Geoff Gill, International Insulin Foundation

Name of Lead Author: Geoff Gill
Organization: International Insulin Foundation
Country: UK

Abstract

Insulin is needed to preserve life in type 1 diabetes, and is required for adequate control of many people with type 2 diabetes. Despite efficient production systems, many types of insulin are expensive, and supplies to patients in many resource-limited countries are often precarious. Patients often have inadequate supplies, and complications of diabetes and even deaths are occurring due to availability issues. The International Insulin Foundation (IIF) is a charity and NGO committed to the global access of affordable insulin to all who need it. We believe this is an achievable aim, and hope to see it achieved by 2022 (the 100th anniversary of the original introduction of insulin for patient use). However, to achieve this, we need promotion of the use of inexpensive insulin supplies, and international and national political will.

submission

The International Insulin Foundation (IIF) was founded in 2002, and our aim is to achieve global access to free or affordable insulin for all those with diabetes who require this life-saving and life-preserving drug. Insulin was discovered in 1921, and first used in a type 1 diabetic patient in 1922, with dramatic results. Without insulin, people with this type of insulin will die, and many with the type 2 variety of diabetes need insulin for adequate control of their disease. Sadly, almost 100 years later, insulin is still poorly available to those who need it - particularly in resource-poor countries (1).

We are a non-governmental organisation (NGO) and registered UK charity. We receive no funding from pharmaceutical companies or other sources which may lead to conflicts of interest. Our trustees are a group of internationally know diabetes-experts. They are Professor Geoff Gill (Chair - Liverpool, UK), Professor John Yudkin (Vice-Chair and Treasurer - London, UK), Professor Solomon Tesfay3 (Secretary - Sheffield, UK), Professor Sarah Wild (Edinburgh, UK), Dr Kaushik Raimaya (Dar es Salaam, Tanzania), Professor Nigel Unwin (St Michael, Barbados), Professor Ayesha Motala (Durban, South Africa) and Professor Max de Courten (Melbourne, Australia). Advisors to the board are David Beran (Geneva, Switzerland), Merith Basey (Washington, USA), and Molly Lepanska (Amsterdam, Netherlands).

The problem of insulin availability is related to complex issues, but are particularly related to the relatively high cost of insulin. Manufacturers have progressively adapted insulin formulations ("analogue insulins") to protect patients and maintain high costs (2). This problem does not only affect developing and resource-limited countries, but is also an issue in the USA due to it's insurance-based health system, and consequent limits to funded insulin supplies (3). Cheaper insulins are available ("human insulins"), and we have strongly advocated the use of these less expensive, but fully effective insulin formulations (4).

We operate by research, information-gathering and advocacy. We have investigated barriers to insulin supply in a variety of countries (including in Africa, and Eastern Europe) using a method we have developed known as the "RAPIA" (Rapid Assessment Protocol for Insulin Access). This method has now been officially adopted as a research tool by the World Health Organisation (WHO). We have also adopted twinning programmes in some countries and demonstrated improvement in insulin access ((5,6).

We have strong links with WHO, and are a recognised partner-NGO with them. We have a frequently visited website ( www.access2insulin.org ), and also are partners in the "100 Campaign" ( www.100campaign.org ). This campaign aims to ensure global affordable insulin supply by the year 2022 (the 100th anniversary of the introduction of insulin treatment). A recent development is our involvement in the ACCISS Study ("Addressing the Challenges and Constraints of Insulin Sources and Supply"). This is a funded 3 year international study aimed at analysing global constraints to insulin supply, and to identify inexpensive supplies available to all countries.

We believe that access is to insulin is a global human right, and deserves to be a public health priority. Using the right supplies of insulin, and with adequate political will, be believe the aspirations of the IIF and 100 Campaign are eminently achievable.

Bibliography and References

1. Beran D, Yudkin J. The double scandal of insulin. J Roy Coll Phys Edinb 2013; 43:194-196.

2. Greene JA, Riggs KR. Why is there no generic insulin? Historical origins of a modern problem. New Eng J Med 2015; 372:1171-1175.

3. Randall L, Peng L, Begovic J et al. Recurrent diabetic ketoacidosis in inner-city minority patients. Diabetes Care 2011; 34:1891-1896.

4. Gill GV, Yudkin JS, Keen H, Beran D. The insulin dilemma in resource-limited countries. A way forward? Diabetologia 2011; 54 :19-24.

5. Beran D. Rapid Assessment Protocol for Insulin Access - overcoming barriers to care. Diabetes Voice 2004; 49 : 20-22.

6. Beran D, Silva Matos C, Yudkin JS. The Diabetes UK - Mozambique Twinning Programme - results of improvements in diabetes care in Mozambique. A reassessment 6 years later using the Rapid Assessment Protocol for Insulin Access. Diabetic Medicine 2010; 27 : 855-861.