[Salon] A century of insulin inequity

[Chas Freeman <cwfresidence@gmail.com>]

https://www.bloomberg.com/news/newsletters/2022-10-07/the-hope-for-affordable-insulin?cmpid=BBD100722_prognosis

A century of insulin inequity

Here’s a sad truth: despite the devastating consequences of diabetes, there is a persistent gap in the world’s access to insulin, the hormone that regulates blood sugar levels, almost a century after the medicine was discovered.

Unsurprisingly, low and middle-income countries are the ones left behind, according to a report by non-profit Access to Medicine Foundation. That’s even though three out of every four adult diabetes patients worldwide come from these nations.  

The report lists 24 countries where there is simply no insulin registered with regulators.  

The foundation’s chief executive, Jayasree K. Iyer, says the pharma industry is in part to blame for its “shortsightedness.”  

“A lot of companies always have the US-and-Europe first mentality,” she says. “That makes a chronic problem even more exacerbated.”
 

A selection of Novo Nordisk branded insulin. Photographer: Erin Kirkland/Bloomberg

Eli Lilly, Novo Nordisk and Sanofi, which control about 90% of the world’s insulin market, do make efforts to improve access in poor countries, such as offering discounts or making donations, but the approach doesn’t give governments a long-term, reliable solution for drug access. And it often leaves out newer medicines like the more expensive analogue insulins. 

But there’s hope that things might finally be about to change. Patents on some of the analogue insulins developed by big pharma companies have either expired or will do so soon. That should usher in a flurry of cheaper products -- think generics, except for this type of drug they go by the name biosimilars. 

Indian and Chinese manufacturers including Biocon and Gan & Lee Pharmaceuticals are major developers of biosimilar insulins, and could play a role in broadening access, according to Access to Medicine. Competition from smaller players can sometimes force big pharma to lower prices on their branded products, the report said, citing Bangladesh as an example. 

The World Health Organization is also trying to help. It started a review framework for biologic medicines such as insulins in 2019, which can provide a stamp of approval for safety and efficacy for countries lacking the sophistication to clear medicines on their own. 

The Covid-19 pandemic has shown the world how up-and-coming drugmakers can change things for the better. Chinese vaccine makers and the Serum Institute of India provided shots to developing countries while the potent mRNA vaccines were largely divvied up among rich nations. So here’s hoping that insulin is next — Dong Lyu