The Importance of Protecting Domestic Insulin Production in Low- and Middle-Income Countries

Duane Pohlman with a T1International poster

The story of Argentina’s insulin crisis offers a poignant illustration of the critical importance of domestic pharmaceutical production and the severe consequences of relying too heavily on multinational corporations for essential medicines. In the mid-1960s, Eli Lilly acquired the only insulin manufacturing plant in Argentina, a move that initially promised stability for the nation’s insulin supply. However, the economic turmoil of the 1980s brought unforeseen challenges.

The Argentine Case: A Lesson in Vulnerability

In 1985, amidst an inflation crisis with rates soaring around 800%, the Argentine government implemented stringent across-the-board price controls, aiming to curb inflation. Eli Lilly sought to exempt insulin from these controls due to its critical nature, but the government declined. In response, Eli Lilly shuttered its plant and exited Argentina, leaving 73,400 people who depended on insulin without a local source. This abrupt exit highlighted the fragility of Argentina's dependence on a single multinational entity for its insulin supply.

In the aftermath, Argentina turned to Biobras, a Brazilian insulin manufacturer, to fill the gap temporarily. Biobras supplied insulin for approximately two years until Laboratorios Beta, a domestic pharmaceutical company, could ramp up production. However, in 2002, Novo Nordisk acquired Biobras and ceased the production of lower-cost animal insulin, which had been vital for much of Latin America. Laboratorios Beta continued its efforts until 2013, when it ultimately withdrew from the insulin market, unable to compete with Novo Nordisk/Biobras. As a result, Argentina now imports all its insulin, a stark reminder of the vulnerabilities in relying on external sources.

Challenges and Triumphs in Other Nations

Other countries have faced similar challenges. For instance, in India, efforts to establish domestic production of insulin have been ongoing, with varying degrees of success. Indian pharmaceutical companies like Biocon have made significant strides in producing recombinant human insulin and analogues, aiming to reduce dependence on imports. Despite regulatory and market challenges, Biocon’s efforts illustrate the potential for domestic industries to make substantial contributions to national healthcare.

In contrast, South Africa has made notable progress in its quest for pharmaceutical self-sufficiency. Aspen Pharmacare, one of the largest pharmaceutical companies in the Southern Hemisphere, has developed capabilities to produce insulin domestically. However, they face competition from global giants and market access issues, which can hinder their growth and sustainability.

The African Context: A Call for Action

The situation in sub-Saharan Africa is particularly dire, with almost every country importing 100% of its insulin and other essential medicines. This dependency creates a precarious situation where supply chain disruptions and price volatility can have catastrophic effects on people with diabetes. For example, in Tanzania, efforts to produce insulin locally have been hampered by limited infrastructure and financial constraints. However, partnerships with global health organizations have shown promise in building capacity for future domestic production.

The Way Forward: Policy and Advocacy

To mitigate these challenges and build resilient healthcare systems, local governments must prioritize policies that support and protect domestic pharmaceutical production. This includes ensuring that price controls do not stifle innovation and growth of local companies, providing financial incentives and infrastructure support, and fostering collaborations between local firms and international organizations.

Countries like Brazil, despite past setbacks, offer a blueprint for success. Brazil’s public health policies and investment in local production capabilities have enabled it to maintain a degree of self-sufficiency in insulin production. The lessons from Brazil emphasize the importance of sustained government support and strategic partnerships in overcoming market and regulatory barriers.

Conclusion: Building Resilient Health Systems

The story of Argentina, along with the experiences of other nations, underscores the urgent need for low- and middle-income countries to develop and protect their domestic pharmaceutical industries. We must advocate for policies that promote local production, ensure regulatory environments that support rather than hinder innovation, and build robust supply chains that can withstand global economic fluctuations.

By taking these steps, we can reduce dependence on multinational corporations, secure our health sovereignty, and ensure that life-saving medicines like insulin are accessible and affordable for all who need them. The path forward requires collaboration, innovation, and unwavering commitment from governments, healthcare providers, and the global community. Together, we can create a future where essential medicines are produced locally and sustainably, improving health outcomes for millions of people worldwide.