Insulin is still out of reach for many people with diabetes, a new report by the World Health Organization has said.
Keeping the 100-year-old promise: making insulin access universal reports the main barriers to universal access are high prices, low availability of human insulin, few producers dominating the insulin market and weak health systems.
The report, published for World Diabetes Day yesterday (14 November) and to commemorate the 100th anniversary of the discovery of insulin, found that one out of every two people needing insulin for type 2 diabetes does not get it.
While diabetes is on the rise in low- and middle-income countries, their consumption of insulin has not kept up with the growing disease burden, and while three in four people affected by type 2 diabetes live in countries outside of North America and Europe, they account for less than 40% of the revenue from insulin sales.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: “The scientists who discovered insulin 100 years ago refused to profit from their discovery and sold the patent for just one dollar.
“Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps. WHO is working with countries and manufacturers to close these gaps and expand access to this life-saving medicine for everyone who needs it.”
The report says among the main reasons for gaps in global access to insulin are the that the global market shift from human insulin, which can be produced at low cost, to the pricier analogues is imposing an untenable financial burden on lower-income countries.
It points out that three multinational companies control more than 90% of the insulin market, but suboptimal regulation and policies, weak procurement and supply chain management, insufficient financing to cover demand, and overall weak governance all affect access to insulin.
The authors also warn that lower-income countries are constrained by insufficient health system capacity and infrastructure, supply management, and lack of local production of insulin.
Among the actions to improve access to insulin, the authors say human insulin production and supply should be increased to create competition and reduce prices. They also call for prices and mark-ups to be regulated to improve affordability, while local manufacturing should be promoted in under-served regions.
The report also adds that research and development should centre on the needs of low- and middle-income countries.
Following WHO pressure, the industry has committed to a number of actions, including developing a policy blueprint for improving access to biosimilars of insulin; taking part in WHO’s prequalification programme for insulin, glucose metres, test strips and diagnostic tools; and participating in international/UN pooled procurement or aggregated demand mechanisms.
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