100th Anniversary of Insulin: Advocating for a Resolution to Achieve Universal Access to Insulin

The year 2021 marks the centenary anniversary of the discovery of insulin in 1921 at the University of Toronto in Canada. Insulin is a life-saving treatment for millions of people with diabetes around the world. The number of people with diabetes is growing rapidly and the need for human insulin will continue to increase in the coming years. The International Diabetes Federation estimates that by 2045 the number of people affected by this chronic disease will have increased by 51%. Access to affordable treatments is critical for patient survival and it is also absolutely crucial for developing countries to be able to define and deploy national strategies.

But to date, access to these treatments is far from being a reality for all. Global production capacity remains concentrated in the hands of three producers — Sanofi, Novo Nordisk et Eli Lilly — which hinders competition and affects the supply and price of insulin in developing countries, as well as in rich countries such as the United States.

In Mali, the price of a vial of insulin reaches nearly 7 euros while the minimum wage barely exceeds 50 euros. A study conducted in the country demonstrates that a year supply of insulin could take up more than 17% of family’s annual income.

These high prices represent a major barrier to access to insulin. This is all the more unacceptable as cost of production are estimated at less than 72 dollars per year per person, and all the more paradoxical because the inventors of insulin had given up their patents for a symbolic dollar in 1923.

The price barrier comes in addition to other constraints for the management of patient cares in the field, such as the access to trained health professionals, to better monitoring instruments (blood glucose meters and strips), to administering supplies (syringes, pens...) etc.

An international mobilisation

Santé Diabète led an international campaign jointly with other civil society organizations on the occasion of the insulin’s 100th anniversary, in particular for a resolution on insulin to be carried by the Member States of the World Health Organisation (WHO) at the 74th World Health Assembly that took place in Geneva between May 21 and June 1, 2021.

The goal of such a resolution is for the international community to recognize the barriers to access to insulin, 100 years after its discovery, and intensify the efforts to make it more accessible. The solutions include greater transparency on the prices (charged from one country to another by the three multinationals sharing the world market : Eli Lilly, Novo Nordisk et Sanofi), increased production of biosimilars, especially the biosimilars pre-qualified by the World Health Organization (WHO) or approved by the country’ medicines agencies.

Alongside with MSF Access Campaign, Health Action International (HAI), T1 International and the Observatoire de la transparence dans les politiques du médicament (OTMeds), Santé Diabète has called on since September of 2020 Member States of the World Health Organisation to table a resolution proposal on the access to insulin at the WHO Executive Board meeting held from January 18 to 26, 2021. Santé Diabète has made a strong advocacy to the French government to support this proposed resolution.

Unfortunately, facing pressure from numerous European countries and the United States no proposal was submitted to the Executive board. However, a " Decision point " was proposed by the Russian Federation and adopted [https://apps.who.int/gb/e/e_eb148.html]. This point was supported by different countries, which did include France.

This decision point paved the way for the Russian Federation to table a resolution on diabetes and MNTs including the issue of the access to insulin.

To support this, in February 2021, Santé Diabète initiated a commentary published in The Lancet : considering that not addressing the issue of the lack of access to insulin on the occasion of the 100th anniversary of its discovery would be an ethical and moral failure from the international community.

On April 14, WHO launched the « Global Diabetes Compact ». Santé Diabète, MSF et OTMeds used the launch of WHO’s new diabetes strategy to call on the international community to do more to address the global diabetes and access to insulin emergency..

Eventually, just after the Global diabetes compact was launched, the Russian Federation tabled a draft resolution, which was negotiated between late April and mid-May. Santé Diabète, MSF Access campaign, Health Action International (HAI), T1 International, OTMeds, NCD Alliance et the International Diabetes Federation advocated for an ambitious resolution, particularly those in the European Union and the United States, who were pushing for a text that weakened references to access to insulin, price transparency and targets.


In the meantime: mobilization in France

Following a Santé Diabète press release, in collaboration with MSF France and OTMeds, on April 14, 2021, a group of members of parliament mobilised and proposed a draft resolution at the National Assembly for universal access to insulin

The resolution, which was supported by 57 members of parliament from all political groups, in particular reminds that: "The World Health Organisation has launched a pilot programme to prequalify human insulin in order to boost access to the drug." and calls on the French government to take action: "It therefore seems useful to invite the Government to support the World Health Organisation’s initiatives in this area." and invites, in particular : "the Government to support the initiatives of the World Health Organisation by proposing an appropriate mechanism to ensure transparency on sales prices, the margins of intermediaries and the real costs of production, in order to rebalance the insulin market and allow universal access to these treatments; Proposes to the Government to support the increase in the number of laboratories producing quality insulin by providing stronger support for local production initiatives through the World Health Organisation's pre-qualification programme for human insulin". This approach by French parliamentarians was backed by Members of Senate who publicly questioned the government on the subject.

To push the French government to support an ambitious resolution during the negotiation phase, on 14 May, the daily newspaper Le Figaro published an opinion piece co-signed by a large number of these Members of Parliament, jointly with Santé Diabète, Diabète et méchant, Aide aux Jeunes Diabétiques, the French Federation of Diabetics and OTMeds. [https://www.lefigaro.fr/sciences/acces-a-l-insuline-a-l-oms-la-france-doit-soutenir-une-resolution-ambitieuse-20210514]