A health worker prepares an insulin shot. Photo by: Sebastián Oliel-OPS / OMS / CC BY-NC
Member States have finalized negotiations on a resolution on diabetes to be presented to the 74th World Health Assembly this week. The draft resolution addresses some of the concerns of civil society about the exclusion of transparency texts in diabetes medicine – including insulin – and the development of goals for the prevention and treatment of diabetes.
Proponents called for a resolution that includes price transparency for insulin and one that mandates the World Health Organization to develop targets for the detection and treatment of diabetes. However, according to sources Devex spoke to, there has been a setback with a diabetes-specific solution.
The same sources, who are familiar with the negotiations but wish to remain anonymous as they are not empowered to comment on the resolution, told Devex that Member States are divided because they have more transparency about the market for and prices of Diabetes medicines, including insulin. Some Member States, notably the European Union and the United States, also opposed the development of targets.
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Devex contacted the European Commission and the US Mission in Geneva but received no response.
However, the text now adopted by the WHA contains an operational paragraph calling on the WHO Director General to develop recommendations for strengthening and monitoring diabetes responses under national NCDs and “Recommendations for prevention and treatment of obesity throughout life, including taking into account the possible development of goals in this regard. “The WHO Director General will present these recommendations to the 75th World Health Assembly in 2022.
It also maintains language exploring a mechanism for exchanging information on the diabetes drug market.
The draft calls on the WHO Director-General to “continue to analyze the availability of data on inputs throughout the value chain, including clinical trial data and pricing information, to assess the feasibility and potential value of setting up a web-based tool to share information, relevant to the transparency of the diabetes drug markets, including insulin, oral hypoglycemics and related health products, including information on investments, incentives and subsidies. “
Premature deaths from diabetes increased 5% between 2000 and 2016, and global deaths from diabetes increased by 70% between 2000 and 2019. Diabetes was one of the top ten causes of death worldwide according to the WHO Global Health Estimates 2019 published in December 2020, but only half of the people who need it have access to the drug, according to a study published in 2019.
One of the current global voluntary NCDs targets is to stop the rise in diabetes by 2025. However, there are no specific targets for diagnosis and access to insulin, a drug that was discovered 100 years ago.
Proponents welcome the resolution, arguing that it is an important step in the fight against diabetes, although some are disappointed that the resolution did not go far enough to set specific global goals similar to those for the diagnosis, treatment and control of type 1 and 2 diabetes 90 Set -90-90 Goals Used For The Global HIV Response.
“The Global Compact describes the 90-90-90 approach, but this should have been explicitly mentioned in the resolution. We are disappointed to see that the global goals only talk about starting treatment and not mention control rates which would be covered by a third of the 90 and are an important topic we see in our projects, ”said Dr. Helen Bygrave, chronic illness advisor for the Médecins Sans Frontières access campaign.
“We need to put this on the international health agenda and ensure that everyone in all countries has access to affordable life-saving insulin when they need it.”
– Dag-Inge Ulstein, International Development Minister, Norway
MSF wanted the resolution to keep its original title, which focuses on the prevention and management of diabetes and includes access to insulin. However, the current text has deleted the mention of insulin and instead suggests reducing the burden of NCDs through greater prevention and control of diabetes.
Split views on insulin price transparency
“We believe this solution is important because diabetes causes 1.6 million deaths each year – making it one of the top ten killers in the world. And the number is growing rapidly in low and middle income countries, ”Dag-Inge Ulstein, Norway’s international development minister, told Devex last week. Norway is a co-sponsor of the resolution.
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“We need to put this issue on the international health agenda and ensure that all people in all countries have access to affordable life-saving insulin when they need it,” he said, adding that fighting diabetes and NCDs has a role to play in part Norwegian development policy and supports both the development of targets for diabetes and the transparency of insulin.
However, the Development Minister also said that during the negotiations, “one of the issues on which countries have different views is the issue of a pricing mechanism for insulin.” “Another tough question is developing global targets for the detection and treatment of diabetes,” he added.
Insulin prices vary from country to country and, according to surveys in low and middle income countries, they can go as high as $ 25 for a 10 ml vial of human insulin and up to $ 100 for analog insulin, according to Molly Lepeska, project manager at Health Action International.
Such high prices make it difficult for diabetics to get access to this life-saving drug, but few governments disclose how much they pay for insulin to get it, and manufacturers don’t disclose their prices either.
According to MSF, insulin is among the top five most expensive drugs in NCD programs. Price transparency aside, Bygrave told Devex earlier last week that the resolution should include “specific requests” on insulin access, including how to increase market competition and secure global supplies to meet growing demand for the drug to satisfy with more generic biosimilar manufacturers. According to the WHO, the insulin market is currently only dominated by three companies.
Civil society groups are demanding transparency about insulin prices and other related medical supplies such as blood glucose meters. This year saw a special push for a solution to diabetes that emphasizes access to insulin as the world marks the 100th year since the drug was discovered by scientists at the University of Toronto. Last month, the WHO launched the Global Diabetes Compact, whose components include global price reporting for insulin and other major diabetes drugs and targets for treatment.
Civil society calls for greater commitment to WHO member states
The first WHO-led informal meetings with non-governmental organizations ahead of the 74th World Health Assembly concluded last week. This is what happened, including WHO’s response to civil society and feedback from NGOs on the meetings.
“Price transparency enables public procurers and others to determine a reasonable price. Countries that oppose transparency bow to the pharmaceutical industry and don’t want anyone to know their actual selling prices, ”said Lepeska of Health Action International.
Ulstein is aware of the high retail price of insulin, which can be up to ten times the cost of production. Norway supports a global mechanism for reporting prices on insulin, arguing that “there is clearly a need for more transparency”.
“In Norway, people with diabetes can live well with their disease because they have access to affordable insulin. This may not be the case for a poor Malawi family who have a child with type 1 diabetes and are unable to provide life-saving insulin. Or having to choose between life-saving insulin for one child or food for the other, ”he added.
While diabetes is mentioned twice in the nine World Voluntary NCDs, civil society also wants more detailed targets for the detection and treatment of diabetes to encourage more government action.
All indicators of diabetes are wrong and “going in the wrong direction,” said Nina Renshaw, director of policy and advocacy for the NCD Alliance.
“The goals that are currently in place say nothing at all about access to diagnosis. There is still a huge void … Many people living with diabetes don’t know their status until they have acute complications, ”said Renshaw.
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