My name is Jean Claude Mbanya. I'm professor medicine and
endocrinology at the Faculty of Medicine and Biomedical Sciences
at the University of Yaoundé I, Cameroon. I've been dealing with
diabetes since 1990 so you understand that I've been in the
diabetes field for a long time. I have seen people dying from
Type-1 or tType-2 diabetes, because of a lack of access to
medication, to medical treatment, to care.
In sub-Saharan Africa, diabetes, especially Type-2 diabetes,
has emerged as the most important cause of morbidity and
mortality. This is a region where in the early 60s, they
said diabetes was rare but nowadays, diabetes is so common
that you see it everywhere on the continent. In fact, if we
look at the IDF Diabetes Atlas of 2019, you will see that
the projection of sub-Saharan Africa is exponential, if you
think that diabetes would increase from 19 million to
about 47 million from 2019 to 2045, which is an increase of
143%, which is in a region with the greatest increase in the
world. I think part of the hypothesis, what is
happening is that as we have embraced economic development in
sub-Saharan Africa, we've lost some of our cultural norms, that
is walking, riding, we didn't use to have cars, we used to walk on
food. Our diet was mostly not refined carbohydrate. Things
have changed now. So we've changed the way we live, we've
changed what we eat, and then we are physically inactive.
I think if you live on a continent where there is no
social insurance or health insurance system, where the
patient has to pay for their drugs, even when you have a chronic
disease like diabetes, then the situation is alarming. Why do I
say alarming? Because in Type-2 diabetes, for example, you
need the tablets, you need monitoring, and then you
eventually need insulin. And if you think about the modern
treatments which are the oral drugs and some injectables,
they are not found everywhere. In fact, in most sub-Saharan
Africa, they depend on generic drugs. That does not mean that
some people cannot afford it, there are rich people who can afford
best drugs. But there is also the problem of accessibility - if
you live in a rural village, which is 400 or 500 kilometers from
the center, it's difficult for you to have the best drugs. We know
that Type-2 diabetes is about 80 or 85% of the general prevalence
of diabetes. So most of the people with diabetes in
sub-Saharan Africa have Type-2 diabetes. And we would have all
the generic drugs like Metformin, like Sulfonylureas, they
are present in most places, but access to new medication, new
proven medications, which would reduce morbid mortality in
Type-2 diabetes are uncommon. Because the people, the patients cannot
afford it, or the governments cannot procure these types of
drugs with their meagre health budget. I think if we take the
rest of the 15%, about 15 or 18%, who have Type-1
diabetes, and I must say that in type one
diabetes, you need insulin for life, if you don't have insulin,
you are going to die. This is the most crucial part because we
know that so many children are dying in Africa because they
lack insulin. And this lack of insulin is more prominent,
especially in the poorer parts of our society, where people
cannot pay for the medication. In sub-Saharan
Africa, we have a two-tier system. One which is the
infectious disease system, where it's fully funded
a patient with an infectious disease like HIV AIDS has
everything at their disposal and free medication, free tests. But
if you have a non communicable disease, like diabetes, or high
blood pressure, if your family cannot pay for a medication,
fair treatment, you are going to die, because there's no
universal health coverage for those two diseases. Something
has to be done to reverse the situation when we have one
healthcare system, taking care of everyone in our communities.
I think one of the important things in the history of
diabetes is the development of insulin about some 100 years
ago. How many people really still benefit from that
discovery? Part of the problem in 1921 is that children
especially with Type-1 diabetes, were dying because of
lack of access to insulin. Has the situation change in Africa?
Slightly, but people and children are still dying because of a lack
of access to medication- insulin and other diabetes supplies.
So the 100 year anniversary of insulin should mean that we should have
universal access to insuline. This is a drug that can be
manufactured, it's complex yes, I know. But there can be
international solidarity to ensure that those who need
insulin, have the insulin wherever they live in the
world. If you live in a high income country of insulin, and you have insulin
and people are dying in low income countries because of a lack of
access to insulin, what are we celebrating? The 100th anniversary of
insulin for the rich or for the poor? What you need is
international solidarity. International solidarity like
the one we had in HIV AIDS, where the World Bank, governments
private sector, donors, WHO - all came together to procure
medication for HIV, and today, HIV has been transformed into a
chronic disease. Why can we not do this for diabetes, especially
Type-1 diabetes, access to insulin, as we're discussing the
100 years from the discovery of insulin