Read the Conversation
Conversation highlights:
- 2025 as an opportunity: Despite challenges, Sara views 2025 as a pivotal year to improve healthcare efficiency, refocus priorities, and achieve better outcomes through smarter investments.
- Tackling NCDs: Non-communicable diseases now surpass HIV and TB; Novo Nordisk aims to apply community-based HIV strategies to diabetes and obesity while reframing obesity as a chronic disease, not a personal choice.
- Cities for Better Health: The Soweto-based Childhood Obesity Prevention Project, supported by WHO, UNICEF, and local partners, studies root causes of childhood obesity to drive scalable, sustainable interventions.
- Bridging public–private gaps: Collaboration with South Africa’s Department of Health has expanded access to modern insulins; further progress requires faster regulation and more flexible, fair pricing mechanisms.
- Future outlook: Novo Nordisk is expanding cardiovascular research and pushing for greater collaboration across sectors, emphasizing that real progress depends on shared responsibility beyond medicines alone.
EF: From your perspective, how do you view the year 2025 in South Africa?
SN: 2025 is a year to rebalance the system. We face real challenges, inflationary pressures, reduced donor funding, and a shrinking public-health budget, but this is precisely when bold, future-facing investments are needed. When systems are stretched, we must rethink how we deliver care, where we allocate resources, and how public and private sectors work together. A stable Government of National Unity (GNU) is essential. Healthcare investment only follows policy predictability. We must maintain that stability to unlock the reforms that will secure long-term access to lifelong, innovative treatments.
EF: What is South Africa’s real burden: NCDs
SN: South Africa has made remarkable progress against HIV and TB, a global benchmark. But the story has changed. 1 in 3 deaths is now caused by NCDs. Diabetes deaths have risen by more than 50% in the past decade, while cardiovascular disease kills 225 South Africans every day. NCDs are not imported threats; they are South Africa’s own local crisis. Yet we have not applied the same innovation and urgency that transformed HIV care. Community-based models, pharmacy-driven care, and decentralized treatment are successful approaches that must shift toward diabetes, cardiovascular disease, kidney disease, and obesity.
This is also equally about fighting a silent epidemic of stigma. Obesity is a chronic disease, driven by biology and environment, not willpower. The faster society shifts its mindset, the sooner we can prevent the costly complications that overwhelm households and health budgets. 4.5 million South Africans have diabetes, and 50% don’t know it. 1 in 8 school-aged children in South Africa is living with obesity; early intervention could change a lifetime. The economic cost is equally stark: R33 billion is lost every year due to diabetes-related complications alone.
EF: How are you educating around NCDS?
SN: At Novo Nordisk South Africa, we are focused on reshaping how society understands and responds to non-communicable diseases, particularly diabetes, cardiovascular disease, kidney disease, and obesity. The reality is that NCDs have overtaken HIV and TB as South Africa’s leading cause of death, yet the level of urgency and public awareness has not kept pace. We are working to shift perceptions of obesity from a lifestyle issue to a recognized chronic disease driven by biology and environment. That change is essential to improving earlier diagnosis, reducing stigma, and enabling people to receive the care they deserve. By engaging through media, public education initiatives, and scientific platforms such as the first Africa Summit on NCDs, we are helping build a future-focused conversation that supports prevention, early intervention, and better long-term outcomes.
EF: How has the Cities for Better Health initiative evolved over the past year, and how are you supporting local health infrastructure?
SN: Cities for Better Health has entered an exciting phase with the launch of the Childhood Obesity Prevention Project in Soweto, one of only five such initiatives worldwide to receive multi-agency support from partners such as WHO, UNICEF, academic institutions, and local communities.
The program works with 22 schools to study the root causes of obesity in children and identify scalable, sustainable interventions. It is looking not only at nutrition and physical activity within schools, but also the broader community environment, because improving school meals alone won’t drive change if unhealthy options surround the school gate. Our role is to help ensure that what we learn can translate into system-level improvements, strengthening early prevention and supporting healthier environments across South Africa. The evidence gathered will then move into analysis and solution-design phases, laying groundwork for long-term, measurable impact on children’s futures.
EF: How can greater trust be built between the public and private sectors in South Africa?
SN: Collaboration is the only way to unlock equitable care in South Africa. Healthcare spending remains deeply uneven. 84% of the population depends on the public health system, while 16% in private care consume almost equal financial resources. We cannot afford silos. We cannot afford mistrust. We must accelerate the adoption of innovative medicines where they deliver the most value, faster regulatory approvals to shorten patient wait times, pricing frameworks that reflect local economic realities and bring South Africa’s pricing models in line with other countries around the world, and co-created care delivery models that support long-term sustainability. This would truly unlock access to innovative care needed here in South Africa and stop the growing tide of NCDs in the country.
Innovation only matters when people can reach it!
EF: Which emerging healthcare area excites you most for future impact, and what are the market access challenges?
SN: We are witnessing the most significant transformation in cardiometabolic care in a generation. GLP-1 therapies are reshaping global medicine, offering life-changing weight-related outcomes, improved glycaemic control, and emerging cardiovascular and renal protection benefits. Treating obesity early can reduce lifetime complication risk by up to 50%. But innovation has no impact if people cannot access it.
Market access delays mean patients in South Africa can wait 3–5 years longer for innovative medicines than those in high-income markets. Pricing rigidity and regulatory delays limit the reach of advanced therapies, especially for underserved communities. We are actively working with government, funders, and experts toward patient access and alternate pricing models that enable equitable access while maintaining economic sustainability. At the same time, patient safety must be protected. Counterfeit GLP-1 seizures have increased by more than 300% in the past year, making stronger regulatory enforcement and public awareness critical. Early intervention is the single most cost-effective investment we can make in the country’s future health and productivity.
EF: What is the one project you are currently working on that excites you the most?
SN: The work that excites me the most right now is our effort to transform how obesity is understood and treated in South Africa. For too long, obesity has been reduced to personal responsibility – ‘eat less, move more’. We now know it is a chronic, relapsing, biologically driven disease, just like diabetes and cardiovascular conditions, and so it should be treated as such. Changing this mindset has the potential to reshape health outcomes on a national scale because we know that obesity, if left untreated, becomes the gatekeeper to many other diseases and complications. This shift is not simple, though, and requires education, policy change, and new care pathways. But the impact could be extraordinary. More lives lived in good health, fewer complications, and a stronger, more productive economy.
EF: Is there a final message you would like to share with our readers from your experience in the pharmaceutical sector?
SN: Our responsibility extends beyond medicines. It is to ensure that every South African, regardless of income, geography, or insurance status, has a fair opportunity to live a longer, healthier life. Progress only counts when everyone benefits. That is the future we are building.
