Diabetes and NCDs health systems and access
Access to Insulin
Insulin: A Century-Old Breakthrough, Still Out of Reach for Many
Discovered in 1921, insulin revolutionised the treatment of type 1 diabetes, transforming it from a fatal disease into a manageable chronic condition. Yet, more than 100 years later, access to insulin remains strikingly unequal around the world, including in some high-income countries. At the Geneva Faculty Diabetes Centre, a multidisciplinary team led by Professor David Beran has extensively studied these global disparities. Their research reveals how access is shaped not only by clinical need but by entrenched structural, economic, and policy barriers. In many countries, insulin availability is limited by market monopolies, making health systems vulnerable to pricing instability and shortages. Even when insulin is available, affordability varies widely, with high markups, weak procurement systems, and limited competition placing essential treatment out of reach for millions, especially in low- and middle-income countries.
Systemic Barriers with Human Consequences
Access challenges go far beyond pricing and supply. The Geneva team’s research in low-resource settings has shown that the absence of trained healthcare professionals, glucose monitoring equipment, refrigeration, syringes, and structured care pathways severely limits the safe and effective use of insulin. These gaps in health systems have devastating consequences: in parts of sub-Saharan Africa, a child diagnosed with type 1 diabetes may not survive more than a year due to a lack of access to insulin and related care. In some low-income settings, insulin can consume up to 10% of national drug budgets, posing difficult trade-offs for governments and threatening the sustainability of care. Moreover, while insulin itself is no longer under patent, the evergreening of intellectual property, through patents on delivery devices and formulation tweaks, limits the entry of lower-cost alternatives, further reinforcing these inequities.
Geneva’s Commitment to Global Insulin Equity
In response to this urgent global challenge, the Geneva Faculty Diabetes Centre is actively contributing to international efforts to promote equitable and sustainable access to insulin. Through the works of Prof Beran and leadership in initiatives such as the Lancet Diabetes & Endocrinology Commission on Type 1 Diabetes, the Centre supports a security-of-supply model, encouraging a diversified insulin market, reliable procurement mechanisms, and the development of local production capacity. The team also advocates for transparent pricing, regulatory harmonisation, and the broader use of biosimilar insulins via WHO prequalification. Working from Geneva, home to many global health institutions, the Centre is uniquely positioned to engage with stakeholders, including governments, manufacturers, and patient groups. It conducts real-world assessments in low-resource settings, supports health system strengthening through capacity-building initiatives, and translates evidence into action through global policy dialogue. For the Centre, access to insulin is not only a medical necessity, it is a fundamental human right and a global health priority that demands collaboration, innovation, and long-term commitment.