Short Wave - There's A Plan To Drive Down Global Insulin Prices. Will It Work?

Episode Date: February 10, 2020

Diabetes is a growing global problem, especially in low and middle income countries. Half of the 100 million in need of insulin lack reliable access. The World Health Organization wants to do something about it. Short Wave reporter Emily Kwong tells host Maddie Sofia about the WHO's pre-qualification program, a two-year plan to pave the way for more insulin manufacturers to enter the global market.See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, everybody. I've got Shortwave reporter Emily Kwong with me today. Hey, Maddie. Hey, you. Today, we're going to talk about a disease that's touching the lives of more and more people around the world. Diabetes. That's right.

Diabetes is super common in the United States, affecting nearly 10% of the population. Wow. I saw it up close with my own grandfather. I watched him prick his finger, measure his blood sugar level. But I didn't really. GASP diabetes as a global issue until I met John Peter Molo. I'm 29 years old, and I live in Tanzania. So John Peter is a lab technologist at a hospital in Tanzania, and he's been living with type 1 diabetes since he was 15 years old.

Right. So type 1 diabetes is when your body doesn't produce insulin at all. And type 2 diabetes is when your body resists insulin or does it make enough of it? Yes. Inulin, it's really important for regulating blood sugar in the body. And as a person with type 1 diabetes, John Peter relies on injections of insulin to stay healthy. He gives himself four shots a day. And it's been really tough to uphold this routine in Tanzania.

Many of the necessities that we are supposed to have are not there. So we have to struggle. It's very expensive. And the important word here is necessity. A type 1 diabetic within a few days or weeks will die without insulin treatment. And globally, half of people that need insulin do not have regular access to it. So John Peter remembers when he was younger sharing one vial of insulin with his cousin. Wow.

So it was one vial, two people. Insulin rationing like this, it's common worldwide but really dangerous. And it's not just an access issue, but a cost issue too. Insulin, particularly long-acting insulin, is so expensive in Tanzania that John Peter gets his supply from Kenya to save money. I have to buy them from the other country. Oh my gosh. You go to great lengths to get this medicine. Yes.

And I know there are issues with insulin here, too, in the United States having to do with the high prices, right? Yes, we could do an entire episode on that, actually. But today I want to look at the global market because this past November, the World Health Organization made an exciting announcement, a program to expand access to insulin in low and middle income countries especially. Where diabetes rates are actually increasing the most rapidly. Yes, and to do it, they issued a special invitation. So today on the show, we talk about how the World Health Organization, or the WHO, plans to bring more insulin onto the global market.

And maybe, just maybe, make insulin more affordable. All right, Emily Kwong, today we're talking about diabetes and a plan by the World Health Organization to increase the global supply of insulin, which would be a big deal. It would. Yes. I have a million questions, but to start, let's talk to. Okay, I want to talk about the history of the drug insulin, which is pretty cool.

But first, let's start off with how insulin is naturally made in the body. Sure. All right. So we know insulin is made in the pancreas by a cluster of cells called the islets of Langarhans. Right. And insulin works by helping blood sugar enter the cells in your body. body so that it can be used for energy. And it also plays a big role in storing blood sugar for later use. Correct. Because without insulin, sugar in the blood accumulates. It's not being absorbed by

your cells. And this can lead to nerve damage, eye damage, and in the worst case, death. So prior to its discovery, people with diabetes could not expect to live very long. The only real treatment was a starvation diet. Because that kept the level of sugar low in your blood. Yes. But a radical new treatment came along in 1922. That changed everything. A very ill 14-year-old boy in Toronto on his deathbed was the first person to receive an injection of insulin from an animal. The dose was developed in the pancreas of a cow. And it worked. It was a total success. Science. Yes, this won the Nobel Prize in medicine, this first injection of insulin. And pretty soon, you had companies manufacturing insulin in mass. For over 90 years, Lilly has been at the forefront of how insulin

in this manufacturer. Today, there's Eli Lilly, Novo Nordisk, and Sinoffi, what some people call the big three of insulin manufacturing, and the insulin is now made by genetically engineered microbes in a lab. Can we just take a moment here for molecular biology appreciation? Well, we only have 10 minutes, but go on. When we figured out how to put the human insulin gene into bacteria, so the bacteria spit out insulin for us, the supply of insulin went up, we didn't have to be bothering any cows pigs and it reduced some bad reactions that some patients had from putting cow insulin into humans.

It was a molecular biology triumph, quang. You are a human exclamation point right now, Maddie. I am for molecular biology. Thank you. And you're welcome. Okay. So back to the big three drug companies. Right. The dominance of these three companies to manufacture this molecule, insulin, is in part why prices for the drug are so high. Is that because there's a lack of of competition? Well, there is competition, but it hasn't really translated into lower prices. The big three control 96% of insulin buy volume worldwide. Wow. And for several decades, Maddie, they've been raising prices, even suing other companies that attempt to make copycat versions of

insulin, which are called biosimilers. There's a lawsuit alleging that these three companies have increased prices in lockstep with one another. Wow. And the companies, for their part, say, listen, this is the insurance landscape. Our prices reflect that landscape. And the issues in the drug supply chain cannot be solved by us alone. There are many players. But at the end of the day, diabetes patients are struggling to afford this medication they need to survive. Exorbitant prices and low insulin availability, especially in low and middle income countries, where diabetes is on the rise, is a global problem.

One that the World Health Organization has been paying close attention to, including Emor Cook, in Geneva. That's the headquarters of the World Health Organization. I'm sitting here in my office on a sunny but cold afternoon. So in November, Imer and her colleagues at the WHO made a pretty exciting announcement, a formal plan to test and approve quality assured insulin and insulin biosimilars to broaden access. And it began with an invitation to manufacturers. Okay. Is that the invitation? Oh, you bet it is. To paraphrase what is basically a pharmaceutical party invitation, it says, quote, If a product meets WHO recommended standards, the product will be included in the WHO list of pre-qualified products,

acceptable for procurement by interested United Nations agencies and WHO member states. What does that actually mean? Okay. So basically, the WHO wants to create a supply chain that would expand the global medicine cabinet, so to speak, of insulin, insulin that's been evaluated for safety and effectiveness and cost, giving it their stamp of approval, what's known as pre-qualified. So if you're coming to the party, you're basically saying, we're going to be cheap. Yes, whichever manufacturers pass that test can then sell their insulin to UN agencies and countries that request those products. NGOs, too, like doctors without borders. With this influx of insulin coming onto the market, the hope is it will reduce the global price.

And which manufacturers have RSVPed to this pharmaceutical party? Well, as of my conversation with Emir last month, seven. But? Yeah, we're not in a position to talk about the individual companies because at the moment, we have a confidential relationship with the companies until we actually pre-qualify the actual products. And are the big three among these companies? Spill the tea, Emer?

She wouldn't tell me. But the other six, she said, were small to medium-sized companies. And she's ecstatic. They want to certify their insulin product with the WHO. I'll be very proud when we pre-qualified the first insulin. I think the in this area is very important. I'm very proud that we've started it. There's a lot more to be done, but Emir wants to see the WHO-approved insulin on the market in two years.

So if this strategy works, could the price of insulin go down one day? Well, that is absolutely the goal when it comes to this program and the global market. The WHO actually tried this approach with HIV drugs in the early 2000s, and prices did significantly drop, which helped enormously with treatment around the world. But insulin is a much more difficult drug to produce because it's extracted from a living organism, your beloved E. coli. It's not chemically manufactured. So there's that to consider. And this is mostly designed to impact the markets of low and middle income countries. So if you're wondering whether this would come to the United States, so to speak, that would be entirely up to the FDA, our regulatory agency, to approve these drugs. But Emer hopes it could cause a ripple.

WHO prequalification will increase trust in the newcomers to market. They still will need FDA approval, absolutely. but maybe there will be more confidence in switching to less expensive products. And again, it's early days for this program. The invitation just went out in November. But remember John Peter Molo, who I spoke to earlier? He's now a diabetes advocate for the group T1 International. And when I told him about all of this, he hadn't heard of the program.

But he welcomed its possibilities. He personally considers insulin access a human right. If you get insulin, then you have the chance to live for the next day and next day and next day. So insulin, of course, it is a human right. Okay, Emily Kwong, thank you for bringing us this story. You're welcome. This episode was produced by Rebecca Ramirez, edited by Viet Le, and fact-checked by Emily Vaughn. I'm Maddie Safaya.

And I'm Emily Kwong. You've been listening to Shortwave from NPR.