The World Health Organization (WHO) today announced the start of a pilot programme to prequalify human insulin to increase treatment for diabetes in low- and middle-income countries.

The decision, announced ahead of World Diabetes Day (14 November), is part of a series of steps WHO will take to address the growing diabetes burden in all regions. About 65 million people with type 2 diabetes need insulin, but only half of them are able to access it, largely due to high prices. All people with type 1 diabetes need insulin to survive.

“Diabetes is on the rise globally, and rising faster in low-income countries,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Too many people who need insulin encounter financial hardship in accessing it, or go without it and risk their lives. WHO’s prequalification initiative for insulin is a vital step towards ensuring everyone who needs this life-saving product can access it.”

Insulin prequalification can lead to lower prices

WHO prequalification of insulin is expected to boost access by increasing the flow of quality-assured products on the international market, providing countries with greater choice and patients with lower prices.

Insulin was discovered as a treatment for diabetes almost 100 years ago and has been on WHO’s List of Essential Medicines since it was published in 1977.

Despite an ample supply, insulin prices are currently a barrier to treatment in most low- and middle-income countries. Three manufacturers control most of the global market for insulin, setting prices that are prohibitive for many people and countries.

Access to insulin a challenge in many countries

Data collected by WHO in 2016-2019 from 24 countries on four continents showed that human insulin was available only in 61% of health facilities and analogue insulins in 13%. The data showed that a month’s supply of insulin would cost a worker in Accra, Ghana, the equivalent of 5.5 days of pay per month, or 22% of his/her earnings.

In wealthy countries, people often have to ration insulin, which can be deadly for people who do not get the right quantity of the medicine.

“Prequalifying products from additional companies will hopefully help to level the playing field and ensure a steadier supply of quality insulin in all countries,” says Dr Mariângela Simão, Assistant Director General for Medicines and Health products.