Insulin Imports Fail to Meet Many Countries’ Needs

Despite being a 100-year-old medicine, insulin remains inaccessible to millions around the world, owing to limited availability and high cost. Indeed, insulin is manufactured in just 20 countries worldwide, meaning there are 170 countries who are import-dependent for insulin. This limited physical availability of various forms of insulin, and the high cost of what is available, constitutes a global health concern, particularly in low- and middle-income countries that have experienced an unprecedented increase in the prevalence of diabetes over the past two decades. 

A new journal article published in Science by Abhishek Sharma and Warren Kaplan uses an innovative linkage of two datasets to determine the source countries of insulin imports and whether their present levels of insulin imports sufficient to treat the in-country number of persons with diabetes. Their results showed insulin imports in many countries with no local production of insulin failed to meet the insulin need of their populations living with diabetes. 

While the gap between countries’ insulin imports and the domestic need has narrowed in all regions since 2000, the authors find it has not declined for countries in Africa and Asia. In particular, the authors found that African nations are importing insulin from countries that themselves cannot make it, suggesting that African imports are made through intermediaries that must first be buying from insulin manufacturing countries and then shipping on to Africa. This trade route has implications for insulin supply security. Most importantly, the authors say Africa currently lacks a regional insulin manufacturing “champion.” Until such time when one is available, the authors argue smaller manufacturers in India, Brazil and China must step up to support insulin supply to Africa.

The authors also urged national and regional governments to develop mechanisms to generate better information about their diabetes population and treatment needs. Additionally, they urge further information gathering on how the provision of diabetes treatment and access barriers varies within a country and across socio-economic strata, as this is essential for improving insulin-needs forecasting.