Memo: Insulin access in low- and middle-income countries still fall short by 2035 – Clinton Health Access Initiative

Report on Global Insulin Access and its Implications for Sustainable Development Goals

Executive Summary

A new market analysis indicates a significant and growing gap between insulin demand and access in low- and middle-income countries (LMICs). This disparity poses a direct challenge to the achievement of several Sustainable Development Goals (SDGs), most notably SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). Projections show that despite an increase in treatment, millions will remain without essential insulin by 2035, undermining the global commitment to universal health coverage.

Analysis of Current and Projected Insulin Access

The report highlights a critical shortfall in the global insulin supply chain, particularly affecting vulnerable populations.

• Current Need: 95 million people globally require insulin.
• Current Access: Only 36% of those in need (35 million people) currently have access.
• Projected Growth: The number of people receiving insulin in LMICs is expected to more than double to 76 million by 2035.
• Projected Gap: Despite this growth, an estimated 30 million people will still lack access to insulin in 2035.

Alignment with Sustainable Development Goal 3 (Good Health and Well-being)

The insulin access crisis directly impedes progress towards key targets within SDG 3.

1. Target 3.4: The failure to provide insulin for diabetes management hinders efforts to reduce premature mortality from non-communicable diseases (NCDs).
2. Target 3.8: The gap in access represents a fundamental barrier to achieving Universal Health Coverage (UHC), which mandates access to affordable, essential medicines for all.

Market Dynamics and Implications for SDG 10 (Reduced Inequalities)

Progress in insulin access is unevenly distributed, exacerbating existing inequalities between and within countries, a core concern of SDG 10. The analysis identifies several forces shaping the market and contributing to this disparity.

• Regional Disparities: Persistent access challenges are concentrated in sub-Saharan Africa and South Asia.
• Market Fragmentation: Inefficient distribution and a fragmented product landscape limit availability.
• Systemic Weaknesses: Inadequate diagnostic capacity and a lack of health system readiness prevent effective treatment delivery.
• Evolving Market Trends: China’s transition towards GLP-1 therapies indicates future market shifts that could further complicate access in other LMICs.

Conclusion: A Call to Action for the 2030 Agenda

Addressing the global insulin gap is imperative for advancing the 2030 Agenda for Sustainable Development. Ensuring equitable access to this life-saving medicine is a prerequisite for achieving good health, reducing inequality, and fulfilling the central promise of the SDGs to “leave no one behind.” Collaborative action is required to overcome systemic barriers and strengthen health systems globally.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is access to insulin, an essential medicine for managing diabetes, a non-communicable disease (NCD). This directly aligns with SDG 3’s goal of ensuring healthy lives and promoting well-being for all at all ages. The text highlights a critical health gap, stating that “millions will still go without” this life-saving treatment.

SDG 10: Reduced Inequalities

• The article explicitly points out disparities in insulin access, noting “uneven progress” and that “most progress [is] concentrated in just a few regions.” It identifies “persistent barriers in sub-Saharan Africa and South Asia,” highlighting a clear inequality in health outcomes and access to essential services between different parts of the world, which is a core concern of SDG 10. The closing statement, “ensure no one is left behind,” is a foundational principle of this goal.

SDG 17: Partnerships for the Goals

• The article, a market analysis memo by the Clinton Health Access Initiative, discusses complex systemic issues such as “product fragmentation, diagnostic capacity, and health system readiness.” Addressing these multifaceted barriers requires coordinated efforts among governments, private sector manufacturers, and civil society organizations. This implicitly calls for the multi-stakeholder partnerships that SDG 17 aims to foster.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment. The article focuses on expanding access to insulin, which is a critical treatment to prevent premature mortality from diabetes (an NCD). The projected gap where “30 million people will remain without access” directly impacts this target.
• Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines for all. The article’s core finding that “only 36% of the 95 million people who need insulin can get it” is a direct measure of the failure to provide an essential medicine, which is a key component of universal health coverage.
• Target 3.b: Provide access to affordable essential medicines for all. This target is central to the article, which analyzes the market for insulin, an essential medicine, and highlights the massive access gap, particularly in low- and middle-income countries (LMICs).

SDG 10: Reduced Inequalities

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all. The article’s focus on the disparity in insulin access, especially in regions like sub-Saharan Africa and South Asia, relates to this target by highlighting how health inequalities prevent full inclusion and well-being for populations in these areas.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3

• Implied Indicator for Target 3.4 (Indicator 3.4.1: Mortality rate attributed to… diabetes): While the article does not provide a specific mortality rate, the entire premise is that a lack of insulin access leads to premature death from diabetes. The number of people without access (currently over 60 million, and a projected 30 million in 2035) is a proxy for the population at high risk of premature mortality, which this indicator tracks.
• Mentioned Indicator for Target 3.8 (Indicator 3.8.1: Coverage of essential health services): The article provides a direct quantitative measure for this indicator. The statement that “only 36% of the 95 million people who need insulin can get it” is a precise measurement of the coverage for an essential NCD treatment service.
• Mentioned Indicator for Target 3.b (Indicator 3.b.2: Proportion of the population with access to affordable medicines): The same statistic, “36% of the 95 million people who need insulin can get it,” directly serves as this indicator, measuring the proportion of the relevant population with access to an essential medicine.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: clintonhealthaccess.org