Children's Rights and Health - The Case of Access to Insulin
PRESENTATION
In 2022 we celebrate the centenary of insulin’s first use, a discovery that changed Type 1 diabetes from a death sentence to a manageable chronic condition.
Today, it is estimated 9 million people are living with type 1 diabetes 1 . This autoimmune disease, generally diagnosed before the age 35 years, requires people living with this condition to have daily injections of insulin for survival. Without such injections, people will die in a matter of days.
Regrettably, 100 years after its discovery, insulin still fails to reach all those who need it for their survival. Indeed, from a global perspective, the most common cause of death for a child living with type 1 diabetes is the lack of access to insulin 2 . Many barriers exist at global and national levels, but the main ones are the price of insulin as well as its availability. The global insulin market is largely dominated by three multi-nationals.3 While the cost of production of a 10ml vial of insulin rarely exceeds US$ 34 , the median price that a patient is required to pay in the public sector is US$ 31 and can reach up to US$ 1125.
According to Article 6 of the Convention on the Rights of the Child (CRC), every child has the inherent right to life and that they are required to ensure to the maximum extent possible the survival and development of the child. Moreover, a number of determinants need to be considered for the full realization of children’s right to health, including individual factors such as socioeconomic status6 . Additionally, States parties to the Convention not only have obligations to implement children’s right to health within their own jurisdiction, but also to contribute to global implementation through international cooperation, paying, particular attention to the children’s health priorities among the poorest parts of the population and in developing States7 .
Over 100 years after the insulin’s discovery, governments should not merely accept that the lack of availability of insulin nor its unaffordable price results in the death of numerous children living with Type 1 diabetes. Solutions do exist to guarantee the survival of persons living with this condition and have already been implemented in several countries. States have legal obligations to ensure to the maximum extent possible the survival of children and, as these solutions do not require insurmountable efforts to be put in place, even in low and middle-income countries. States should take the necessary steps to respect their obligations and guarantee the rights of all children and their highest attainable health. 8
ORGANIZED BY
Olivia Heller, Division of Tropical and Humanitarian Medicine, Geneva University Hospitals David Beran and Mathieu Demont, Faculty of Medicine, University of Geneva
Philip Jaffe, Center for Children's Rights Studies, University of Geneva (Valais Campus) Yvon Heller, International Institute for the Rights of the Child
AGENDA
09:30 Arrival and coffee
10:00 Welcome and introduction
Mikiko Otani, Committee on the Rights of the Child (5’)
Antoine Flahault, University of Geneva (5’)
Erika Placella, Swiss Agency for Development and Cooperation (5’)
10:15 Access to insulin global challenges
Problem statement – Olivia Heller, Geneva University Hospitals (10’)
Medical lens – Philippe Klee, Geneva University Hospitals (10’)
Global perspective – Gojka Roglic, World Health Organization (10’)
Humanitarian experience – Sigiriya Aebischer Perone, Geneva University Hospitals, International Committee of the Red Cross, Terre des hommes
Person with diabetes perspective – Carol Abidha (10’)
Discussion – Moderated by David Beran, University of Geneva (60’)
12:15 Lunch Break
13:30 How can the next 100 year be different from the last 100? Can the rights of children make a difference? Workshops (60’)
Access to insulin and health system: exploring barriers and facilitators – Moderated by Raoul Bermejo, UNICEF
A child rights-based approach to ensuring global access to insulin – Moderated by Jeffrey Goldhagen, International Society for Social Pediatrics and Child Health
Feedback and discussion (30’)
15:00 Concluding remarks and next steps (30’)
Philip D. Jaffé, University of Geneva
David Beran, University of Geneva
WITH THE SUPPORT OF
1 Anders Green et al., Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults, 2021
2 Edwin A M Gale, Dying of diabetes, 2006
3 David Beran et al., Constraints and challenges in access to insulin: a global perspective, 2016
4 Dzintars Gotham et al., Production costs and potential prices for biosimilars of human insulin and insulin analogues, 2018
5 Margaret Ewen et al., Insulin prices, availability and affordability in 13 low-income and middle-income countries, 2019
6 CRC/C/GC/15, General comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), Committee on the Rights of the Child, §17
7 CRC/C/GC/15, op. cit., §86
8 Convention on the Rights of the Child, UN General Assembly, 1989, art.24