AMSTERDAM—Health Action International (HAI) has launched an innovative global study, called Addressing the Challenges and Constraints of Insulin Sources and Supply (ACCISS), to identify the causes of poor availability and high insulin prices and develop policies and interventions to improve access to this life-saving medicine, particularly in the world’s most under-served regions.

The initiative is being funded by a $1.25 million grant from The Leona M. and Harry B. Helmsley Charitable Trust.

ACCISS is a three-year study aimed at providing a comprehensive, first-of-its-kind evidence base on the global insulin market, including the type, extent and impact of barriers to global insulin access, as well as lessons from existing models to improve supplies of insulin for the estimated 100 million people world-wide that need insulin.

“Research into the inequities and inefficiencies in the global insulin market is long-overdue,” said HAI’s Margaret Ewen, who is co-leading the study. “This project brings together a remarkable group of individuals and, together with HAI’s experience, is truly an opportunity for action to improve access to insulin.”

David Beran from Geneva University Hospitals and University of Geneva and Richard Laing from Boston University are also co-leading the ACCISS Study with Margaret Ewen. They are backed by a unique group of leading international experts as members of the study’s Advisory and Technical Groups.

ACCISS builds on previous work by David Beran and the International Insulin Foundation on barriers to insulin access in Kyrgyzstan, Mali, Mozambique, Nicaragua, Vietnam and Zambia, as well as a global survey of insulin prices undertaken by HAI in 2010, which showed great variations. Various health system factors, such as poor purchasing practices, distribution channel problems and irrational use, resulted in substantial barriers. These impacted affordability with the price of insulin being substantially higher in comparison to other medicines, with individuals in Mali having to spend 25 per cent of their average income for insulin. In addition, availability was poor in Mali and Mozambique, where only 20 per cent of required facilities had insulin in stock.

“Through previous work by the International Insulin Foundation we have a good understanding of the barriers to insulin access at a country level,” said David Beran. “We now need to understand the global picture to develop responses in order to make access to insulin a reality globally.”

Ultimately, this project aims to use the data collected to develop the means for addressing global barriers to insulin access and propose concrete recommendations to countries to ensure access to insulin for those in need.

“Lessons from HIV/AIDS show us that improving access to medicines for a chronic disease in lowincome settings is possible,” said Richard Laing. “The ACCISS Study has the potential to do the same for insulin.”

ACCISS will do this through a rigorous scientific approach, involving a variety of stakeholders and using the vast experience of those involved in this work.

“For those with type 1 diabetes, lack of a consistent supply of affordable insulin can be a death sentence,” said Eliot Brenner, Program Director of the Helmsley Charitable Trust’s Type 1 Diabetes Program. “The Trust is delighted to support the ACCISS Study, a project that has the potential to illuminate what barriers stand in the way of global insulin access and set us on a course to improving the situation globally.”

Facts about diabetes and insulin:

  • Approximately 347 million people around the world have diabetes mellitus, a non-communicable disease for which there is no cure.
  • All people with type 1 diabetes (approximately 17.4 million people, including 490,000 children) need insulin on a daily basis for survival.
  • Approximately 20 percent of people with type 2 diabetes need insulin for better management of their diabetes.
  • Insulin was first used in 1922, but today, more than half of the 100 million people with diabetes who need insulin cannot afford and/or access it.
  • Life-expectancy for children with type 1 diabetes is one year in Sub-Saharan Africa in comparison to near normal life expectancy in the Western world.

For further information or comment, please contact:
Margaret Ewen
Health Action International
Telephone: +31 20 412 4523

About Health Action International (HAI)
Established in 1981, Health Action International is an independent, global network working to increase access to essential medicines and improve their rational use through research and evidence-based advocacy. For more information, visit

About the Helmsley Charitable Trust
The Leona M. and Harry B. Helmsley Charitable Trust aspires to improve lives by supporting exceptional nonprofits and other mission-aligned organizations in health, selected place-based initiatives, and education and human services. Since 2008, when the Trust began its active grantmaking, it has committed more than $1 billion. The Helmsley Type 1 Diabetes Program is the largest private foundation funder of T1D-related research, treatment and support services in the United States. For more information, visit


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