Steps are afoot to supply affordable insulin to the developing world

The Jutland peninsula in Denmark provides half the world’s supply of insulin, the life-saving pancreatic hormone that regulates blood sugar levels.

And Novo Nordisk, the Danish company is the largest global supplier. For more than a decade Novo’s sales have grown each year at double-digit rates, helping turn it into a $115bn behemoth that has overtaken Norway’s Statoil as the Nordic region’s biggest company by market capitalisation.

Thanks to Denmark’s enormous pig-rearing industry, the raw material for commercial insulin manufacture – porcine pancreatic glands – was plentiful and formed the basis of Novo’s business.

With the number of diabetes sufferers worldwide predicted to surge to more than 500m in the next two decades, Novo is on a rising ride. Some 24m people use the company’s insulin every day.

But in poor countries – such as India where about 1m people died from diabetes in 2012 – with weak healthcare infrastructure, tens of millions of people go without the drug. An unfolding diabetes epidemic is being fuelled by rapid urbanisation, changing diet and sedentary lifestyles.

The human cost is measured in sight loss, amputated limbs and premature death. “When a child gets diabetes in the third world it is more or less left to die,” says Laurence Gerlis, a central London doctor and former medical director of Novo Nordisk.

Indeed, life expectancy for a child with newly diagnosed type 1 diabetes is often less than a year in parts of the developing world, according to Novo Nordisk.

In response to these concerns, it has said it will strive to make its diabetes drugs available to 40m people by 2020 – an increase of 33 per cent in six years – by selling them at cost price.

“We cannot change the demographic problem that people are getting older and more overweight,” says Mads Krogsgaard Thomsen, Novo Nordisk’s chief science officer.

“But we now have three generations of insulin, and the older varieties we can sell to the least developed countries for no profit.”

Under this policy, the company offers so-called “human insulin” – the first generation of manufactured insulin – to governments in 48 of the poorest countries at a price that does not exceed 20 per cent of the average for Europe, the US, Canada or Japan. This does not guarantee that the saving is passed in full to sufferers, however: intermediaries take their cut in many countries, and even hospitals increase the price of medicines as a source of revenue.

The Access to Medicine Index, which ranks pharmaceutical companies’ efforts to improve availability of drugs in developing countries, notes with approval that Novo supports its provision of non-patented human insulin with efforts to improve healthcare infrastructure, logistics and education, and combat corruption, seeking to ensure that treatment in target communities is sustainable over the longer term.

The company has come a long way since August Krogh returned from Canada in 1922 after winning the Nobel Prize for medicine, bringing with him the rights to produce insulin, which had been discovered at the University of Toronto a year before.

Mr Thomsen says he looks forward to even greater innovation, such as making insulin available in tablet form, based on new understanding of how such a fragile protein can be made sufficiently stable to survive the stomach’s enzymes and get into the blood.

“That will be a huge benefit for the patients, and I believe we can make that happen in the next decade,” he says.

Jenny Hirst, chair of the UK charity Independent Diabetes Trust (IDDT), says that for many people with diabetes, orally administered insulin would be an important step, but not a panacea. “The injections are like brushing your teeth.”

She would rather Novo Nordisk spent more of its annual $2bn R&D budget on freeing diabetes sufferers from medication altogether, for example through stem cell research.

Dr Gerlis, who is also a medical adviser to IDDT, has “deeply held misgivings” about the priorities of pharmaceutical companies in developing new forms of insulin.

Yet he concedes that low-cost human insulin for poor countries is certainly saving lives.

However, Mr Thomsen explains, profit from new medicines is what makes it possible for the older types of insulin – still very effective in combating the symptoms of diabetes – to be sold cheaply to the world’s poorest.

When insulin was first manufactured, the life expectancy of a person with diabetes was 30 or 40 years shorter than for healthy people – now this is down to only seven or eight years, he says.