A new report published by the World Health Organization (WHO) finds that high prices, low availability of human insulin, few producers dominating insulin production, and weak health systems are the main barriers to universal access to insulin.
“One out of every two people needing insulin for type 2 diabetes does not get it. Diabetes is on the rise in low- and middle-income countries, and yet their consumption of insulin has not kept up with the growing disease burden,” the WHO said.
The WHO also said that while three out of 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.
The barriers to greater access include:
- The global market shift from human insulin, which can be produced at relatively low cost, to the pricier analogues (synthetic insulins), which are at least 1.5 times more expensive than human insulins
- Relatively few, or three, multinational companies that control more than 90% of the insulin market
- Suboptimal regulation and policies, including suboptimal pharmaceutical pricing approaches, weak procurement and supply chain management, insufficient financing to cover demand, and overall weak governance are affecting access to insulin and related devices, such as monitoring and delivery devices, in all countries
- Insufficient health system capacity and infrastructure, including a lack of service integration at the primary care level, inadequate capacity for providing diabetes care and ensuring supply continuity and infrastructure for information management, supply management, and local production of insulins are widespread challenges in lower-income countries
The report suggests actions to improve access to insulins and related products, including:
- Boosting human insulin production and supply and diversifying the manufacturing base for biosimilar analogue insulins to create competition and reduce prices
- Improving affordability by regulating prices and mark-ups, using pooled procurement, and transparency in the way prices are set
- Promoting local manufacturing capacity in under-served regions
- Promoting R&D centered on the needs of low- and middle-income countries
- Ensuring that increased access to insulin is accompanied by prompt diagnosis, and access to affordable devices for blood sugar monitoring and injecting insulin
