Lack of access to insulin: undermining the Rights of the Child
Authors: Olivia Heller, Olivier Duperrex, Philip D Jaffé, Jeffrey Goldhagen, Carol A Abidha, Ann Skelton, Mikiko Otani, Yvon Heller, Jean-Dominique Vassalli, David Beran
Journal: The Lancet Diabetes & Endocrinology (2024)

2024 marks the centenary of the League of Nations' Declaration of the Rights of the Child. The Geneva Declaration highlighted the health needs of children and proclaimed the duty of governments to respond to these needs.1League of NationsGeneva Declaration of the Rights of the Child. League of Nations, Geneva1924Google Scholar Its influence led to the adoption of the 1989 Convention on the Rights of the Child that imposes obligations on governments, with regard to the right to life (article 6) and the right to health (article 24), which must be granted to every child without discrimination (article 2).2UN General AssemblyConvention on the Rights of the Child.https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-childDate: 1989Date accessed: January 20, 2024Google Scholar Insulin's first use in 1922 transformed type 1 diabetes from a fatal to a manageable chronic disease. Insulin has been considered as an essential medicine since WHO established the Essential Medicines List in 1977. In addition, the Committee on the Rights of the Child asserts that States have an obligation to make all essential medicines mentioned on this list available, accessible, and affordable.3Committee on the Rights of the ChildCRC/C/GC/15, General comment No. 15 on the right of the child to the enjoyment of the highest attainable standard of health.https://www.ohchr.org/en/documents/general-comments-and-recommendations/crccgc15-general-comment-no-15-right-child-highestDate: 2013Date accessed: January 20, 2024Google Scholar Regrettably, insulin remains inaccessible to many of the 9 million people worldwide living with type 1 diabetes.4Green A Hede SM Patterson CC et al.Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults.Diabetologia. 2021; 64: 2741-2750Crossref PubMed Scopus (84) Google Scholar, 5Beran D Lazo-Porras M Mba CM Mbanya JC A global perspective on the issue of access to insulin.Diabetologia. 2021; 64: 954-962Crossref PubMed Scopus (61) Google Scholar Beyond the direct impact on morbidity and mortality, a lack of access to insulin undermines the rights to life, survival, and development (article 6) and right to health (article 24). Indirectly, lack of access to insulin and diabetes care infringes on the child's right to education opportunities (article 28) and even the right to leisure (article 31). In addition to the obligations of States to their own populations, parties to the Convention should also contribute to global implementation of children's rights through international cooperation. This cooperation must prioritise the health of children in resource-limited settings and low-income and middle-income States.3Committee on the Rights of the ChildCRC/C/GC/15, General comment No. 15 on the right of the child to the enjoyment of the highest attainable standard of health.https://www.ohchr.org/en/documents/general-comments-and-recommendations/crccgc15-general-comment-no-15-right-child-highestDate: 2013Date accessed: January 20, 2024Google Scholar In addition to government responsibilities, General Comment 15 also highlights the role of non-governmental organisations, the international community, and the private sector.3Committee on the Rights of the ChildCRC/C/GC/15, General comment No. 15 on the right of the child to the enjoyment of the highest attainable standard of health.https://www.ohchr.org/en/documents/general-comments-and-recommendations/crccgc15-general-comment-no-15-right-child-highestDate: 2013Date accessed: January 20, 2024Google Scholar With respect to diabetes and access to insulin and care for type 1 diabetes, these roles have been framed by WHO through the Global Diabetes Compact and a resolution approved by Member States in May, 2021,6WHOReducing the burden of noncommunicable diseases through strengthening prevention and control of diabetes. World Health Organization, Geneva2021Google Scholar with the target that "100% of people with type 1 diabetes have access to affordable insulin treatment and blood glucose self-monitoring" by 2030.7WHOFirst-ever global coverage targets for diabetes adopted at the 75th World Health Assembly.https://www.who.int/news-room/feature-stories/detail/first-ever-global-coverage-targets-for-diabetes-adopted-at-the-75-th-world-health-assemblyDate: 2022Date accessed: January 20, 2024Google Scholar These global declarations lay the foundation for action. The 100th anniversary of the Rights of the Child, 2 years after the centenary of insulin's first use, is an opportunity to highlight the issue of lack of access to insulin and diabetes care and catalyse a global rights-based response to help address it. To meet the global target of 100% access to affordable insulin and self-monitoring tools, it is also critical to improve regional and national data collection on type 1 diabetes and access to insulin. These data must both document existing challenges and drive global responses and advocacy by mobilising a global response from the public, private, and business sectors—within and beyond the health sector. Finally, there is the need to ensure accountability at national, regional, and global level. As stated by Kofi Annan, on the 10th Anniversary of the Convention on the Rights of the Child, "…children's rights can no longer be seen as optional. Respecting them is not an act of charity. It is a binding obligation. No one must be allowed to get away with violating or neglecting children's rights. Almost every area of government policy affects children in some way, directly or indirectly." As concerned global citizens, it is incumbent upon us to ensure that access to insulin and comprehensive diabetes care, enabling children with type 1 diabetes to realise their fullest potential, becomes a shared responsibility for all, and satisfies the Convention on the Rights of the Child. Suggested actions are listed in the appendix and require input from a diverse audience of experts and people with lived experience. Their aim is to initiate discussion and debate to find ways of addressing the issue of access to insulin and diabetes care with a focus on taking a rights-based approach and ensuring multi-stakeholder engagement. DB is a Commissioner on the Lancet Diabetes & Endocrinology Commission on type 1 diabetes and is the main grant holder for a project supported by the Swiss Agency for Development and Cooperation which contributed to the costs of a workshop on this topic held in Geneva on Sept 17, 2022 (Children Rights And Health—The Case Of Access To Insulin). J-DV is a Member of the Board of the Fondation Brocher. All other authors declare no competing interests. We wish to thank the participants in the aforementioned workshop, which led to the development of the concepts in this Correspondence. The workshop was supported by the Swiss Agency for Development and Cooperation and the Fondation Brocher. Download .pdf (.19 MB) Help with pdf files Supplementary appendix