One hundred years after the discovery of insulin, this lifesaving medicine is still out of reach for many people suffering from diabetes, a new report by the World Health Organization (WHO) has exposed. “Keeping the 100-year-old promise – making insulin access universal” report, was published on November 12, 2021, from Geneva in the lead-up to 2021 World Diabetes Day due on November 14. It highlights the ‘alarming’ state of global access to insulin and diabetes care, and finds that high prices, low availability of human insulin, few producers dominating the insulin market and weak health systems are the main barriers to universal access. According to the report, the year 2021 marks 100 years since the momentous discovery of insulin in 1921, which marked a turning point in care for those suffering from diabetes. Insulin is vital to the treatment of diabetes. It is a hormone that controls the blood glucose (sugar) level so that the energy it produces to power human body is not excessive. Absence of insulin in the body or lack of response to insulin are the causes of diabetes – a long-term health problem characterised by a persistently high level of blood glucose. “The scientists who discovered insulin 100 years ago refused to profit from their discovery and sold the patent for just one dollar,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps. WHO is working with countries and manufacturers to close these gaps and expand access to this life-saving medicine for everyone who needs it,” he observed. Speaking to The New Times, Etienne Uwingabiye, Executive Director of Rwanda Diabetes Association said that access to insulin is still unaffordable for some diabetic patients, especially those who are economically vulnerable. He pointed out the fact that the patient has to rely on the use of the medicine every day is also one of the factors that make its associated expenditure high. Meanwhile, he appreciated the Government’s support in the management of this disease as insulin is covered by the community-based health insurance – Mutuelle de Santé – which provides healthcare coverage for many Rwandans. “Insulin is considered one of essential medicines in Rwanda. Cheap insulin cost Rwf7,000 a small bottle, and a patient who injects it into their body twice a day needs about two bottles of Rwf14,000 per month,” he said, indicating that, a patient pays 10 percent of that cost thanks to health insurance. However, he said that some patients are not able to pay the amount that remains after the insurance has covered the largest part of the medical bill. In addition, he said that a glucose meter (a blood sugar monitor) costs about Rwf35,000 (this device can be used for long), while a set of 50 test strips cost Rwf20,000 and can be used for about a month, and those costs are not covered under Mutuelle de Santé. A test strip is a material used to collect blood a drop and is inserted into the blood sugar monitor to indicate the sugar level. “We want that this price be reduced to, say, Rwf500 for two bottles of insulin (as a dose for one month), and be available close to the patients so that they do not incur huge transport cost. We also request that the blood sugar monitoring devices be included in Mutuelle de Santé health benefits package,” he said. Why millions of people with diabetes need insulin Left untreated or poorly managed, diabetes can lead to complications like heart attacks, strokes, blindness, kidney failure, and lower limb amputation (surgical removal of limbs such as leg or arm), WHO has warned. Diabetes is a significant cause of premature deaths and a major public health problem. It also imposes a significant financial burden on countries’ health systems and individuals. Today, more than 420 million people are living with diabetes globally; while four in five of them live in low- and middle-income countries, according to WHO. However, at least 30 million people who need insulin for diabetes do not have access to it, the report showed. According to the Ministry of Health’s 2015 survey (the latest), diabetes prevalence in Rwanda is at 3 percent implying that at least one in 30 people have diabetes in the country. Actions that can help address the problem The report noted that since the introduction of higher-priced types of insulin in the 2000s, their use is increasing in place of cheaper ones. Some insulins are more than double the prices of others. It suggested several actions to improve access to insulins and related products. They include boosting the production of low-cost insulin, and improving transparency in the way prices are set. Others are promoting local manufacturing capacity in under-served regions; ensuring that increased access to insulin is accompanied by prompt diagnosis, and access to affordable devices for blood sugar monitoring and injecting insulin. It is to note that overweight, obesity, and physical inactivity are some of the culprits for diabetes. Prevention is the best way to guard against the diabetes burden. This can be achieved through, among others, regular physical activity, maintaining normal body weight, eating healthy foods such as fresh fruits and vegetables, and avoiding sugar and saturated fats as well as tobacco use.
