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Member Research & Reports

Member Research & Reports

BU: Access to Insulin Limited in Nepal

Access to insulin, an essential medicine for both type 1 and 2 diabetes, is a major concern globally. Access to insulin is particularly limited in low- and middle-income countries with no local production facilities.

Now, a new study co-authored by Boston University School of Public Health (BUSPH) researcher has found that access to insulin in Kathmandu Valley, Nepal, is limited due to low availability and highly unaffordable prices.

The study was published in International Health.

“Diabetes is one among several non-communicable diseases that place a heavy burden on the healthcare systems of low-income countries,” says co-author Dr. Warren Kaplan, clinical assistant professor of global health. “Insulin, the lack of which would be fatal in many patients, is manufactured primarily by European and U.S.-based pharmaceutical companies that continue to market expensive, modified [analogue] insulins, which are replacing less expensive unmodified insulins.”

The researchers found that the availability of two human insulins was 14.3 percent and 42.85 percent in the surveyed private- and public-sector pharmacies, respectively; the World Health Organization (WHO) target of availability is 80 percent. Moreover, depending on insulin type, the researchers calculated that the lowest-paid worker would need to spend between 3 and 17 days’ wages to purchase a month’s supply of insulin out of pocket.

Most insulin in Nepal comes from European and U.S.-based pharmaceutical companies and not from the insulin made in India, which serves the same function — even though the distance between Delhi and Kathmandu is less than 1,500 kilometers.

“Nepal’s existence as a land-locked country, with the insulin market dominated by a few companies, and its position as having a single primary gateway (i.e., trading partner India) for imported insulin poses certain challenges in this regard,” the authors wrote. “Nepal should employ pooled procurement mechanisms and strategic price negotiations with companies and develop collaborations with neighboring countries to ensure a supply of quality-assured, affordable insulin.”

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