ACCISS Study Reveals Numerous Barriers Hindering Access to Insulin for Millions in Need

(Press release | 7 April, 2016 | Download PDF)

GENEVA—A number of barriers are impeding access to insulin around the world, according to new research published today by Health Action International, Geneva University Hospitals/University of Geneva and Boston University School of Public Health.

The findings, released on diabetes-focused World Health Day 2016, are the result of an extensive review of the global insulin market under the Addressing the Challenge and Constraints of Insulin Sources and Supply (ACCISS) Study.

The review found that:

  • Three companies (Eli Lilly, Sanofi and Novo Nordisk) control almost 90 percent of the US$20.8 billion global insulin market. In many low- and middle-income countries, particularly in sub-Saharan Africa, insulin is exclusively supplied by one or two of the big three manufacturers. They are also the sole providers of insulin products in most high-income countries in Western Europe.
  • There does not appear to be a lack of insulin supply; a global surplus of 67.6 million vials was reported in 2014.
  • Germany, Denmark and France collectively export between 85–96 percent of global retail insulin by value.
  • Around 60 countries have imported insulin from only one country for at least one year, making them vulnerable to disruptions in supply.
  • The price of insulin is 2.5 to 45 times higher than other non-communicable disease medicines and highly variable between countries. In a public facility, the lowest-paid, unskilled government worker must pay 2.5 days and 7.5 days of wages every month for 10ml of human insulin and analogue insulin, respectively. This increases to 3.5 days and 9.5 days of wages per month in a private facility.
  • Value-added taxes (VAT) on medicines, including insulin, ranged from 0 to 24 percent. Countries in Latin America (e.g., Argentina, Brazil, Paraguay and Uruguay) have the highest import tariffs on insulin, exceeding 10 percent.
  • There are no patents on human insulin. For analogue insulins already on the market, key patents have expired, or will soon expire. This is not the case for products still in development. Increased intellectual property protection on devices, which may tie individuals to certain types of insulin, is concerning.

“This study presents the first comprehensive overview of the insulin market in trying to understand why, almost 95 years after its discovery, insulin still fails to reach those in need,” said David Beran, co-investigator of the ACCISS Study from the University of Geneva/Geneva University Hospitals. “World Health Day offers an opportunity to spotlight the work of the ACCISS Study and highlight this important issue for the global health community.”

“The unaffordability of insulin for those most in need is a startling outcome of this work,” said Marg Ewen, co-investigator with the ACCISS Study from Health Action International. “This research shows that prices for insulin are highly variable around the world and continue to be a major barrier to access in many places.”

The research was released during a panel event in Geneva coordinated by ACCISS Study investigators and The Lancet Diabetes and Endocrinology to mark World Health Day 2016 which is focusing on the increasing global burden of diabetes.

The World Health Organization estimates that 422 million people worldwide have diabetes and its prevalence is growing in all regions. Insulin is essential for the survival of people with type 1 diabetes. It is also used to manage some cases of type 2 diabetes. Although insulin has been used in the treatment of diabetes for more than 90 years, at least half of those in need still cannot regularly access it.

The three-year ACCISS Study was launched in January 2015 to identify the causes of poor access to insulin, and develop policies and interventions to improve the situation. The research is co-led by Margaret Ewen at Health Action International, David Beran from the University of Geneva/Geneva University Hospitals and Richard Laing from Boston University School of Public Health.

The Study is funded by The Leona M. and Harry B. Helmsley Charitable Trust and Stichting ICF. The analysis is that of the authors alone and does not necessarily reflect the views of the funders.

Background materials:
The five new profile reports and fact sheets presented today regarding the insulin market, insulin tariffs and taxes, insulin prices, insulin patents and insulin trade are available on the Health Action International website: http://haiweb.org/what-we-do/acciss/research-findings/.

For further information or comment, please contact the press office.

 

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