With increased average disposable income in Saudi Arabia eliciting more sedentary lifestyles and less healthy dietary choices, more than 68 percent of all mortality in the Kingdom is nowadays attributed to non-communicable diseases (NCDs). Not only does this come at immense cost to the public purse, but also presents a formidable challenge to policymakers’ attempts to build a financially sustainable national healthcare model.
“Frankly, with over 35 percent of the national healthcare budget consumed up treating an interrelated trio of chronic conditions – namely diabetes, obesity and cardiovascular disease – that have reached epidemic proportions, there has been a pressing need to start to think outside of the box and come up with alternative solutions,” muses Vineta Bhalla, partner and chief medical officer for the Middle East at Deloitte. “Business as usual is simply no longer a viable option,” she insists.
Thankfully, when it comes to diabetes, companies like Danish specialty play Novo Nordisk, French biopharma Sanofi, and iconic American originator drug developer, Lilly are finally managing to demonstrate some progress in reining in the disease. “With a diabetes prevalence rate surpassing 18.7 percent – among the highest in the world and more than twice the global average – we realised that it just wasn’t going to be sufficient to bring our therapies to market and that we’d have to really engage locally by diversifying our activities and partnering to cultivate an appropriate supporting infrastructure,” recalls Melvin D’Souza, corporate vice president and general manager at Novo Nordisk.
Novo Nordisk’s in-country approach has become increasingly holistic over time. “We are focusing both on the upstream aspects, such as clinical trials and training doctors to treat patients with the latest innovations, while simultaneously vigorously setting about raising public awareness and putting in place initiatives to facilitate early diagnosis and better disease management,” claims D’Souza.
This strategy of not only offering an optimal portfolio of products but proactively helping to build the capacity and capability within the healthcare system also appears to have been rewarded handsomely with strong market performance. The company has been consistently registering double-digit growth to the point where it now ranks the second placed multinational overall within the Saudi market.
“Growth in Saudi Arabia is certainly not automatic; it requires continuous effort to offer a complete, sustainable solution that meets the needs of patients at every stage of their journey. Our success in the Kingdom’s diabetes market is down to a comprehensive approach that combines both depth and breadth accompanying the patient continuously,” believes D’Souza.
“After all, diabetes is a chronic condition requiring lifelong treatment and patients with these disorders live longer when they have the right approach to lifestyle, medication, and ongoing care,” he acknowledges, noting that, in this scenario, optimal health outcomes and profitability is inextricably linked.
Meanwhile, plenty of promising innovation in this therapeutic area has been occurring at the grassroots level. Local researchers and pioneering healthtech outfits have, for instance, been experimenting with latest-generation digital technologies in an effort to come up with homegrown solutions to some of diabetes’ manifold complications.
One notable initiative underway is the ongoing collaboration between King Abdullah University of Science and Technology (KAUST) and amplifAI health. They have been combining AI technology with hyperspectral imaging technology, known as Hyplex, to develop a novel disease-detecting method centred around diabetic foot complications with a view to flagging up diabetes early, developing better treatment protocols, and reducing the necessity for lower limb amputations. According to Business Monitor International, this application alone is now anticipated, if proven successful in forthcoming clinical trials, to save the Kingdom as much as SAR two billion (USD 530 million) annually in averted medical costs.
Securing Insulin Supply
A further significant development in Saudi Arabia’s ongoing war on diabetes has been the government’s effort to secure a stable and reliable supply of insulin. Historically reliant upon imports, the Kingdom is finally transitioning towards localised production in a move that should significantly bolster national drug security and ensure greater access to life-saving treatment for hundreds of thousands of patients.
In a landmark moment for the local healthcare sector, the Kingdom recently inaugurated its first domestic insulin manufacturing facility thanks to a collaboration between Sanofi, Sudair Pharma Company, and the National Unified Procurement Company (NUPCO). Once fully operational, the facility will manufacture, assemble, and package approximately 15 million SoloStar insulin pens annually, meeting the treatment needs of 500,000 patients across the Kingdom, and covering some 70 percent of the entire diabetic population receiving insulin.
“This project is not just about producing medicine but rather investing in a country’s future. The facility marks a pivotal step in Saudi Arabia’s healthcare transformation and our combined determination to overcome contemporary healthcare challenges, ensuring security of supply of high-quality insulin manufactured in Saudi, for Saudi, by Saudi and empowering local talent to sustain this progress,” explains Preeti Futnani, specialty care general manager for the Greater Gulf at Sanofi.
At the same time, Lifera, through their subsidiary SaudiBio, have announced an agreement to localise insulin production with Novo Nordisk, meaning that, by 2027, Saudi Arabia will enjoy the distinction of becoming the first producer of a biologic innovator insulin in the Gulf Cooperation Council (GCC) region.
“As the executive arm for medical procurement in Saudi Arabia, NUPCO played a decisive role in both deals which guarantee sufficient stocks of several types of biomedicine that will be essential to overcoming the scourge of diabetes in our country. Both agreements extend over seven years and are explicitly designed to transfer critical technology and knowledge to local partners and empower us to counter this disease with full force,” concludes Fahad Al Shebel, CEO of the centralised procurement body
Obesity: The Next Frontier
Meanwhile, Saudi Arabia also finds itself right on the frontline of parallel efforts to shift the paradigm in how another closely related NCD, obesity, is perceived and contained. After all, approximately half of Saudi adults are considered overweight, according to the 2024 Health Determinants Statistics Publication released by the General Authority for Statistics (GASTAT). Concerningly, the report highlights a second spiralling public health challenge, with 23.1 percent of all Saudis declared clinically obese, and a worrying 33.3 percent of Saudi children aged between two and 14 categorised as overweight.
“Obesity is not just a risk factor but a chronic, progressive, and relapsing disease that carries serious downstream complications, including type 2 diabetes, cardiovascular diseases, certain cancers, sleep apnoea, among many others. The impact of obesity on health and mortality simply cannot be understated,” argues Felipe Borges dos Reis, former general manager at Lilly.
“Addressing the rising prevalence of obesity in Saudi Arabia is imperative and It’s crucial to dispel myths and misconceptions surrounding obesity, such as the erroneous notion that it’s solely a matter of individual choice. This misconception contributes to stigma and can badly hinder individuals from seeking proper care and treatment,” he warns.
Interestingly, however, Saudi Arabia, unlike many of its peers, has been quick off the mark in embracing new pharmacotherapies for obesity. Undoubtedly significant advancements have been made in convincing Saudi policymakers to understand the true pathophysiology of the disease.
“This country has distinguished itself by being one of the first to introduce and push for the proper treatment of obesity, ensuring access to the latest medications and establishing a care pathway system whereby patients with obesity can be referred from primary healthcare to secondary and tertiary care hospitals,” explains Dr. Nasreen Alfaris, a metabolic syndrome and obesity consultant to the administration of King Saud Medical City who has been working to codify obesity medicine guidelines in collaboration with the Saudi Endocrine Society with a view to standardizing obesity care across the nation.
“Saudi Arabia’s very enlightened healthcare community, including those involved in prescribing and managing treatments, has largely accepted obesity as a disease. Bariatric surgery is reimbursed locally, and most public institutions have begun reimbursing for obesity medications, recognizing it as a pathology that requires treatment and management,” agrees Novo Nordisk’s Melvin D’Souza.
On the other hand, Alfaris spots a discrepancy when it comes to the private sector. Saudi Arabia’s private healthcare system operates on an insurance basis, which means that treatment access and affordability depend on the patient’s health insurance coverage. Insurance plans vary and not all cover obesity treatment. The level of coverage is also contingent upon on the tier of the healthcare plan which can affect access to necessary care. Certain insurance organizations still view obesity as a lifestyle issue rather than a medical condition forcing policy holders to pay out-of-pocket for treatment,” she observes.
Ultimately there remains much to improve in this sphere in spite of the Kingdom’s foresight and forward-looking posture. “When you compare contrast the local diabetes and obesity care landscapes the gaps in the latter become evident,” observes Alfaris. “Diabetes care is deeply rooted in the nation’s public health policy and what stands out to me is the comprehensive training program for diabetologists offered by the Saudi Commission for Health Specialties. Saudi Arabia enjoys a robust network of trained diabetologists and these specialists are present at every level of care: primary, secondary, and tertiary care centres. In contrast, the field of obesity is still embryonic and developing, especially within primary and secondary care environment,” she elaborates.
That’s not to say though, that Saudi Arabia can’t take the lead in revolutionising the treatment paradigm for this pathology. “I firmly believe that Saudi Arabia is in pole position to establish itself as a centre of excellence for obesity-related research, particularly in view of the strengths of our healthcare system,” posits Alfaris.
“After all, we possess a large, stable population that primarily relies on the governmental healthcare system, which means patients tend to stay within the system from a young age, providing a consistent pool of individuals for long-term clinical trials. This continuity allows for high-quality data collection over time which is crucial for meaningful research,” she adds.
“Saudi Arabia actually already plays a prominent role in international trials related to obesity,” confirms D’Souza. “Possessing one of the highest obesity rates globally, and with a significant economic impact on per capita GDP, Saudi Arabia logically provides a large patient pool for these trials so it’s a no-brainer for pharma and medtech companies testing out innovations in this space,” he reasons.
“While companies like Novo Nordisk cannot necessarily justify building large trial bases, we can assemble strong representations in specialised areas like this where the country is clearly ahead of the game. Moreover, it is my firm belief that scoping in on specialty research areas like this where there is a strong match with local health imperatives will hold the key to successfully integrating Saudi Arabia into the worldwide clinical trial landscape,” he concludes.
