Insulin was discovered by four Canadians, who famously sold the patent for $1 each to the University of Toronto—enabling the public manufacture of the new miracle drug for people with diabetes. That was in 1921, and for 65 years insulin was produced in Canada at a publicly owned laboratory—Connaught Laboratories—and distributed across the country at prices near the cost of production.
In 1972, the University of Toronto sold Connaught to the federal government. By the 1980s it had grown to become a major supplier of medicines and vaccines, and Canadians had one of the lowest overall drug bills among developed nations. That all changed when the Conservatives were elected in 1984.
In his first budget speech, Michael Wilson, the new finance minister, announced that “Crown Corporations with a commercial value but no ongoing public policy purpose will be sold.” That included Connaught, which was privatized a year later and bought by what is now Sanofi, based in Paris. Ten years later, Canada was no longer producing a single drop of insulin.
Today Sanofi is the smallest player in a group often referred to as “the Big Three” insulin manufacturers. It includes the French manufacturer, Novo Nordisk and Eli Lilly and together, they control 97 per cent of the world insulin market. Consequently, people’s access to safe, effective, and affordable insulin is a hit or miss affair. Amsterdam-based Health Action International estimates that half of the world’s people who need insulin to live can’t get it, most (but not all) of them in low and middle income countries. The reasons are complex, but the Big Three are at the top of the list of villains.
Another consequence of this oligopoly is that domestic insulin manufacturing around the world has collapsed with very few exceptions. India is one of these, but the several domestic producers there together occupy only 14 per cent of their home market, and even that appears to be shrinking. Argentine-based Laboratorios Beta was the last domestic company in the Western Hemisphere to manufacture insulin, and in 2013 they shuttered their production facility because they couldn’t compete with the Big Three in their deregulated home market. Biobras, based in Brazil, was bought by Novo Nordisk in 2006 and now its main job is to fill its parent’s pockets with money, not supply Brazilians with secure access to affordable insulin.
Today observers are concerned that Eli Lilly and Novo Nordisk have found bigger fish to fry and may want to abandon insulin altogether, or at least move the product down their list of priorities. That’s because the two companies are focused on weight loss drugs which bring in a lot more revenue and a lot more profit. Last year, for example, Novo Nordisk withdrew Levemir from the U.S. market, a unique type of insulin used by 300,000 Americans. In April, it announced it would be discontinuing the sale of Mixtard cartridges, India’s top selling insulin product, and signalled that other withdrawals were just around the corner for the rest of the world. Eli Lilly, meanwhile, stopped supplying 3-ml vials of Humalog used by hospitals who save money (and waste) buying the insulin in smaller quantities.
Canada, where about 640,000 people rely on insulin, is also vulnerable to corporate decision-making and the lack of a more interventionist national regulator. Between 1995 and 2006, Novo and Lilly withdrew over 30 different types of insulin from Canada, most of them from animal sources. In 2003, the House of Commons Standing Committee on Health conducted two days of hearings on the issue after hundreds of people from across the country demanded the government intervene. Alarmed officials at Health Canada acknowledged that a subset of people with diabetes were unable to safely use any kind of human or analogue insulin and must have access to animal-sourced products. Some among these experience serious autoimmune reactions and their lives are at stake.
In the glare of ongoing publicity, the federal government arranged for an Indian manufacturer, Wockhardt, to supply Canada with animal insulin from its manufacturing facility in Wales. But in March the company announced it will no longer be providing insulin to Canadians who need it, leaving this vulnerable population at high risk.
All of this is going on over 100 years after insulin was discovered. Something needs to be done immediately for those who need animal insulin. But in the longer term, Canada needs a plan. Activists are once again proposing the idea of a public manufacturer to assure access to safe, effective and affordable insulin for all Canadians, regardless of what kind they need.
The withdrawal of 30 different types of insulin was a warning shot across the bow that Health Canada failed to heed. Now, with the global insulin market in upheaval, they can’t sit back wringing their hands until Novo Nordisk or Eli Lilly or both announce they are pulling out of the insulin market.
We need a plan.
