Science / Healthcare

Worldwide Access to Insulin Falls Short

Type 1 Diabetes is a chronic condition that, with current technology and a strong education, is manageable, yet remains the eighth leading cause of death worldwide. In individuals with Type 1 Diabetes, the pancreas does not produce the insulin needed to allow sugar to enter the cells and produce energy. A diagnosis with diabetes used to be a death sentence, but today individuals can maintain healthy lives through insulin therapy and an excellent education and support system. Therefore, because insulin “satisfies the priority health care needs of the population” it is classified as an “essential medicine” by the World Health Organization. According to the WHO, “Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.” Therefore, by definition, it is unacceptable and a severe violation of human rights that many people with diabetes still lack access to insulin. It is shocking that, globally, a lack of insulin is the most common cause of death for an individual with Type 1 Diabetes.

While insulin has been available for ninety years, some people still do not have access to the life-saving resource. Insulin was discovered in 1922 by Dr. Fredrick Banting and Charles Best and, as a result, Type 1 Diabetes became a condition with which an individual could live and thrive. This was a miraculous advancement, and since then the production of insulin and technologies used to administer it have greatly improved. However, a large population still does not have access to a basic supply of insulin necessary to keep them alive. There is a network of barriers that prevent this access including high prices, a dearth of medical facilities and professionals, the impediment of low socioeconomic status, and inadequate health policies.

In many countries, namely low and middle-income countries, there are not nearly enough hospitals and doctor’s offices properly equipped to help treat a diabetic patient. For example, in Mozambique, there are about one million people per hospital. This ratio makes it extremely difficult for patients diagnosed with Type 1 Diabetes to receive adequate care. In addition many people have to travel great distances to get to the nearest healthcare facility; in fact, the majority of patients travel one to two hours to get to their nearest doctor’s office. This prohibits many who are not able to afford the trip and is one of the major costs of managing the disease. Travel costs can constitute anywhere from twelve percent of the total cost of managing the disease as in Mali to sixty-one percent in Mozambique. Furthermore, there is an appalling lack of healthcare workers. There are only two endocrinologists, or doctors specializing in diabetes, Mozambique, Mali, and Zambia. Additionally, in Nicaragua and Vietnam, specialists are concentrated in large urban areas, thereby depriving those who lived outside these areas of proper medical care.

The reality of living with diabetes in the United States is in great contrast with living with the disease in other parts of the world. I, for example, have experienced a very different reality of living with diabetes. In comparison to Mozambique, in the United States there are about 56,000 people per hospital. Travel times are much shorter for the average American in comparison to travel times in most low and middle-income countries. Furthermore, there are about 1000 endocrinologists in the United States, a much more favorable statistic, but one that still represents a serious shortage.

Additionally, the lack of medical care is correlated with a lack of education on how to manage the condition. Education is just as important as insulin in diabetes management. One must understand how much insulin to inject, how exercise affects blood sugars, how to properly test blood sugar, and much more. A lack of guidance is detrimental to the health of a person with Type 1 Diabetes.

The barriers to caring for diabetes in these countries have severe consequences on the lives of those who are diagnosed with this disease. Paying for insulin makes up a large percentage of per capita income for families; in Zambia it makes up twenty-one percent, while in Mali it makes up sixty-one percent. Many simply are not able to pay for the proper medicine. In Nicaragua an estimated one in five people with diabetes are receiving treatment. Furthermore, the obstacles result in high mortality rates for children.  In the United States, ninety-eight percent of Type 1 patients in the United States survive six years after being diagnosed. In contrast, one percent of children with type 1 diabetes survive six years in sub-Saharan Africa. Fifteen percent of children in the pre-insulin era, where the treatment entailed extreme diets, survived for six years after diagnosis. Without exacting treatment, diabetes results in many severe complications such as blindness, foot neuropathy, amputations, kidney disease, an increase in risk for heart attacks, and depression. These statistics are alarming and point to the outcome of problematic health care policies and monopolization by pharmaceutical companies.

Pharmaceutical companies have a lot of the power in determining the accessibility of insulin. Currently this power is not being harnessed in a positive way. The main reason that insulin is so expensive is that about eighty percent of the global insulin market is controlled by three pharmaceutical companies. The market is heavily monopolized because of the insurmountable barriers companies face entering the marketplace.

Ensuring that all people have access to the medicine they need should be a top priority of the world’s leaders. The hope in the midst of the current situation is that many individuals are noticing the dire nature of the issue. Recently, many grassroots organizations have sprung up to address the issue of accessibility to insulin such as the 100 Campaign, AYUDA, the Big Blue Test, and the International Insulin Federation. Furthermore, researchers in Geneva and Boston have announced a new study that will map the global insulin market from the angle of insulin manufacturers, regulatory barriers, and patents. While these organizations and researchers are making positive steps in improving access, big pharmaceutical companies and international governments are not taking the steps that they have a responsibility to take in order to ensure the right to health care that each individual deserves.