The discovery of insulin in 1921 revolutionised diabetes care. Type 1 diabetes went from being a death sentence to a manageable chronic condition.
To ensure access to this vital medicine to as many people as possible, the researchers who discovered insulin sold the patent to their university for one symbolic dollar. Yet, a century later, a significant proportion of people with diabetes still cannot obtain this essential medicine.
In 2021, the World Health Assembly highlighted the importance of insulin access in its resolution to strengthen diabetes prevention and control. Yet, since then, little has changed at the global level.
The 4th UN General Assembly on the Prevention and Control of Noncommunicable diseases (NCDs) held on the 25th of September 2025 in New York highlighted how crucial governmental action is in ensuring that all people who need insulin can actually access the supplies they need.
Governments play a key role in achieving this and key takeaways from our work are presented below. Some of these conclusions extend beyond the scope of access to insulin and highlight key issues as to what the role of governments is with regards to global health challenges.
A vital medication that is still out of reach
Discovered over a century ago, in 1921, and its first therapeutic use in 1922 to treat a child was hailed as a medical miracle. Since then insulin has transformed the lives of millions of people with diabetes.
Insulin is a hormone synthesised in certain specialised cells of the pancreas (the beta cells of the islets of Langerhans. It regulates blood sugar, in other words glucose levels in the blood. Insulin promotes the entry of this sugar into cells, which decreases its blood concentration.
There are two distinguishable types of diabetes: Type 1 diabetes mellitus – T1DM (which is due to insufficient insulin production) and type 2 diabetes mellitus – T2DM (resulting from reduced insulin sensitivity or β-cell failure).
Lack of access to insulin and treatment results in chronic hyperglycemia (high blood sugar). The consequences of chronic hyperglycemia impact the heart and blood vessels with possible catastrophic complications, such as an increased risk of atherosclerosis, infarction (a three to fivefold increase), stroke or arteritis (inflammation of the arteries) in the lower limbs (which can lead to amputation), severe kidney failure and blindness.
Both types of diabetes may require insulin, but for type 1 it is a matter of survival, because without insulin, this condition constitutes a death sentence. We understand why the discovery of the role of this hormone, then how it could be used as a drug, revolutionised the management of this condition. To the point that, as early as 1923, the team of scientists behind it (Frederick Banting, Charles Best, John Macleod, and James Collip) were awarded the Nobel Prize in Physiology (or, medicine). Since then, the prestigious award has never been awarded so quickly after a breakthrough.
In 2026, however, this medication is essential for the survival of 9 million people living with type 1 diabetes and which contributes to better care for 63 million people living with type 2 diabetes, remains inaccessible to a significant portion of the global population.
Significant public health consequences
Overall, it is estimated that only one in two people worldwide with type 2 diabetes has access to the insulin they need.
In Africa, this proportion is even worse, since it is estimated that only one person out of seven can obtain the insulin needed for their care.
In recent years, this situation, which mainly affected low- and middle-income countries, has affected the United States, where it is estimated that insulin has become so costly in this country that it is forcing about 16.5% of people who need insulin to “ration” its use (by delaying or reducing the dose, for example). This amounts to approximately 1.3 million adults.
It is important to note that this issue of access to insulin does not concern only type 1 diabetes, but also type 2 diabetes, a form of the disease that is rapidly increasing worldwide.
In 2020, it was estimated that approximately 445 million adults aged 20-79 years were living with type 2 diabetes. According to the most optimistic assessments, this was the case for at least 730,000,000 people by 2025, with 15.5% of them needing insulin.
This access problem is mainly due to the price of insulin, but also to the lack of availability of the medication in many health systems. However, determining the reasons why insulin is available or not is not always obvious, because accessibility depends on a complex chain in which each step can fail.
To achieve this, the World Health Organization (WHO) suggests taking eight factors for analysis into consideration: research and innovation, manufacturing, regulation, market uptake and reimbursement, procurement and supply, prescription, dispensing, and use. In the case of insulin accessibility, this analytical framework teaches us that at each step, governments have an important role to play.
Research and innovation: ensuring that the public good does not shift towards the market
At the global level, governments are investing a lot of money in research. This funding, often given to universities, promotes the discovery of innovative treatments and the history of insulin illustrates the importance of the role of academia. The insulin patent was sold by the researchers who discovered it to their university for one symbolic dollar to ensure universal access. One of them, Frederick Banting, is said to have declared:
However, once in the hands of the pharmaceutical industry, prices soared, illustrating the tensions between patents, innovation and accessibility. Today, insulin production is dominated by three manufacturers: Sanofi, Eli Lilly, and Novo Nordisk, which control 90% of a market estimated at $29.4 billion (€25.2 billion) in 2024.
This situation limits competition and neutralises the effect on prices that could result from the introduction of biosimilar insulin (in other words, “generics” of insulin as it is a biological product). For this reason, governments must rethink their support for innovation.
It is not only a question of funding research for new technologies and considering local and public production, but also of promoting “smart innovations”. These less spectacular solutions are often overlooked by the private sector, but can still be well adapted to real needs. For example, new approaches to patient therapeutic education can be developed, based on new technologies, or artificial intelligence (AI) tools can be used to make better use of data generated by health systems.
Regulation and market uptake: harmonising and simplifying
Marketing authorisation is the responsibility of national or regional agencies, such as the European Medicines Agency (EMA) in Europe or the US FDA (Food and Drug Administration) in the United States. These institutions are essential for ensuring the quality and safety of medicines, but their procedures remain complex, especially when it comes to introducing biosimilars.
In response, the WHO launched a pre-qualification program for insulin in 2019, aimed at making it easier for new manufacturers to enter the market. Yet, to date, few manufacturers have submitted a dossier. To increase competition, governments still need to harmonise and simplify procedures, while supporting the entry of new manufacturers into markets, in parallel to guaranteeing safe and quality assured medicines.
The question of pricing is equally crucial. In some countries, prices of medicines are set by governments. In others, this is done after negotiations between the state and the private sector. But in most low-and-middle income countries, such policies are non-existent.
Lack of price transparency hampers bargaining power, leading to price inflation not only for people but also for the healthcare system. To address the problem, governments must develop price-setting mechanisms. They must also ensure affordability for the health system and (ideally make medication free of charge) for their populations.
Supply and distribution: the logistical challenge
The fact that a medicine is manufactured and has marketing authorisation is not enough to ensure its accessibility. There must also be logistics chains allowing it to be stored properly and transported in appropriate conditions, particularly respecting cold chain management, which is important for a biological product such as insulin.
The supply chain must also be efficient and inexpensive, in order to have as little impact as possible on the final price of the medicine. In many countries, however, infrastructure problems or high logistical costs add to the final price paid by individuals.
Again, the role of governments is central. They must make the right investments to ensure that their supply-chain infrastructure is efficient. At the same time, they must ensure that it does not result in additional costs for the system or people. Recent notifications of insulin shortages and product withdrawals globally require governments to intervene to ensure that sustainable insulin supplies remain globally.
Insulin prescription and use: strengthening health systems
Insulin only saves lives if it is prescribed, dispensed and used properly.
However, at the end of the day, people with diabetes may face usage barriers due to a variety of factors, such as a weak healthcare system, a shortage of health professionals, or unreliable availability of medicines in pharmacies.
Governments must invest in improving health systems and ensuring comprehensive, holistic diabetes care within the Universal Health Care agenda.
Rebalancing the power struggle with the private sector
To use the metaphor of the Canadian Economist Henry Mintzberg, society is like a three-legged stool, represented by government, civil society, and the private sector. If the three legs are not at the same level, the balance is disrupted. Yet this is exactly what happens in the case of insulin. The private sector often imposes its rules, to the detriment of the public interest.
In response to this, governments must fully assume their role as countervailing powers. They have the levers in their hands to change the situation. They must invest in research and innovation, regulate an overly concentrated market, fund strong health systems, and protect their populations from predatory pricing.
Without firm action, inequality will continue to grow. Insulin is a symbol. It embodies both the promise of modern medicine and the glaring inequalities in access to care. Ensuring its accessibility is not just a public health issue; it is an issue of social justice and human rights.
More than a century after its discovery, it is time for insulin to finally become what it should have always been: a global public good, accessible to all.
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This article was originally published on The Conversation. Read the original article.
