Taipei, Taiwan – Ozempic is big business in China.
Last year, Danish pharmaceutical giant Novo Nordisk doubled its sales of the diabetes drug in the country to nearly $700 million, 5 percent of Ozempic's global sales.
Ozempic was approved in China to treat diabetes in 2021, but it has been its anti-obesity ingredient, semaglutide, that has driven demand for what many Chinese call the “internet celebrity weight loss drug.”
Chinese influencers and vloggers have promoted the use of Ozempic on Chinese social media.
The same platforms are also the birthplace of a series of “beauty challenges” that have gained traction over the years and in which, for the most part, young women show off their thinness.
“In general, 'thinness' is the standard of beauty for women in China, and some are even willing to demonstrate and pursue it to the detriment of their health,” said Pan Wang, senior professor of Chinese and Asian studies at the University of New Zealand in Australia. South Wales, told Al Jazeera.
For Wang, the growing demand for Ozempic is not a surprise.
“Nowadays, many people in China are willing to try all kinds of methods and supplements to lose weight,” he said.
Those desperate to lose weight at almost any cost are not limited to beauty-conscious young women on social media.
China has the largest number of overweight or obese people in the world, and about half of the population is overweight.
Rising obesity rates, combined with demanding beauty ideals, make the Chinese market an attractive prospect for drugmakers like Ozempic, Wang said.
“There is a chance to make a lot of money.”
Pharmaceutical companies have not sat idly by.
Novo Nordisk has asked China's drug regulator to expand the use of Ozempic amid speculation that it hopes to win approval to market the drug specifically for weight loss.
The company expects its drug Wegovy, explicitly aimed at weight loss, to be approved for sale in China this year.
In May, Indianapolis, Indiana-based pharmaceutical company Eli Lilly received approval from Chinese regulators for its Ozempic rival, Tirzepatide.
China's Hangzhou Jiuyuan Gene Engineering, owned by pharmaceutical giant Huadong Medicine, earlier this year applied for approval to sell the first local rival to Ozempic.
Despite these developments, demand for weight loss drugs has outpaced supply, and Eli Lilly expects demand to outpace supply in 2024 as well.
On Chinese e-commerce platforms such as Taobao, the price of Ozempic has risen to 1,000 yuan ($138), double the cost of the same drug at a public hospital.
While established companies are working with Chinese health authorities to increase supply, the sale of counterfeit versions of semaglutide products has increased online in China.
“The gray market for weight loss drugs has been booming in China,” Allan Von Mehren, chief China analyst and economist at Danske Bank, told Al Jazeera.
“Weight loss drugs are in a market with enormous growth potential in China.”
Von Mehren said growing demand means competition between suppliers will not be a major obstacle in the coming years.
“Instead, the limitation right now is capacity,” he said.
“Those who can invest in capacity and master it will likely be the ones who eventually capture the largest share of the market.”
Von Mehren said state intervention and regulation will be decisive in determining who will build capacity and who will be left out of the market in the near future.
“Until recently, the market was like the Wild West,” he said.
People in China have been able to buy Ozempic without a prescription, and increasing unauthorized use of the drug limits its availability to diabetics.
But since last year, Chinese authorities have intervened.
In February last year, censors removed more than 5,000 posts from social media platform Xiaohongshu about weight loss experiences attributed to Ozempic.
In March last year, police investigations into the development and sale of unregulated semaglutide products ended with a series of arrests and convictions.
Last month, six people were prosecuted for selling weight-loss chocolates containing banned substances after a child who consumed some of them ended up in hospital.
“As new drugs are approved for the Chinese market, we are likely to see Chinese authorities increase their involvement compared to when Ozempic was initially launched,” Von Mehren said.
While Western products currently dominate the weight loss drug market in China, greater state intervention could change this.
Novo Nordisk is already involved in a patent dispute brought by Huadong Medicine, the pharmaceutical giant seeking to launch a Chinese rival to Ozempic.
In 2021, Huadong Medicine filed an application with China's State Intellectual Property Office arguing that Novo Nordisk's patent for semaglutide in China, valid until 2026, should be invalidated.
The patent was invalidated the following year, but Novo appealed the decision and the patent office has not yet made a final decision.
“Unless the competent court finally decides that this patent is invalid, we will not be able to commercialize JY29-2 [the drug similar to Ozempic] before the expiration of the patent,” the Huadong Medicine subsidiary said in January.
If Novo's patent is invalidated, it could increase the supply of weight-loss drugs in China as more Chinese companies try to launch their own Ozempic equivalents.
On the other hand, foreign companies have long expressed concern about Chinese companies enjoying preferential treatment in their domestic market.
At the World Economic Forum in Davos in January, Chinese Premier Li Qiang attempted to allay those concerns by saying that “China is open for business” and that there is much “potential for foreign investment.”
“Do they still primarily favor their own companies? Or are they willing to level the playing field to accommodate foreign companies? Von Mehren said.
“The patent dispute and the involvement of the Chinese authorities in the weight loss market may be a small proof of this.”
