Insulin Shortage Leaves Millions Diabetic Pakistanis In Peril

In a troubling development for Pakistan, a critical shortage of high-quality insulin has emerged, exacerbating the nation’s already dire diabetes situation.

In a troubling development for Pakistan, a critical shortage of high-quality insulin has emerged, exacerbating the nation’s already dire diabetes situation. With over one-fourth of the adult population grappling with diabetes, the scarcity of essential medication is a consequence of unfavorable policies and bureaucratic red tape that has impeded investment in the local pharmaceutical industry.

The International Diabetes Federation (IDF) reports that Pakistan boasts a staggering 34 million people, or 26.7% of the adult population aged 20-79, afflicted with diabetes. This rate is significantly higher than the global average of 1 in 10 individuals. Pakistan ranks third globally in the number of diabetes patients, trailing only behind India and China. Experts warn that with high sugar intake prevalent, the situation is likely to worsen further.

The pharmaceutical sector, already grappling with multiple challenges, finds itself in a predicament that seems far from resolution. Industry experts highlight neglect, under-investment, and a lack of conducive policies as key factors contributing to the growing reliance on insulin imports, straining the country’s foreign exchange reserves.

While there are three major insulin providers in Pakistan—two multinational corporations, Eli Lilly and Novo Nordisk, and local player Getz Pharma—the preference among consumers remains tilted towards multinational brands. Abdul Razzak, a seasoned figure in the pharmaceutical distribution network, emphasizes the inclination towards multinational products for their perceived quality.

Ayesha T Haq, Executive Director of Pharma Bureau, a representative body of 22 multinational pharmaceutical companies in Pakistan, attributes the insulin shortage to supply-chain issues. Six months ago, Eli Lilly sought a ‘source change’ due to operational scaling back in Pakistan but has been awaiting government approval ever since. This bureaucratic delay underscores the hurdles faced by businesses in the country.

Pakistan’s need for insulin imports from Eli Lilly may shift from the US to a closer geographic source, potentially redirecting it from a manufacturing facility in India. The delay in approval raises concerns of an imminent shortage, further straining an already fragile healthcare system.

Comparisons with neighboring Bangladesh highlight the stark contrast in policies and investments. Bangladesh’s favorable policies have attracted significant investments, making the country self-reliant in the pharmaceutical sector. In contrast, Pakistan has witnessed a decline from 30 manufacturing multinational companies to only four—GSK, Abbott, Novartis, and Bayer—underscoring the lack of policy certainty and discouraging investment.

Pharma Bureau’s Haq stresses the crucial role of multinational companies in fostering growth and innovation in the pharmaceutical sector. However, challenges such as price regulations, as witnessed in the case of a drug priced at Rs700, deemed anti-business, further deter investment and hinder sector development.

Former Chairman of the Pakistan Pharmaceutical Manufacturers Association (PPMA), Dr. Kaiser Waheed, confirms the short supply of insulin in the country, citing price regulation as a contributing factor. An alarming anecdote reveals that a company sought a hardship price of Rs 1,300 but faced rejection. Consequently, the drug ceased production, leading to a thriving black market where the medicine is sold at ten times the hardship price.

While an official acknowledges the wide availability of insulin in general, brand-specific shortages persist, aggravating concerns about the accessibility of critical medication for diabetes patients. Last month, the Drug Regulatory Authority of Pakistan (DRAP) approved the registration of five insulin products, aiming to address the pressing issue and ensure a more stable supply chain in the future.