Elsevier

The Lancet

Volume 355, Issue 9207, 11 March 2000, Pages 919-921
The Lancet

Public Health
Insulin for the world's poorest countries

https://doi.org/10.1016/S0140-6736(99)09225-9Get rights and content

In the industrialised world, type 1 diabetes rarely results in death from ketoacidosis. The same is not true in many countries in the developing world where insulin availability in intermittent, and insulin may not even be included on national formularies of essential drugs. The life expectancy for a newly diagnosed patient with type 1 diabetes in some parts of Africa may be as short as 1 year. The World Bank has identified 40 highly indebted poor countries (HIPCs) whose national debt substantially exceeds any possibility of repayment without heavy impact on health and social programmes. Incidence and prognosis of type 1 diabetes in HIPCs are lower than in most industrialised countries, and 0.48% of the world's current use of insulin is estimated to be sufficinet to treat all type 1 diabetic patients in these countries. A proposal is made for the major insulin manufacturers to donate insulin, at an estimated cost of US$3–5 million per year, as part of a distribution and education initiative for type 1 diabetic patients in the HIPCs. No type 1 diabetic patient in the world's poorest countries need then die because they, or their government cannot afford insulin.

Section snippets

Prevalence of type 1 diabetes in highly indebted poor countries

Amos et al15 reported the prevalence of diabetes in all countries in 1997. Because there are few studies of prevalence in the developing world, and those for all 40 HIPCs are based on but seven studies, these date are subject to substantial guesswork.

African type 1 diabetic patients under 15 years of age can expect to live for just 1 year;5, 6 and this figure has been applied to estimates for all countries where life expectancy for non-diabetics is under 50 years. Proportionately better

Logistics, education, and monitoring

Besides the supply of insulin, secure distribution networks and educational support will also be needed. Nevertheless, the experience of the Internatinal Diabetes Federation (IDF) insulin task force suggests that grass-roots health workers in these countries know how to use insulin when it is available. Clearly it would be invidious to prescribed single approaches to insulin delivery and patient education and care in countries with very different health care systems. Attempts to install

Costs of a programme of insulin supply

If manufacturers supply the insulin needs of type 1 diabetic patients in the 40 HIPCs free of charge, would the cost be proportionate to that of requirement—in other words around 0.5% of current world insulin costs? At present, animal insulin is sold at a substantially lower price than human insulin, so that, even at market prices, supplying 0.45% of the world's insulin supply because animal insulin should cost US$3–4 million.3, 19 Costs might be reduced by use of insulin that is being

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