We believe in a world where everyone with diabetes, no matter where they live, has access to everything they need to survive and achieve their dreams. Everyone should have access to the insulins that work best for their body. That is why we are calling on the World Health Organization to add rapid-acting insulin analogues in vials and insulin pens to the List of Essential Medicines for children and adults with all types of diabetes.

Short-acting insulins like Eli Lilly’s Humalog and Novo Nordisk’s Novolog have been available for decades and are part of the status quo for treatment of type 1 diabetes in high-income countries. Human insulins like Regular and NPH work slower and do not allow for flexible dosing around varying amounts of carbohydrates and eating schedules; additionally these human insulins put people with diabetes at a higher risk of low blood sugar.

Rapid-acting insulin analogs allow for the use of insulin pump technology, more flexible diets and eating schedules, eating around faith events like Ramadan and others, lower risk and fear of hypoglycemia, and overall improved quality of life. It is an injustice that people in high-income countries can expect access to the most effective and health-promoting insulins available, while people in low- and middle-income countries do not benefit from the same access. This is a double standard of diabetes care.

With the recent addition of long-acting insulin analogue vials and pens to the Essential Medicines List, it is time for rapid-acting insulin analogues to also be added to further improve quality access and outcomes for people with diabetes. In patients with type 1 diabetes, it is highly unlikely that someone prescribed long-acting insulin analogue would not also be prescribed rapid-acting insulin analogue. The two are complementary, as long-acting insulin analogues function as a background basal rate while rapid-acting insulin analogues are taken before meals or times of carb consumption and to quickly correct high or rising blood glucose levels.

The inclusion of rapid-acting insulin analogues will signal the vital importance of analogues in the List of Essential Medicines and, in turn, will catalyse further reduction of list prices. Currently, the insulin market does not hold the interest of patients reliant on insulin therapy and does not follow typical market patterns, as three companies control 96% of the insulin market by volume and 99% in terms of value globally. The lack of robust competition leaves the world with a market insulated from price controls and inevitably strips patients of choice: choice of medicine, choice of cost, and choice of survival in many cases.

World Health Organization, we urge you to add rapid-acting insulin analogue vials and pens to the Model List of Essential Medicines for adults and children with diabetes!