A global perspective on the issue of access to insulin

Abstract

The discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO’s framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients’ abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes. Graphical abstract

Transforming type 1 diabetes: the next wave of innovation

“…There continues to be a huge disparity in therapeutic options available to people with type 1 diabetes and tremendous region-and country-specific differences in diabetes-related outcomes. Despite the introduction of a slew of newer insulin analogues and the development of biosimilar insulins, the insulin supply chain remains highly fragmented and reliable global access to affordable insulin for people with type 1 diabetes remains uneven, even in some wealthy nations [23].…”

Celebrating 100 years of insulin

“…In fact, globally, only one in two people have access to the insulin they require. In their review, Mbanya and colleagues [3] present the different barriers to insulin access using a framework proposed by the WHO that looks at the whole pathway of a medicine, from its discovery until its use. The obstacles faced by individuals in accessing insulin are complex and occur at both global and national levels; the authors propose that major changes at societal and political levels are needed to overcome these, as well as more international collaborations.…”

Centenary of the discovery of insulin: People with diabetes in Africa still have poor access to insulin

“…Insulin is a complex biological product that requires specific expertise to manufacture to ensure high quality, safe and efficacious product and this has led to the monopoly held by three multinational companies who control over 95% of the global insulin supply [1]. There have been developed many forms of insulin over the years.…”

“…Lack of expertise on insulin use among health care providers especially in peripheral settings affects insulin prescription. Misperceptions around insulin being a medication of "last resort" for patients with T2D combined with fear of hypoglycaemia affect insulin acceptance [1]. The use of insulin remains a major issue in Africa where poor diabetes knowledge, traditional beliefs, use of traditional medicine and low socio-economic status act as barriers [1].…”