Expanding access to diabetes care for children and young people in LMICs
Project Syndicate op-ed: Insulin Belongs to the World
Diabetes is a growing issue, but access to treatment lags behind
Today, more than half a billion people around the world are living with diabetes, and this number is expected to hit three quarters of a billion in the next 20 years. Most of this increase will take place in low- and middle-income countries (LMICs). This rising disease burden threatens to put fragile healthcare systems under ever more strain.
Daily access to insulin is essential for survival for patients with type 1 diabetes, and also for many with type 2. Yet insulin products are often unavailable to the millions of diabetes sufferers living in LMICs – and when they are available, they may still be unaffordable. This is often compounded by a lack of access to other essential products for managing diabetes, such as blood glucose monitoring devices and testing strips.
The stark reality is that without better access to essential diabetes care, many more children and adults will suffer and die from this life-long, chronic disease.
The global insulin market is dominated by a few key players
The insulin market is dominated by just a handful of major players. Together, Eli Lilly, Novo Nordisk and Sanofi control over 90% of the global insulin market by value, and produce 83% of the insulin sold in LMICs.
In 2021, the World Health Organization (WHO) launched the Global Diabetes Compact, which identifies access to diagnostic tools and medicines – especially insulin – in LMICs as one of the most urgent areas where improvement is needed. The major producers of insulin therefore have a critical role to play in lifting the burden of diabetes for the world’s poorest citizens.
How we work to tackle the lack of access to diabetes products
Responding to the critical need to improve access to diabetes care in LMICs, we launched our dedicated stream of work on diabetes in 2022. It builds on the momentum of the Global Diabetes Compact and the WHO-spearheaded push to ensure that all people with the disease have access to quality care and treatment.
This stream of work draws on the Foundation’s long experience of mobilising healthcare companies to drive the uptake of good practices, and builds on our existing work on access to diabetes care. Since our first Access to Medicine Index was launched in 2008, we have included key medicines for diabetes, such as insulin, in our assessment of how pharmaceutical companies perform on ensuring access to essential products in LMICs.
As we move forward, we will use a blend of research and stakeholder dialogue to identify solutions for companies to expand access to insulin and diagnostics, informed by an in-depth assessment of current approaches.
Sharing insights and identifying solutions
In October 2022, we published a report outlining what the major insulin manufacturers are currently doing to address access to diabetes care in LMICs – and what still needs to be done. It found a range of strategies that were being used to expand access to the companies’ products, including insulin donation programmes, training programmes, and access-focussed pricing strategies.
However, these efforts do not yet address access issues at the scale necessary to change the overall picture. For example, the data showed an urgent need for companies to register their insulin products more widely with regulatory authorities in LMICs. The report also indentified opportunities for companies to pursue more systematic and sustainable approaches, and to address affordability issues and supply chain challenges.
What are pharma companies doing to expand access to insulin – and how can efforts be scaled up?Download
The report has been featured in major media outlets around the world, including Stat (USA), MO* (Belgium), Vanguard Nigeria, Forbes Mexico, and The Hindu (India). To turn insights from the report into tangible change, we have engaged with pharmaceutical companies, investors and global health policymakers.
Also central to our changemaking strategy is the Foundation’s ability to bring a range of key stakeholders together for dedicated roundtables and workshops to share insights and build consensus.
In July 2022, the Access to Medicine Foundation hosted an in-person expert session in Amsterdam focused on how to widen access to diabetes care in LMICs. In this full-day session, expert representatives from industry, public sector partners and global health organisations discussed practices and solutions for closing the gaps in access to diabetes care in LMICs.
A further workshop will be convened in 2023, with a focus on diagnostics and monitoring devices. In the coming years, we will continue to expand our efforts to move essential healthcare companies on access to diabetes care. in this way, we can help make diabetes a manageable condition for more sufferers worldwide.