Know the Facts – Become 100% informed about access to insulin

  • ♦ Insulin was first used to treat a person living with diabetes in 1922
  • ♦ Insulin has been available for 92 years and is recognized as an Essential Medicine by the World Health Organization (WHO)
  • ♦ Globally the most common cause of death for a child living with Type 1 diabetes (T1D) is a lack of access to insulin
  • ♦ Insulin is the only medicine currently considered to be an effective treatment for T1D– and when combined with the appropriate education, care and support, can help people living with T1D live long and productive lives.
  • ♦ The life expectancy of a child living with T1D can be as low as one year (compared to an average life-expectancy for a child diagnosed in parts of Europe and the US).
  • ♦ The cost of treatment of T1D can push poor families around the world further into poverty as any savings may quickly disappear as costs are on-going and increase if a child becomes unwell through a lack of sufficient insulin or other resources.  In some countries, the cost of insulin can consume a minimum of 25% of a family’s income or more.

Why are 1 in 2 of those in need still not getting access to insulin?

There are multiple barriers to access that can create situations where insulin is not readily available to those whose lives depend on it. These barriers exist at both the national and global levels and none can be looked at in isolation. Below are listed some of these issues. Much of this list was taken directly from the ACCISS Study Factsheet: Inequities and Inefficiencies in the Insulin Market. To download it, please click here.

Market Domination

  • ♦ It is believed that market domination of the global insulin market by three multi-national companies may be one of the reasons that the price of insulin has remained so high over the years. These companies control 99 percent of the insulin market value and 96 percent of its volume.This domination has led to withdrawals of certain insulin formulations, as well as shifts in the insulin market.

Rise in Use of Analogue Insulins

  • ♦ The use of the higher-priced analogue insulins continues to rise. In 2009 (the last year for which data is available), analogues represented two-thirds of all insulin in high-income countries and trends in middle- and lower-middle-income countries followed suit. In the United Kingdom (UK), spending on analogue insulin jumped from 12 percent of total insulin costs in 2000 to 85 percent in 2010.

Tax on Insulin

  • ♦ Fifty-five percent of countries reported charging a tax on insulin.The average tax was 13 percent and Mongolia charged the highest tax (30 percent).

Burdens on Health Systems

  • ♦ In many countries T1D remains unreported to governments contributing to the invisibility of the disease and resulting in limited national data for advocacy.
  • ♦ Some countries only purchase insulin once a year; therefore, errors or changes to need estimates can be costly. They lead to supply shortages or countries having to pay higher prices through local wholesalers.
  • ♦ Insulin places high financial burdens on health systems. Data from Mozambique, Zambia, Mali, Nicaragua, Vietnam and Kyrgyzstan from the mid-2000s shows that the annual cost of purchasing insulin for the health services represented an average of 40 times the annual public sector pharmaceutical expenditure per person

Wild Range in Availability

  • ♦ Availability of insulin is critical for treatment of diabetes because it must be taken daily. A 2012 Health Action International study revealed a huge range in availability—from 3.3 to 100 percent in the public sector to 4.8 to 56.7 percent in the private sector.
  • ♦ Poor availability in the public sector forces people to purchase insulin in the private sector, often making it unaffordable and out of reach. In Zambia, for example, the price of insulin is US$18.20 per vial in the private sector—almost 10 times the price of insulin in the public sector.

Affordability to the User

  • ♦ In many developing countries, diabetes and the cost of insulin place a huge financial burden on people living with diabetes and their families. For example, in 2005 the median annual cost for a child with type 1 diabetes in Sudan was US$28311, representing 32 percent of GDP per capita.
  • ♦  HAI’s snapshot survey found that the price an individual with diabetes would pay for a vial of human insulin in the private sector range from US$1.55 in Iran to US$76.69 in Austria— a difference of almost 5,000 percent.
  • ♦ With the increased use of analogues, out-of-pocket expenditure for insured people with type 2 diabetes in the US increased from a median of US$19 in 2000 to US$36 in 2010.
  • ♦ Affordability issues can be seen globally, for example, insulin discontinuation was the leading precipitating cause of DKA (keto-acidosis) in 68% of patients in inner-city Atlanta, USA. Among those who stopped insulin, 27% reported lack of money to buy insulin

Conflicts of Interest

  • ♦ "The approaches to management that are so heavily advocated by the research based drug industry are not just irrelevant to diabetes care in low income countries, but are actually counterproductive," Professor Jon Yudkin (Emeritus Professor of Medicine, UCL & Founder of IIF).
  • ♦ Through more than a decade of work in the diabetes arena, the 100 Campaign has identified the role of insulin-producing pharmaceutical companies and their influence within the diabetes field to be a major part of the global access to insulin problem.  The 100 Campaign see these relationships as conflicts of interest that prevent such organizations from advocating for the rights of people with diabetes globally since they do not wish to bite the proverbial hand that feeds them.
  • ♦ Much like the movements behind access to antiretrovirals for people living with HIV in South Africa in the 1990s, the 100 Campaign believes that consumer pressure can and must encourage pharmaceutical companies to pay serious attention to issues of accessibility and affordability of insulin, and prioritize social responsibility, not just profit, in these growth markets.
  • ♦ The 100 Campaign will not receive any funding from the pharmaceutical industry and will never use funds for the purchase of insulin or other diabetes-related supplies.
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