'I skip meals' Counting the cost of diabetes in global south

'I ration my insulin every month," said Khushi Ahuja, a law student from Delhi who has type 1 diabetes and relies on human insulin manufactured by the US company Eli Lilly. While insulin is available at no cost in some public hospitals in India, it is mostly up to individuals to buy the drug.

- Weronika Strzyżyńska

"Every month I hear about insulin prices rising and I feel guilty about burdening my parents," Ahuja said. "I skip meals to make my insulin last longer." 

Eli Lilly and two European companies, Novo Nordisk and Sanofi, control 99% of the market by value and 96% of the market by volume. The three manufacturers produce 83% of the insulin sold in low and middle-income countries, where it is now estimated that one in two people who rely on insulin do not have sufficient access to the drug. Earlier this month, all three companies made a commitment to cutting the costs of insulin in the US, where the drug was sold at the highest price in the world.

Ahuja will not benefit from the price cuts, but she hopes the announcement will mark a change in how global insulin suppliers view the drug.

Elizabeth Pfiester, director of TiInternational, a non-profit organisation advocating for people with type 1 diabetes, said: "Even though people in the United States are paying the highest dollar-for-dollar amount, many people around the world, particularly in the global south, have to pay up to 100% of their income to access insulin."

According to T1's data, the average out-of-pocket costs of insulin and diabetes supplies in the US cost 10% of GDP per capita, but in Kenya this rises to 125% of GDP per capita.