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100 years since discovery of insulin: Import of insulin, an essential medicine, fails to meet needs of many countries, says study

While the World Health Organisation (WHO) this year has raised concerns about poor availability of Covid-19 vaccines in lower-income countries, this inequity is also echoed in this new study on insulin, an essential medicine.

Written by Anuradha Mascarenhas | Pune |
Updated: July 30, 2021 8:55:04 pm
A man takes a blood test. Insulin is a medicine discovered 100 years old (File photo)

Despite being a 100-year-old medicine, insulin remains inaccessible to millions around the world, due to limited availability and its high price. A new study published in Science journal on July 30 has said that insulin imports in many countries with no local production of the medicine failed to meet the needs of their populations living with diabetes

“Our previous in-country research shows that often, insulin is not available on pharmacy shelves in low- and middle-income countries. While the actual and physical availability of insulin for use by the patients depends on the myriad processes that are involved in-country, we wondered if the many countries that cannot manufacture insulin and depend on imported insulin – are actually importing enough in the first place,” Abhishek Sharma and Warren Kaplan, from Boston University of Public Health and authors of the study, told The Indian Express.

While the World Health Organisation (WHO) this year has raised concerns about poor availability of Covid-19 vaccines in lower-income countries, this inequity is also echoed in this new study on insulin, an essential medicine.

Sharma, along with co-author Kaplan, analysed both epidemiological data and global trade data for retail insulin (using the United Nations Commodity Trade, UN COMTRADE data) of 194 trading countries to provide evidence on where the countries with no local insulin production source their insulin from, and whether or not the volumes of imported insulin are adequate to meet needs of patients living with diabetes in these countries.

Insulin is manufactured in only 20 countries, so there are 174 import-dependent countries in the COMTRADE database. However, many of those 174 import-dependent countries also exported varying volumes of insulin at various times during the study period (2000 to 2018). That is why the authors limited the study to those countries lacking domestic insulin production that exported either no insulin at all or just trivial amounts (annual average of 104 kg insulin or less, which approximates insulin for less than 500 persons with diabetes) and had import and diabetes prevalence data for at least seven years between 2000 and 2018.

Of the 82 study countries, 32 were from Africa, followed by 13 each in Central and South America and in the Caribbean and Oceania regions. The remaining 24 countries were from Asia, Eastern Europe, and the Middle East. “We assessed if the insulin imports are enough to meet the need of in-country patients only for the import-dependent countries, which are those with no local production of insulin. India does not fit that profile as the country hosts insulin manufacturing units of multinational companies as well as Indian insulin manufacturers. Hence in our study, India is among the 20 countries that manufacture insulin and export to other countries/regions,” Sharma said.

African nations are importing insulin from countries that themselves can’t make it, suggesting that African imports are made through intermediaries that must first be buying from insulin-manufacturing countries and then shipping it to Africa. This has implications for insulin supply security.

Most importantly, Africa currently lacks a regional insulin manufacturing “champion”. Until the time the continent has one, smaller manufacturers in India, Brazil and China must step up, the authors have said.

“The good news is that the gap between countries’ insulin imports and the domestic need has narrowed down… since 2000. Sadly though, this is not true for countries in Africa and Asia. Even in recent years (2012-18), there are countries in almost all parts of the world where insulin imports are just not enough to treat all those who need it,” said Sharma and Kaplan.

They have also urged that national and regional governments should develop mechanisms to generate better information about the population with diabetes and their treatment needs – and also on how the provision of diabetes treatment and access barriers vary within a country and across socio-economic strata. This is essential for improving forecasting of insulin needs, the authors said.

 

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