The Geopolitics of Healthcare: Beyond Ozempic and the Future of Access
For decades, access to medicine was understood primarily as a clinical and economic issue. Today, it’s increasingly a geopolitical one. International tensions, industrial concentration, and the power strategies of nations are influencing which treatments arrive first, at what price, and for whom. GLP-1 receptor agonist drugs, used in diabetes and obesity treatment (with Ozempic being the most well-known brand), clearly illustrate this shift.
The Pandemic as a Turning Point
The COVID-19 pandemic marked an inflection point. Vaccines demonstrated how much health depends on decisions made outside the healthcare sphere: patent control, industrial capacity, international diplomacy, and trade policy. Since then, concepts like “health sovereignty,” “strategic autonomy,” and “supply chain security” have entered the public agenda. It’s no longer just about innovating, but about guaranteeing access in a more fragmented and uncertain world.
Healthcare Technologies Through a Geopolitical Lens
This contextual change affects all healthcare technologies, but is particularly visible in pharmaceuticals. Pharmaceutical innovation is concentrated in a few countries and companies, creating a structural asymmetry: those controlling research, production, and intellectual property also have greater capacity to set access conditions.
Healthcare systems are now forced to negotiate not only prices, but also volumes, supply schedules, and therapeutic priorities. Even health technology assessment – traditionally focused on efficacy and efficiency – faces new dimensions, such as supply chain responsiveness and territorial equity.
The GLP-1 Phenomenon: Innovation Under Pressure
GLP-1 medications, which mimic the function of a natural hormone to control blood sugar, originated as a treatment for type 2 diabetes. However, their effectiveness in weight loss has turned them into a global phenomenon. Demand has skyrocketed in recent years, driven by clinical evidence, media coverage, and social networks. This rapid growth has also generated risks of overuse and unrealistic expectations, as healthcare systems attempt to balance innovation, safety, and sustainability.
This situation highlights a structural problem: innovation is advancing faster than the capacity to guarantee access to the product. Manufacturing these drugs is complex, concentrated in a few production plants, and protected by patents that limit competition. When demand grows abruptly, the market doesn’t respond quickly enough.
The consequences are visible: shortages, supply delays, and prioritization of certain markets. Patients with diabetes have had treatments interrupted, while people with obesity face economic and administrative barriers to accessing this therapy.
The Geopolitics of Access: A New Reality
This is where geopolitics becomes decisive. Countries with greater economic power and negotiating capacity secure preferential contracts; others are relegated to waiting. This pattern, already observed with vaccines, is repeated: access depends as much on clinical need as on position within the international system.
In Europe, the debate on strategic autonomy in essential medicines has gained momentum. However, much of the production and technological control remains concentrated outside the decision-making scope of many states, limiting the ability to guarantee stable supplies.
Simultaneously, innovative medicines have become instruments of industrial policy. Where production plants or research centers are established, employment, tax revenues, and negotiating power are generated. The line between health policy and economic policy is becoming increasingly blurred.
A Social Dilemma: Innovation and Inequality
The case of GLP-1s raises a fundamental question: what happens when an innovation with high public health potential is distributed unequally and used without adequate clinical prioritization? If these drugs consolidate their role in the fight against obesity – one of the major health challenges of the 21st century – but are only accessible to those who can afford them or live in countries with greater negotiating power, the result may be an increase in health inequalities.
This is compounded by an additional risk: when access expands without clear criteria, population-level efficacy may be limited by adherence issues, side effects, or inappropriate uses.
This dilemma takes on an even greater dimension in a context of geopolitical fragmentation. Conflicts, economic sanctions, and trade tensions directly affect pharmaceutical supply chains, with particularly severe impacts on low- and middle-income countries.
Beyond the Market: Governing Innovation
Recent experience shows that relying exclusively on market logic does not guarantee either efficiency or equity. The key question is no longer just how to finance innovation, but how to govern it. This involves exploring mechanisms of joint purchasing, value-based pricing agreements, incentives for local production, and a broader vision of health technology assessment, incorporating social and geopolitical dimensions.
GLP-1s are, in this sense, a paradigm case. They anticipate the challenges that other advanced therapies will bring: personalized medicines, gene therapies, or data-driven digital solutions. All of these will depend on global infrastructures and decisions made beyond the clinical sphere.
Looking Ahead: A New Era of Healthcare
The major lesson is clear: access to healthcare innovation can no longer be considered separate from geopolitics. If these dynamics are not incorporated into health planning, there is a risk of building systems that are increasingly sophisticated, but also more unequal.
the debate about GLP-1s is not just pharmacological. It’s a debate about what kind of healthcare model we want in an interdependent but fragmented world, and whether scientific advances will truly reach the entire population.
Frequently Asked Questions
Q: What are GLP-1 agonists?
A: GLP-1 agonists are a class of medications that help manage blood sugar levels and promote weight loss, often used for Type 2 diabetes and obesity.
Q: How does geopolitics affect access to medicines?
A: International relations, industrial concentration, and national power strategies influence which treatments are available, their price, and who can access them.
Q: What is “health sovereignty”?
A: Health sovereignty refers to the right of nations to independently make decisions about their health policies and access to medicines.
Q: What can be done to improve access to innovative medicines?
A: Exploring joint purchasing, value-based pricing, incentivizing local production, and incorporating social and geopolitical factors into health technology assessment are potential solutions.
