Diabetes Control: Report Highlights Barriers To Insulin Availability, Suggests Actions To Promote Access

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By; MATTHEW UKACHUNWA, Lagos

It is regrettable that 100 years after its discovery, insulin is still out of reach for many people who are living with diabetes.
In order to tackle this problem, new World Health Organization (WHO) report has mapped barriers to insulin availability and suggested actions to promote universal access.
The new report which was published by WHO in the lead-up to World Diabetes Day highlighted the alarming state of global access to insulin and diabetes care.
The report found that high prices, low availability of human insulin, few producers dominating the insulin market and weak health systems are the main barriers to universal access.
“The scientists who discovered insulin 100 years ago refused to profit from their discovery and sold the patent for just one dollar,”  WHO Director-General, Dr Tedros Adhanom Ghebreyesus, said. “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.”
Insulin is the bedrock of diabetes treatment – it turns a deadly disease into a manageable one for nine million people with type 1[i] diabetes, WHO stated. 
“For more than 60 million people living with type 2 diabetes, insulin is essential in reducing the risk of kidney failure, blindness and limb amputation,” WHO wrote in a news statement dated 12th November 2021.
According to the international authority on public health, one out of every two people needing insulin for type 2 diabetes does not get it. 

WHO said that 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 report highlighted that 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 per cent of the revenue from insulin sales.

“Keeping the 100-year-old promise – making insulin access universal, published today to commemorate the 100th anniversary of the discovery of insulin, spotlights the main causes for the gaps in global access to insulin as,” WHO said on the 12th of November.
It disclosed that the global market shift from human insulin, which can be produced at relatively low cost, to the pricier analogues (synthetic insulins) is imposing an untenable financial burden on lower-income countries. 
“In general, human insulin is as effective as analogues, but analogues are at least 1.5 times more expensive than human insulins, and in some countries three times more expensive;
Three multinational companies control more than 90% of the insulin market, leaving little space for smaller companies to compete for insulin sales,” WHO declared.
It explained that 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.
In addition, itnsufficient 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 United Nations (UN) organ said.

“Research is geared towards wealthy markets, neglecting the public health needs of low- and middle-income countries, which account for 80% of the diabetes burden.
“The pricing landscape is also uneven and reveals a lack of transparency in the way prices are set, according to the report. For example, biosimilar insulins (essentially generic versions) could be more than 25% cheaper than the originator product, but many countries, including lower-income ones, are not benefitting from this potential saving,” WHO clarified.
The report suggested that several actions to improve access to insulins and related products, included: Boosting human insulin production and supply and diversifying the manufacturing base for biosimilar analogue insulins to create competition and reduce prices.
Other initiatives are to improve affordability by regulating prices and mark-ups, using pooled procurement and improving transparency in the way prices are set.
WHO said that promoting local manufacturing capacity in under-served regions, promotingresearch and development (R&D) centred on the needs of low- and middle-income countries as well as ensuring that increased access to insulin is accompanied by prompt diagnosis, and access to affordable devices for blood sugar monitoring and injecting insulin has become essential.

“Use health resources wisely by selecting human insulin where possible and allocate adequate funding to provide a full package of care,” WHO advised.
It pointed out that it has accelerated efforts to address some of the barriers to the availability of insulin and related medicines and health technologies through a series of dialogues with business associations and manufacturers of these products. 

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