Intended for healthcare professionals

Feature Non-communicable Diseases

The prickly problem of access to insulin

BMJ 2011; 343 doi: (Published 14 September 2011) Cite this as: BMJ 2011;343:d5782
  1. Deborah Cohen, investigations editor
  1. 1BMJ, London WC1H 9JR, UK
  1. dcohen{at}

Insulin remains unaffordable in many countries even though it is no longer protected by patents. Deborah Cohen examines why

For some parents in parts of Africa, having a child die from diabetes is a relief. They no longer have to foot the bill for insulin, which means they can pay to send their other children to school. It’s a story that Jean-Claude Mbanya, professor of medicine and endocrinology at the University of Yaoundé, Cameroon, and president of the International Diabetes Federation, hears during his clinics—and one that is probably not specific to diabetes. But nearly a century after the discovery of insulin, the price remains alarmingly high.

Much has changed since insulin’s discovery in the 1920s, when scientists Frederick Banting and Charles Best isolated it from the pancreas of dogs. It was a feat that persuaded its discoverers to license the process free of charge to approved manufacturers—insulin was seen as a gift to humankind rather than an opportunity for commercial profit.1

But millions of people in poorer countries are unable to claim this gift—manufacturers charge for it and it comes with too high a price attached.

In most high income countries the state or health insurance company pays the bill. But people in low and middle income countries have to pay out of their own pockets. The effect of a diagnosis of diabetes on household spending in many parts of the world is dramatic. A study in Malawi found that one month’s supply of insulin (purchased from a combination of public and private vendors) cost almost 20 days’ wages.2

For people with type 1 diabetes, unavailability is immediately life threatening. The life expectancy of a child with newly diagnosed type 1 diabetes in much of sub-Saharan Africa varies between 7 months and 7 years, depending on the …

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