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Lack of reasonably priced insulin threatens lives for the poor
Ninety years after the discovery of insulin, millions of people with diabetes cannot access this live-giving medicine due to high prices, exposing them to risk of serious disease, such as blindness, and amputation.
Most surprising is that insulin prices vary considerably between regions and between countries within the same region. A vial of 15 mg human insulin in Islamic Republic of Iran costs around US$ 1.5, while in the Congo and Namibia it can reach over US$ 47, a difference of 3000% with no production justification. The high price of insulin is leading poor people to use less than the prescribed amount or simply to go without it.
Prices also vary among regions worldwide. Prices are higher in the African Region than in the Eastern Mediterranean and South East Asia Region. However, stark differences exist in the Eastern Mediterranean Region. In the occupied Palestinian territory, for example, which is undergoing very difficult conditions, patients pay higher prices than Canadian patients pay for the same quantity of insulin.
In an endeavour to study insulin prices in the different countries of the world and the causes of their increase, Health Action International (HAI), an international nongovernmental organization concerned with medicines policy, undertook a one day ‘snapshot’ of the price of insulin from 60 low-income, medium-income and high income countries on 11 May 2010. HAI also compared insulin prices provided by three international drugs companies.
One startling result of the study is that a single company can vary its insulin pricing policy from one country to another. Thus, the price of insulin produced by one company in Zimbabwe is US$ 9 whereas it exceeds US$ 44 in Congo. Similarly, the insulin produced by another company varies in price from US$ 3 in Senegal to US$ 47 in Namibia.
At the same time, it was noted that one company provides human insulin to the least developed countries (public and private sector) at prices that are 20% below the average prices in Europe, Japan and North America. It is believed that 9 of the 12 least developed countries where data was collected are purchasing insulin at low prices. However, the snapshots indicated that governments do not always benefit from this low price offer or that this reduction does not always reach patients.
This means that patients do not benefit from the reduced prices for insulin offered by the producing companies. Consequently, there are startling cases of countries where a family living on US$ 1 a day would need to spend about half its monthly income to buy 1 dose of insulin from a private pharmacy.
Even in a middle-income country (family income US$ 2 a day) a patient spends one third to one half of monthly income to buy 1 dose of insulin from either of the two above mentioned companies. This, together with the other costs, such as for syringes, needles and glucose tests, is preventing access of millions of people with diabetes to insulin.
In general, the following are the results of insulin prices survey conducted by collecting snapshots from 60 countries.
• There is a very limited number of manufacturers of insulin worldwide with the insulin market dominated by just two companies.
• The prices patients pay for insulin are similar within the same country but vary between countries and regions and, although the price the patient pays is often lower in low-income counties, the prices in some of these countries are higher than those in high-income countries.
• Even when prices are reduced in low-and middle-income countries, insulin is still unaffordable for the majority of the population in these countries, causing severe consequences for people with diabetes who cannot afford to purchase insulin.
• Insulin prices could be much lower and hence more affordable to those who need it. In order to achieve this, governments need to set priorities for the health budget and set financial allocations to ensure availability of insulin free of charge to patients in the public sector.
• Adequate forecasting is needed as well as efficient supply systems to prevent stock-outs and maintain product quality.
• Mechanisms need to be developed to provide insulin through the private sector at low cost or free in line with the practice in some countries.
• The low price offers made by some manufacturers should be utilized and passed on to patients.
• Syringes and needles should be available and provided either free of charge or at affordable prices to people with diabetes.
• Traditional vials of insulin should be available in the market rather than relying only on the newer, much more expensive ones.
WHO workshop on prequalification of essential medicines
The World Health Organization in partnership with the UAE Ministry of Health is organizing a three days workshop introducing the WHO prequalification program to manufacturers from the Gulf Cooperation Council states in addition to some selected manufacturers from Egypt, Jordan, Libya, Morocco and Palestine.
Focusing on building regulators’ capacity in the areas of Good Manufacturing Practice, bioequivalence, dossier review, global trends and practices in international bulk procurement, the workshop will assist participating manufacturers to open new markets for export and bulk procurement in international tenders.
The WHO prequalification programme was launched in 2001, driven by global public health needs, to achieve universal access to quality priority medicines, especially for those in need. The programme strives to achieve its vision through close collaboration with national medicines regulatory authorities, manufacturers of priority essential medicines and partner organizations.
Prequalification was originally intended to give UN procurement agencies, such as UNICEF, World Bank and a range of other international organizations, those involved in procurement and access to essential medicines, a safe and effective reservoir from which procurement of a range of quality medicines is ensured.
It is worth mentioning that a number of countries in the Region have producers who meet internationally accredited quality levels and standards, and who export medicines to ICH (International Conference for Harmonization) markets and who therefore have good prospects for prequalification of their products. However, of the 337 priority medicines currently on the WHO prequalified list, only one product, amodiaquine-artesunate tablets produced in Morocco, is among those on the list.
This workshop is one in a series of meetings gearing attention towards a very important United Nations interagency collaborative programme that is managed by WHO, namely the WHO prequalification programme for medicines. The programme is operative at global level as a joint United Nations-WHO-UNICEF initiative. The program currently covers medicines for tuberculosis, malaria and HIV/AIDS, in addition to some selected reproductive health medicines, child medicines and influenza-specific antivirals.
In essence, this is a voluntary programme to which manufacturers of these medicines can apply for prequalification. They will receive free evaluation through dossier review, facility inspection and a thorough testing procedure. If these rigorous evaluations conclude that the medicine product and the manufacturing system are up to the WHO quality standards, that specific product is considered prequalified and is automatically added to the WHO list of prequalified medicines. International agencies like the Global Fund, UNICEF, Médecins Sans Frontières, etc. can procure from this list these for bulk purchase orders.
Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, receives gold medal of honour from the President of Yemen
On Saturday 16 October 2010, Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, received a medal of recognition from His Excellency Mr Ali Abdullah Saleh, the President of Yemen. The gold medal of honour, one of the most prominent awards in Yemen, was given to the Regional Director in appreciation and recognition of his long years of international humanitarian service, particularly the support he had extended to Yemen in the field of public health.
During the event attended by H.E. the Minister of Health Dr Abdulkarim Yehia Rasae and WHO Representative to Yemen Ghulum Popal, the President paid recognition to Dr Gezairy’s efforts and leadership during his years of service as WHO Regional Director and noted WHO’s continuous support to Yemen in the prevention and eradication of diseases and cooperation in other humanitarian fields.
The Regional Director extended his gratitude for this honorable recognition. In his thanking note, he expressed his great appreciation of the many improvements he had witnessed in Yemen’s health sector. He particularly praised Yemen’s national immunization campaigns to reduce child mortality and also the country’s tireless fight against polio, malaria, tetanus, measles and schistosomiasis. He said that it was a source of pride that the country had stopped polio virus circulation and measles was on its way towards being eliminated. He also noted Yemen’s exemplary achievements in reducing the prevalence of malaria and also the considerable progress that had been made in eradicating schistosomiasis. The Regional Director added that the partnership between WHO and the Ministry of Health had resulted in many achievements in primary health care and basic development needs, all of which were in line with Yemen’s national strategies and needs.
