March 7, 2016

Advocacy to Improve Global Access to Insulin

I say advocacy, but the title of the article is call for action. Either way this means that people around the globe often cannot get access to insulin 95 years after the discovery of insulin. This needs action to prevent this being a continuing problem when insulin reaches its century mark in 2021.

More effort needs to be devoted to ensuring people with diabetes have access to insulin. This is the finding of a new in-depth review by three public-health experts. The document was published online February 5 in Lancet Diabetes & Endocrinology by David Beran, PhD, of the division of tropical and humanitarian medicine, Geneva University Hospitals and the University of Geneva, Switzerland, and colleagues.

Much attention has been given to the access of medicines for communicable diseases, think Ebola; however, access to essential medicines for diabetes, especially insulin, has had almost no focus. Very little has been done globally to address the issue of access, despite the [United Nation's] political commitment to address noncommunicable diseases and ensure universal access to drugs for these disorders,

Insulin is essential for the survival of people with type 1 diabetes and is needed for improved management of diabetes for some people with type 2 diabetes. But, today, nearly a century after its discovery, poor access to insulin translates to a life expectancy as low as 1 year following onset of type 1 diabetes in a child in sub-Saharan Africa.

The problem isn't limited to low- and middle-income countries: even in the United States, one study found that discontinuation of insulin use due to high cost was the leading cause of diabetic ketoacidosis in people in an inner-city setting (Diabetes Care. 2011;34:1891–1896).

The new paper outlines the complexity of the problem, including the economic, regulatory, and political aspects, and provides a call to action with potential remedies. The document is aimed at all stakeholders, including professionals who care for people with diabetes, Dr Beran told Medscape Medical News.

"Healthcare workers play an essential role in ensuring that their patients have access to insulin and the necessary education for its use. I also believe that in many settings they should also help advocate for people's access to insulin where this is problematic....The call to action applies for all those who are concerned about the well-being of people with diabetes," he stressed.

In WHO and Health Action International surveys, there is a huge range in the price paid for insulin by governments — across 10 studies, for example, the cost of a range of insulin formulations varied from $2.55 to $48.25 per vial.

The experts stress that insulin also needs to be available, both at a national level, something that can be assessed by the presence of insulin on national essential-medicine lists and guidance as to where insulin should be present, for example health centers vs. hospitals, and at a global level.

The global control of the insulin market by three multinational companies means that countries have a small number of suppliers to choose from, and this has often resulted in people having to change the type of insulin they take as companies have withdrawn formulations from the market or hiked up the price of insulin analogues.

At the same time, regulatory aspects around biosimilars have limited the availability of cheaper alternatives. The shift from use of vials to the more expensive patented pen devices also plays a role, the authors note.

In linking both the availability and affordability elements, only six of the countries surveyed would meet the WHO's 80% availability target of affordable insulin in the public sector, the authors note.

They also point out that insulin alone "is not enough for proper diabetes management, which also requires syringes, blood glucose meters, education, information, and family support."

This is a complex problem that needs support.

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