For decades, access to medicines was understood as primarily a clinical and economic issue. Today, however, it has also become a geopolitical one. International tensions, industrial concentration, and the power strategies of states are increasingly influencing which treatments arrive sooner, at what price, and for whom. Drugs like GLP-1 receptor agonists, used in diabetes and obesity, clearly illustrate this transformation.
The COVID-19 pandemic marked an inflection point. Vaccines demonstrated to what extent health depends on decisions made outside the healthcare sphere: control of patents, industrial capacity, international diplomacy, and trade policy. Since then, concepts like “health sovereignty,” “strategic autonomy,” and “supply chain security” have fully entered the public agenda. It’s no longer just about innovating, but about guaranteeing access in a more fragmented and uncertain world.
Health Technologies in a Geopolitical Context
This shift in context affects all health technologies, but is particularly visible in pharmaceuticals. Pharmaceutical innovation is concentrated in a few countries and companies, creating a structural asymmetry: those who control research, production, and intellectual property also have greater capacity to set access conditions.
In this scenario, healthcare systems are forced to negotiate not only prices, but also volumes, supply schedules, and therapeutic priorities. Even health technology assessment – traditionally focused on efficacy and efficiency – now faces new dimensions, such as the responsiveness of supply chains 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 just a few 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 try to balance innovation, safety, and sustainability. This situation highlights a structural problem: innovation is advancing faster than the ability to guarantee access to the product. The manufacture of 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, delays in supply, and prioritization of certain markets. Patients with diabetes have had treatments interrupted, while people with obesity find economic and administrative barriers to accessing this therapy.
The Geopolitics of Access
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 in 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.
At the same time, 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 potential for public health 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 is expanded without clear criteria, population efficacy may be limited by problems of adherence, 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 serious impacts on low- and middle-income countries.
Beyond the Market
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 digital solutions based on data. All of them will depend on global infrastructures and decisions made beyond the clinical sphere.
Looking to the Future
The major lesson is clear: access to health innovation can no longer be considered outside of geopolitics. If these dynamics are not incorporated into health planning, we risk 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 health model we want in an interdependent but fragmented world, and whether scientific advances will truly reach the entire population.
