Global access disparity (revision 8)

Global access disparity describes the uneven availability and affordability of incretin therapies. Availability tracks national income closely: approval, supply and coverage have concentrated in high-income markets, and the conditions these drugs treat are not so concentrated.^[1]

Four factors drive it. Price, set within markets rather than globally. Manufacturing capacity, which for peptides is capital-intensive and was constrained during the demand growth of the 2020s. Regulatory approval, granted jurisdiction by jurisdiction. And coverage, which determines affordability where a product is available at all.^[2]

Disparity operates within countries as well as between them, along the ordinary lines of income and insurance status. See Prior authorisation.^[3]

Peptide manufacture at scale requires synthesis capacity, preparative chromatography capacity, and fill-finish capacity, each of which is capital-intensive and slow to build. Demand growth outpaced all three during the period these products expanded.^[4]

Constrained supply is allocated by price and by contract, which concentrates it in markets able to pay. This is a market outcome rather than a policy decision, though policy shapes it.

Capacity expansion has been substantial since, and the constraint has eased in some markets. Whether that translates into broader availability depends on price and approval rather than on capacity alone.^[2]