A century after it was discovered, insulin still remains out of reach for many people living with diabetes, the World Health Organisation (WHO) said in a report published to commemorate the milestone anniversary.

The report, published by WHO in the lead-up to World Diabetes Day on Sunday, November 14, highlights the alarming state of global access to insulin and diabetes care.

It also finds that high prices, low availability of human insulin, few producers dominating the insulin market and weak health systems are the main barriers to universal access.

Insulin is the “bedrock” of diabetes treatment, and WHO is working with countries and manufacturers to expand access to everyone who needs it.

“The scientists who discovered insulin 100 years ago refused to profit from their discovery and sold the patent for just one dollar,” said Tedros Ghebreyesus, Director-General of the UN agency.

“Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps.”

Diabetes is characterised by elevated levels of blood sugar which over time, can cause serious damage to the heart, blood vessels, eyes, kidneys and nerves.

There are two forms of the disease. Type 1 diabetes, previously known as juvenile diabetes, is a chronic condition in which the pancreas produces little or no insulin.

For nine million people worldwide living with type 1 diabetes, having access to insulin turns the disease into a manageable condition.

The most common form of diabetes, type 2, is usually found in adults. It occurs when the body becomes resistant to insulin or doesn’t make enough of it.

WHO said for more than 60 million people living with type 2 diabetes, insulin is essential to reduce the risk of kidney failure, blindness and amputation. However, one in two people who need the medicine do not get it.

While diabetes is increasing in low and middle-income countries, their consumption of insulin has not kept up with the growing disease burden.

Even though three in four people who have type 2 diabetes live outside of North America and Europe, they account for less than 40 per cent of revenue from insulin sales.

The report outlines measures to improve access to insulin and related products.

Actions include boosting human insulin production and supply, and diversifying manufacturing of biosimilar products to create competition and reduce prices.

WHO explained that global markets have shifted from human insulin, which can be produced at relatively low cost, to pricier synthetic insulin, which can be up to three times more expensive.

The UN agency called for improved affordability by regulating prices and mark-ups through pooled procurement and greater price transparency, and promoting local manufacturing capacity in under-served regions.

WHO has worked with the industry to address some of the barriers to the availability of insulin, related medicines and technologies, through holding dialogues with business associations and manufacturers.

This has resulted in several commitments by the industry, which range from developing a policy blueprint for improving access to biosimilars of insulin, to participating in WHO’s prequalification programme for insulin, glucose meters, test strips and diagnostic tools.