares in GLP-1 companies.

Updates

* Since this piece was published Novo Nordisk has started offering semaglutide at $499 a month for those paying for the drug themselves.

* Peter & Natasha have published an updated and reframed version of this in the Canadian newspaper, The Globe and Mail.