Insulin Tourism: Our Most Underrated Health Crisis
One autumn morning in 1920, a young doctor named Frederick Banting had a sudden epiphany. In a 25-word hypothesis, he had devised a way to extract the elusive hormone insulin from the pancreas, which could then be used to treat diabetes. Banting’s theory took less than a year to reach reality - first in dogs, then humans. In that short time, he and his assistant, Charles Best, had managed to create a treatment for what had previously been an irrevocable death sentence. For his efforts, Dr Banting received the Nobel Prize and later, a knighthood. It’s incontestable that his breakthrough changed the planet for good.
Once highly accessible, insulin’s rising prices have left many worldwide in a state of emergency. According to studies by Health Action International and BMJ Global Health, insulin is unaffordable in most countries and an estimated 50 million people are unable to afford regular dosage. This is roughly half of those living with the disease. What’s more, the number of people with diabetes is predicted a 48% increase between now and 2045. Taking into account the correlation of increasing demand with increasing prices, swift action must be taken to avoid a worldwide public health crisis.
In addition to high prices, availability is also an obstacle in many middle-and-low-income countries. With insulin (in both human and analogue forms) as a capital-rich manufactured substance, economically prosperous nations such as Denmark, Germany and France dominate insulin exports. Subsequently, lower income countries lacking manufacturing industries of their own are forced to rely solely on imports. This troubling dependency is exacerbated by the fact that many countries import their insulin supplies from just one trading partner; an eggs-in-one-basket situation that renders them vulnerable to any disruption in the global market.
That said, there’s also no guarantee that the world’s strongest economy can’t be hit hardest. Sky-high American prices have resulted in a phenomenon cynically referred to as ‘insulin tourism,’ where desperate diabetics are forced abroad in search of a more affordable version of the medication needed to keep them alive. While this may seem greedy or melodramatic, such measures are hardly unreasonable. According to American news outlets, a three-month supply of insulin in the United States amounts to roughly $4,000. In neighbouring Mexico, it’s as little as $600. Prices aren’t necessarily linked to development either - in Canada, general supplies cost roughly 1/10 of what they do in the USA. In recent years, mainstream media and news outlets have shared stories of Americans crossing both borders with storage coolers in hand; some even including visits to Dr Banting’s home in a sort of sad pilgrimage. By some sources, they’ve even been framed as ‘caravans,’ a term made highly evocative by other border-related events.
The ‘insulin tourists’ have progressed beyond fringe movements. Along the US-Mexico border, the practice has become so commonplace that a Utah-based insurance provider has implemented a ‘Pharmacy Tourism’ program, where clients are sponsored to travel to Mexico and purchase any of 13 prescription medications. In a system where one’s insurance policy dictates the amount (and strain) of insulin a person can access per month, programs like these have found that international accommodation and travel is still cheaper than obtaining the same drugs in the US. These programs are potentially fuelled by horror stories of others less fortunate, including an ‘epidemic’ of middle-and-low income diabetics found dead in their own homes after attempting to ration their supply.
Despite nearly a century having passed since Banting’s miraculous invention, diabetes is still too often fatal.
The struggle for healthcare in the United States is hardly fresh. Nor is the worldwide inaccessibility of vital medications. However, what makes insulin unique is the saga behind it. According to Canadian lore, Banting’s declaration upon his discovery was that “insulin does not belong to me, it belongs to the world.” In that spirit, he promptly sold its patent to the University of Toronto for just one Canadian dollar in a deeply symbolic attempt at making insulin a public good for all eternity. Shortly after, the University extended the patent to 25 additional countries, set up monitoring committees overseas, and implemented a ‘patent pool’ system that allowed them greater control over the drug’s development. Their combined message was clear: insulin was to remain affordable, universal, and out of the hands of private pharmaceutical corporations.
Nearly 100 years later, the situation couldn’t be more different. Today, insulin is concentrated in the hands of three major Western pharmaceutical firms, Novo Nordisk, Eli Lilly, and Sanofi. Prices have skyrocketed over the past few decades, and it’s not a supply-and-demand issue. Rather than manually extracting the hormone from livestock as in 1920, today’s human insulin is manufactured in a lab, which produces virtually limitless quantities. According to Canadian publication MacLean’s, the price hikes are instead linked to newer versions being protected by multiple patents; with deviations of just one molecule often justifying one from predecessors.
There isn’t any one moment at which Banting’s vision went wrong. Inflation during the late twentieth century played a role, as did the decline of the Western welfare state and the incorporation of intellectual property into multilateral trade agreements. Despite this, one conclusion can be made: despite clear intent and admirable effort, the quest to keep insulin universally accessible has failed to stand the test of time.
Today, American insulin tourism is more or less legal. Although it's technically a violation under the Food and Drugs Administration (FDA) to bring foreign medications into US territory, there have been zero prosecutions to date. However, that’s not to say that this won’t change particularly given the increased media presence and recent turn to activism embraced by many ‘tourists.’ Despite justified intentions, their methods (including making the trek in a tour bus and disembarking several times to protest, posters and all) may have the opposite effect. Rather than passing constructive reforms, it’s highly plausible that the current administration may respond by cracking down on the practice and effectively ruining the chances of those who depend it to survive.
In a more uplifting light, representatives of the US Senate have called for an investigation into suspected price collusion between the three reigning pharmaceutical firms; alleging that the tripling of prices over the past 15 years was slightly too synchronised to have occurred organically. Even U.S. President Donald Trump has also made statements condemning the for-profit pharmaceutical industry. If classified as a bipartisan American issue, accountability may be feasible, with implications stretching far beyond the United States.
Our world has come a long way since the days of Banting and Best. Social, economic, and environmental structures have evolved at breakneck speeds with the everyday consumer too often paying the price. However, their value systems remain timeless. In order to follow in their footsteps, a paradigm shift is required in the way our global society views industries like these. The current system is ingrained deeply; reinforced by structures of dependency and unregulated profit. However, it isn’t set in stone. If declared important enough, affordable medical care can still become a right of future generations.