80% of people with diabetes live in low- and middle-income countries, where access to insulin pens is extremely limited due primarily to high prices.
Geneva/Johannesburg, 11 November 2024 – Ahead of World Diabetes Day, Médecins Sans Frontières/Doctors Without Borders (MSF) called on pharmaceutical corporations Eli Lilly, Novo Nordisk, Sanofi, and all insulin manufacturers to take urgent action to increase access to diabetes medical tools in low- and middle-income countries by immediately making insulin* pen injection devices available at US$1 per pen. This call – based on data published by MSF in the Journal of the American Medical Association (JAMA) Network Open estimating that insulin pens could cost as little as $0.94 per pen, including a profit – follows the recent news that Novo Nordisk will soon halt the production of human insulin* pens, a move that will further limit access to an essential and person-centred method of insulin administration.
Eli Lilly, Novo Nordisk, and Sanofi control and monopolise the diabetes market,** making business and manufacturing decisions that affect peoples’ access to insulin and often setting prices of their newer insulins as high as they want. Such decisions effectively block access to more practical treatment with pens for people living with diabetes around the world, and particularly in humanitarian and low-resource settings.
“Over 100 years ago, the scientists who discovered insulin wanted everyone with diabetes to have access to treatment, so they sold the patent for just $1, but since then, something’s gone seriously wrong because now only about half of people around the world who need insulin can access it,” said Dr Helen Bygrave, non-communicable diseases advisor, MSF’s Access Campaign. “Moreover, insulin pens, which were originally developed over 40 years ago by a doctor to help her daughter’s diabetes management, are the standard of care in high-income countries but remain largely unavailable to people living in low- and middle-income countries. It’s devastating that today, pharmaceutical corporations Eli Lilly, Novo Nordisk and Sanofi are maintaining this double standard in access to diabetes care.”
A survey by MSF and T1International highlighted that insulin injected from pen devices is preferred by 82% of people with diabetes over insulin in vials injected with syringes, due to its accuracy, ease of dosing, and reduced stigma. Pens can improve the quality of life for people with diabetes and are now included in the World Health Organization (WHO) Model List of Essential Medicines.
However, despite their advantages, insulin pens remain largely unavailable and inaccessible for most people with diabetes in low- and middle-income countries. But that could change with more affordable pricing and increased supply. MSF’s recent data published in JAMA Network Open found that one pre-filled human insulin pen could be sold at a profit at an estimated generic target price of just $0.94, compared to the $1.99 price in South Africa, $5.77 in India, $14.00 in the Philippines, and $90.69 in the US.
Novo Nordisk is withdrawing its production of human insulin pens so they can produce and sell more of their patented GLP-1 medicine for diabetes and obesity (marketed as Ozempic and Wegovy) in pen devices at markedly high prices in high-income countries. Because of this, many people with diabetes may have to make significant treatment adjustments, and some will be forced to change to using insulin in vials with syringes. For example, people with diabetes in South Africa, which has pioneered a shift towards the use of insulin in pens in the public sector by replacing insulin in vials (injected with syringes) with pens in 2014, had to ration insulin pens earlier this year when Novo Nordisk stopped selling human insulin pens to the South African government.
“Everyone living with diabetes deserves access to the highest standard of treatment and care, and the fact that insulin pens are virtually unavailable in low- and middle-income countries due to high prices is a glaring and unacceptable double standard,” said Candice Sehoma, advocacy advisor for MSF’s Access Campaign. “With Novo Nordisk’s withdrawal from the human insulin pen market, we demand they and other insulin manufacturers make all types of insulin pens available at $1, especially considering that their cost of production is estimated to be as low as $0.94 per pen, including a profit. It’s time to put an end to profiteering on this lifesaving medicine that has been around for more than a century.”
Diabetes affects 537 million people globally. It is not just a disease of high-income countries: cases are rising in low- and middle-income countries, with a projected increase of 134% in Africa by 2045. MSF has significantly increased the number of diabetes consultations in its medical programmes: in 2022, MSF performed 205,122 diabetes-related consultations globally.
*Insulin is classified as either human or analogue, and by its onset and duration of action. Insulin analogues, while similar to human insulins in their basic structures, have been modified to change their onset and duration of action after injection, enabling greater flexibility of use for people living with diabetes and – for some people – facilitating a reduction in episodes of hypoglycaemia (low blood sugar levels).
**Eli Lilly and Novo Nordisk produce insulin and GLP1s. Sanofi produces insulin.
