By Semini Beragama
The successful discovery and innovation of medicines and medicinal procedures is, undoubtedly, one of humanity’s biggest triumphs. Treating otherwise detrimental, life-defining illnesses not only has the power to transform individual lives, but redefine society. These researchers and innovators are heroes, but we must bear in mind that the discovery of a medicine is simply the first—not the only—step to changing lives. In fact, there are numerous obstacles and barriers that follow the discovery of medicines, and they primarily pertain to the socioeconomic structures that hinder an individual’s ability to access it in a fair, affordable manner. This is predominant in low- and middle-income countries (LMICs), where the vast majority of individuals who need insulin and other forms of diabetes care, do not have access to it. For instance, in sub-Saharan Africa, only one out of every seven diabetics is able to access insulin—leaving six in seven with inadequate treatment. And this is still as prominent as ever, 100 years after the discovery of insulin.
Developing the WHO’s Framework
The World Health Organisation (WHO) attempts to detail the many socioeconomic barriers to accessing a medicine, following its discovering, presenting each as a stage in the “life-cycle” of a medicine. Research and innovation are the first stage, and when it comes to insulin, there is still a recognizable need for improved methods of administering it to patients. On the other hand, the second stage (manufacturing) details the lack of competition that exists for the three large multinational companies that comprise the insulin market. The lack of a choice for consumers means that prices are often higher than they need to be. Additionally, government procurement prices are often much higher than the production costs. Insulin is a biological product, meaning that the manufactured product must undergo testing and must prove to meet regulatory standards before it can be accessed. Unfortunately, but unavoidably, this introduces further costs. Worse, LMICs don’t always have the ability to assess the necessary data for biological products.
Both pricing and reimbursing of the medicine are highly dependent on a given country’s policy, but in LMICs, prices are often set by the market itself and government intervention has little to no influence. Additional storage and transportation costs after insulin is purchased by centralised tenders may be introduced. When it comes to prescribing insulin, some health-care providers were only trained in dealing with analogue insulin and not human insulin, thus giving rise to a “fear” of prescribing insulin. Some people try to overcome the high costs of insulin by taking less than the required dose, so as to save it for later. Evidently, they do not end up receiving the full treatment that is necessary for best results.
Overcoming Barriers to Access
The Prequalification Programme, developed by the WHO, aims to evaluate the quality and standards of anti-retroviral products. This would mean that smaller businesses/companies can submit their product to the WHO for this type of quality assessment. Such initiatives will hopefully increase competition in the insulin market while maintaining high standards for the products accessible to the public. The Sustainable Development Goals proposed by the United Nations targets universal health coverage as a means for encouraging countries to cover the costs of insulin and other diabetes care necessities. At the end of the day, these global inequalities really are the products of societal attitudes, ignorance, and preoccupation with personal gain. And organizations and initiatives that aim to foster change through funding and awareness, are vital to overcoming these barriers to fair and equal access to insulin.
1. D. Beran, M. Lazo-Porras, C. M. Mba, J. C. Mbanya. A global perspective on the issue of access to insulin. Diabetologia (2021) 64:954–962. https://link.springer.com/content/pdf/10.1007/s00125-020-05375-2.pdf