Bridging the gaps: Making insulin and diabetes drugs more accessible in the Pacific

The Western Pacific currently has the highest rates of diabetes in the world, with Pacific island countries and areas (PICs) hardest hit. Some of these small island nations face nearly double the global burden of diabetes, but steady access to the lifesaving treatments needed to manage this chronic condition is often out of reach.

As set out in a new paper from the Access to Medicine Foundation, Tackling the diabetes care crisis in the Pacific: Insulin and medicine access, the longstanding access issues in PICs are underpinned by complex and unique factors. Their sheer geographic remoteness alone, only to be coupled with small populations who require relatively low volumes of medicines, present commercial and logistical complexities for both companies and procuring governments. 

However, there are commercial routes and distribution mechanisms in place that can improve the availability and affordability of diabetes treatments in PICs – if they are effectively utilised. 

By examining how these mechanisms are currently being used to bring insulin, metformin and other diabetes medicines to market in nine PICs covered by the Foundation’s research – Kiribati, Marshall Islands, Federated States of Micronesia, Papua New Guinea, Solomon Islands, Samoa, Tonga, Tuvalu and Vanuatu (encircled in the map above) – the Foundation identifies key issues that need to be addressed to bridge the access gaps in the region. 

When the medicine is there, quality, availability, and affordability aren’t always consistent 

For medicines to be made commercially available in a market, pharmaceutical companies need to register them through a national regulatory authority (NRA) to ensure the product is safe, effective and of good quality before it can be used. Of the nine PICs, only Papua New Guinea has an NRA, but, to date, no insulin or other diabetes medicines have been filed for registration in the country by any of the large research-based pharmaceutical companies or generic and biosimilar medicine manufacturers covered by the Foundation’s research. 

In the absence of registration, insulin, metformin and other diabetes medicines are made commercially available primarily through import waivers, which allow for medicines to be procured from wholesalers. While import waivers are a critical lifeline in the supply of these medicines in PICs, the quality and consistency of supply can vary significantly and stockouts are common – leaving many without reliable access to the medicines they need. To ensure quality, some governments do utilise regulatory reliance to conduct quality controls on products procured via import waivers – whereby a country utilises the assessment performed by another country’s NRA or external authority for quality assurance. 

In addition to logistic and geographic challenges, many governments in PICs have limited financial resources for healthcare, making it difficult to secure enough quality-assured medicines to serve their populations’ needs.  

In fact, affordability remains an underlying challenge to expanding access efforts in diabetes care – an issue echoed in the Foundation’s, Access to diabetes care for children and young people: Pharma companies’ current actions and opportunities ahead (May 2025 report). This report shows that some governments in low- and middle-income countries (LMICs) have started to take ownership of elements of diabetes care by, for example, partially or fully reimbursing certain diabetes care medicines. While governments in PICs are also doing this, financial constraints limit their ability to subsidise costs in a way that can ensure all patients living with diabetes can receive the care they need. Insulin from multinational pharmaceutical companies, for example, is currently only available in limited quantities whereas metformin – used by type 2 diabetes patients – is largely available. 

Where can we go from here? 

Solving the unique access challenges faced by PICs will require targeted action, including streamlined efforts from pharmaceutical, companies, governments in PICs and in the region, as well as stakeholders in the field of diabetes care. In acting, there is also scope for these players to form innovative partnerships.  

As set in the Foundation’s paper, these stakeholders now need to focus on increasing and optimising current efforts to ensure the efficiency of supply; stringent safeguarding of quality-assured products; and securing the financing to ensure consistent quantities of quality-assured medicines can reach the people living with diabetes across PICs.  

Through its Access to Medicine Index, Diabetes Care and Generic & Biosimilar Medicines Programmes, the Access to Medicine Foundation will continue to monitor access progress across the diabetes continuum of care, as well as other therapeutic areas covered by our work.