Universal availability of insulin yet to be achieved.

By: Recruiter | 3 Feb 2014

There are fewer than nine years to go before the centenary of insulin’s introduction in 1922, but David Beran is not ready to celebrate. He faces a long battle to meet the objective of the 100 Campaign, which seeks to make the product available universally by the time of the anniversary. “There are very poor levels of access in low- and middle-income countries – and even in richer ones,” says Mr Beran, a researcher at the University of Geneva’s faculty of medicine, and an adviser to the board of the International Insulin Foundation, which created the 100 Campaign.

He laments the lack of systematic data on access to diabetes care, while pointing to unequal access around the world between countries, regions and those on low incomes. As health systems struggle everywhere to meet the costs of the rising burden of diabetes, he laments the drive by pharmaceutical companies to focus on more expensive, innovative products. John Yudkin, emeritus professor at University College London, agrees. Both men argue for a “focus on the basics”, with greater efforts to distribute human insulin widely. Instead, they observe a shift towards more sophisticated, long-acting analogues which they say are far more expensive while offering only modestly improved patient compliance.

As the two academics write in a recent joint article inThe Lancet: “resources are being wasted on products that show only small benefits, while people are not benefiting from a product that was first used some 90 years ago”. But Lars Sorensen, chief executive of Novo Nordisk, one of the world’s largest diabetes companies, says just such a shift towards greater access to more affordable products is taking place in both lower-income and richer countries. Alongside stepping up supplies of cheaper human insulins in the developing world, he has more recently taken a similar tack in countries such as Greece, hit by the difficulties in paying for more expensive analogues after the 2008 financial crisis.

Doing so has also reduced the risk of the product “diversion” he fears if Novo Nordisk discounts its analogue insulin, which is then re-exported by Greek traders to other European countries, undercutting prices elsewhere, while still depriving local patients of supplies.

In poorer parts of the world, he distinguishes between the public purchasers, with governments such as Brazil arranging substantial tenders at low prices for high volume sales, and the richer patients in the emerging economies, who pay directly for premium-priced products. He is currently experimenting in Kenya with a maximum price printed on his product to control mark-ups. “I can probably offer insulin to the public system at 25 cents a day,” he says. “But it typically disappears and reappears in private distribution marked up to $5 a day,” he adds. But Mr Sorensen says just as much effort is required with companies producing glucose monitoring meters and replacement test strips, which are more expensive than insulin supplies.

On that issue, as well as the need for strengthened health systems with more staff to provide prevention advice, diagnosis and support, he can agree with the pharmaceutical industry’s critics. There is also universal agreement about relative prospects across the world. “Emerging markets are where everybody in the pharma industry is looking with enthusiasm,” says Prof Yudkin. “There is growth in India and China, especially at a time of shrinking possibilities in the US and the industrialised world because of financial rigour.”