The road to 2030: What will it take to bring insulin within reach of all who need it?

For people living with type 1 diabetes, insulin is not optional. It is a lifeline. Yet more than a century after its discovery, affordable, reliable access remains a major global health challenge. In low- and middle-income countries (LMICs), an estimated 7.2 million people live with type 1 diabetes, but only 3.8 million are receiving insulin [Source: Insulin Market Memo, CHAI]. Roughly half goes without.

In 2022, the world made a promise. At the 75^th World Health Assembly, World Health Organization (WHO) Member States endorsed global targets stating that by 2030, everyone living with type 1 diabetes should have access to affordable insulin and the means to monitor their blood glucose.

With just over four years left, the question is whether we are on track to keep this promise.

The answer depends partly on a market that is both highly concentrated and changing fast. Lilly, Novo and Sanofi still control the global insulin market: they produce 83% of the insulin sold in LMICs, where they hold approximately 95% of the market share. At the same time, some companies are now slimming their insulin portfolios and phasing out older products. In such a concentrated market, these decisions matter: a single product withdrawal can leave health systems and people living with type 1 diabetes in LMICs with few alternatives to turn to. The 2026 Access to Medicine Index shows where attention is going: innovation is shifting towards GLP-1s and other incretin-based therapies. Across the R&D pipelines of the 20 companies assessed, 25 projects target diabetes, yet only ten of those target type 1.

As companies shift their priorities towards newer diabetes and obesity treatments, this must not come at the expense of access to existing insulin products. Human insulin remains a foundation of diabetes care in many LMICs and is generally more affordable than newer insulin analogues, which offer important benefits for some patients. Ensuring access to both is critical.

There are, nonetheless, encouraging signs of movement. While the market remains concentrated, the manufacturing base is slowly, but surely broadening, potentially creating more supply options, more competition on price and less reliance on any single company. WHO’s recent mapping identifies 22 full-chain manufacturers worldwide, able to produce insulin from crystal to finished product. Only three of them have ever sold into a stringently regulated market, so while the technical know-how is being developed, quality assurance is still catching up – but that too is beginning to shift. In October, WHO prequalified Gan & Lee’s insulin glargine, the first biosimilar glargine on the list. While prequalification can open the door to procurement, wider access in LMICs will depend on where Gan & Lee registers and supplies it, and at what price.

There are also early efforts to bring manufacturing closer to the markets where insulin is needed. Over time, these efforts could strengthen supply chain resilience and improve supply security for regions and countries that today depend on just a few global suppliers. In Egypt, Eva Pharma secured approval for locally made insulin glargine in December 2024 and now produces human insulin too, with Lilly supplying the active pharmaceutical ingredient (API) at reduced cost and transferring technology pro bono. In South Africa, Aspen released its first commercial batches of human insulin in May 2026 under a contract manufacturing agreement with Novo. In Brazil, Biomm already formulates and fills glargine using Gan & Lee’s API, and Bio-Manguinhos is building a plant to make the API itself. These are meaningful steps towards a more diverse and resilient insulin supply, but they remain early and modest in scale.

Manufacturing capacity alone, however, does not guarantee access. New products must still secure regulatory approval, enter procurement systems and reach patients at affordable prices. Governments have a central role to play here. By creating the right regulatory, procurement and health system conditions, they can help ensure a broader manufacturing base translates into real benefits for patients: more competition, lower prices and more reliable supply.

Established manufacturers also have a responsibility to close the access gap. Lilly, Novo and Sanofi have introduced a range of initiatives, from pricing commitments and access programmes to technology transfer and health system support, including new business models designed specifically to reach underserved populations. In September, Lilly announced its Change the Course Commitment, pledging to reach as many people in LMICs as in high-income countries with its innovative diabetes and obesity medicines before 2040. The commitment centers on Lilly's newer diabetes and obesity medicines, and its full product scope has not yet been disclosed, with only Lilly's oral GLP-1, orforglipron, named so far.

Commitments of this ambition are welcome, and more companies should be willing to put concrete targets on the table. But commitments must be matched by evidence of delivery. After years of industry initiatives, there is still limited publicly available evidence of how many people have gained access to affordable insulin – and of those how many are living with type 1 diabetes. So, what will it take for these efforts to reach the millions of people living with type 1 diabetes by 2030? Three areas demand attention:

1. Sufficient and diversified supply

Universal access depends first on enough insulin being made and on it reaching the countries that need it. Diversity matters as much as volume: when supply rests on a handful of producers, a single commercial decision or production failure becomes a national stockout – and for people living with type 1 diabetes, going without insulin is not an option.

2. Access that survives portfolio shifts  

Second, reaching the volumes needed is not only a question of scaling up emerging manufacturers. New supply counts for little if existing supply is withdrawn at the same time. The people relying on insulin do not stop needing it when it stops aligning with a company’s commercial priorities. Where people depend on a company’s insulin, that company has a responsibility to keep it flowing – or to ensure another manufacturer can.

Withdrawing a product should be a last resort, not a routine portfolio decision. Where a company does decide to exit a market, it should plan that exit as carefully as it would an entry: giving advance notice so procurers can switch suppliers and clinicians can prepare patients for a change of treatment, and, where possible, technology transfers to a local manufacturer that can keep serving the market.

3. Accountability for patient reach

Finally, if these four years are going to count, progress has to be measurable. Units shipped and programmes launched tell us what companies are doing; only patient numbers tell us who is being reached. That means publishing patient reach data broken down by condition, country and product – how many people living with type 1 diabetes are receiving insulin, and where – in a form others can verify. Numbers like these do more than measure how many people companies are reaching. They also show who is not being reached, so that efforts can be better targeted towards those still being left behind.

At the Access to Medicine Foundation, we will be tracking all three areas: whether supply is sufficient and diversified, whether it is sustained in the face of portfolio shifts, and whether real patient reach numbers are published. Insulin has been within humanity’s reach for over a century. Together, we can make good on the promise to put it within everyone’s.