Diabetes and the Need for Insulin

Insulin is a naturally occurring hormone that converts sugar, starches and other food into needed energy. People living with diabetes either no longer produce insulin (type 1 diabetes) or their bodies have become resistant to it (type 2 diabetes). For over 90 years those living with type 1 diabetes have relied on external insulin (currently available in bovine, human and analogue forms) to survive. Today, around 100 million people around the world need insulin, including all people living with type 1 diabetes and between 10-25 percent of people with type 2 diabetes (click here to read more about the estimates for type 2 diabetes). But globally, more than half of these people cannot afford and/or access this much-needed medicine. Without access to insulin, people living with type 1 diabetes will die. Many more will suffer from diabetes-related complications like blindness, amputation and kidney failure, and ultimately, premature death.

Barriers to Insulin Access

David Beran and the International Insulin Foundation studied access to insulin in Kyrgyzstan, Mali, Mozambique, Nicaragua, Vietnam and Zambia. Various health system factors, such as poor purchasing practices, distribution channel problems and irrational use, resulted in poor insulin availability and unaffordable treatment costs. In 2010, Health Action International undertook a global survey of insulin prices which showed a 5,000 percent variation, from US$1.55 per vial in Iran to US$76.69 per vial in Austria. Problems accessing insulin also exist in more unexpected places. For example, patients in some communities in the United States have reported rationing or even going without insulin due to high insulin costs.

These studies, and other work by the International Insulin Foundation, provide a good understanding of the barriers to insulin access at a country level. Attention is now needed on the global insulin market.

The ACCISS Study

The aim of the Addressing the Challenge and Constraints of Insulin Source and Supply (ACCISS) Study is to improve access to insulin for those in need around the world. This requires a clear understanding of the barriers that prevent people from accessing affordable insulin. Since 2015, ACCISS has been looking into issues around insulin price and availability, which are preventing access to this life-saving medicine for 1 in 2 people in need. Phase I of the study focused on identifying the barriers to access to insulin and creating interventions based on this evidence. Phase II, starting in 2018 focuses on piloting these tools and interventions at a country level while continuing to work globally to address inequities and inefficiencies in the insulin market.

We will achieve this by:

  • Working with global partners to develop evidence-based tools and strengthening tools already developed, which address worldwide barriers to insulin access (Work Stream 1);
  • Developing, with national partners, comprehensive and contextualised national strategies to address the range of challenges that people requiring insulin face, and to pilot and evaluate the interventions (Work Stream 2); and
  • Further expanding the ACCISS network and develop civil society networks in target countries, amplified in international fora, to reduce, or eliminate, the barriers to insulin access (Work Stream 3).

ACCISS Toolkit 

ACCISS has developed a toolkit that provides solutions that can work to bring down prices and increase the availability of this essential medicine, particularly in low- and middle-income countries. Tools include a diabetes cost calculator, and various papers and guidelines, such as on the use of insulin and its cost of production. Click here to find out more.

The ACCISS Study Team

ACCISS is being led by co-investigators Margaret Ewen at Health Action International, David Beran from Geneva University Hospitals and the University of Geneva and Richard Laing from Boston University, as well as Project Manager Molly Lepeska and Project Assistant Jessica Davy.

Our Study is advised by a unique group of leading international experts as members of the study’s advisory group.  The Leona M. and Harry B. Helmsley Charitable Trust awarded HAI $3.4 million for Phase II of the ACCISS Study for the period of April 2018 – April 2021.