世衛(wèi)組織知道胰島素太貴了。它計(jì)劃如何壓低價(jià)格

世衛(wèi)組織知道胰島素太貴了。它計(jì)劃如何壓低價(jià)格

Johnpeter Mwolo was 15 when he was diagnosed with Type 1 diabetes.

約翰·彼得·姆瓦洛15歲時(shí)被診斷出患有1型糖尿病。

His body, unable to produce the hormone critical for regulating blood sugar, would now rely on manufactured insulin. He learned to give himself the treatment — four injections a day.

他的身體無法產(chǎn)生調(diào)節(jié)血糖的關(guān)鍵激素，現(xiàn)在只能依靠人工制造的胰島素。他學(xué)會(huì)了給自己治療——一天四針。

But as he was growing up in Tanzania, insulin was expensive and not always available. Mwolo resorted to rationing his insulin, sharing a vial with his cousin, who also had Type 1 diabetes. "It was one vial to two people," he says. "Many of the necessities that we are supposed to have are not there."

但由于他在坦桑尼亞長(zhǎng)大，胰島素價(jià)格昂貴，而且并不總是可以買到。姆瓦洛依靠于定量配給他的胰島素，與他的堂兄共用一瓶，他的堂兄也患有1型糖尿病。“兩個(gè)人用一瓶，”他說。“我們應(yīng)該擁有的許多必需品都不在那里。”

It's a global problem that the World Health Organization is now working to address. In November, the WHO launched a pilot program to boost the availability of insulin worldwide. The idea is to work with insulin manufacturers to increase the global supply — and in the process, potentially drive down the price of the treatment. Since then, seven pharmaceutical companies have shown interest in participating in the program.

這是世界衛(wèi)生組織正在努力解決的一個(gè)全球性問題。去年11月，世界衛(wèi)生組織啟動(dòng)了一項(xiàng)試點(diǎn)計(jì)劃，以提高全球胰島素的可獲得性。他們的想法是與胰島素制造商合作，增加全球供應(yīng)量——在這個(gè)過程中，可能會(huì)降低治療的價(jià)格。從那時(shí)起，已有七家制藥公司表示有興趣參與這個(gè)項(xiàng)目。

"The simple fact is, that the prevalence of diabetes is growing, the amount of insulin available to treat diabetes is too low, the prices are too high, so we need to do something," said Emer Cooke, the head of regulation of medicines and health technologies for the WHO, in a statement.

世衛(wèi)組織藥品和衛(wèi)生技術(shù)監(jiān)管負(fù)責(zé)人埃默爾·庫克在一份聲明中說，“簡(jiǎn)單的事實(shí)是，糖尿病的患病率正在上升，可用于治療糖尿病的胰島素?cái)?shù)量太低，價(jià)格太高，所以我們需要做點(diǎn)什么，”世衛(wèi)組織藥品和衛(wèi)生技術(shù)監(jiān)管負(fù)責(zé)人埃默爾·庫克在一份聲明中說。

Insulin is one of the world's essential medicines. For Type 1 diabetes patients, insulin is a rare example of a medication that's absolutely necessary to live. Without insulin, sugar in the blood accumulates, which can lead to acute life-threatening complications, such as nerve damage or eye damage and, in the worst case, death.

胰島素是世界上最基本的藥物之一。對(duì)于1型糖尿病患者來說，胰島素是一種罕見的藥物，它是生存所必需的。如果沒有胰島素，血液中的糖就會(huì)積累，這會(huì)導(dǎo)致嚴(yán)重的危及生命的并發(fā)癥，如神經(jīng)損傷或眼睛損傷，在最壞的情況下，還會(huì)導(dǎo)致死亡。

However, 50% of the estimated 100 million people who are in need of insulin globally do not have reliable access, meaning either they can't afford insulin or it's not available. This is according to a 2017 study led by Health Action International, an independent research group.

然而，全球大約有1億人需要胰島素，其中50%沒有可靠的途徑，這意味著他們要么買不起胰島素，要么得不到。這是根據(jù)獨(dú)立研究機(jī)構(gòu)“國(guó)際健康行動(dòng)”在2017年?duì)款^的一項(xiàng)研究得出的結(jié)論。

The price of insulin is especially prohibitive in the developing world, where diabetes is growing rapidly — and governments are struggling to afford the medication to supply hospitals and pharmacies. A 2010 study in Lancet found that 10% of Mozambique's expenditure on medications was for insulin.

在發(fā)展中國(guó)家，胰島素的價(jià)格尤其高得令人望而卻步，因?yàn)槟抢锏奶悄虿』颊哒谘杆僭鲩L(zhǎng)，而各國(guó)政府正努力負(fù)擔(dān)起向醫(yī)院和藥房提供的藥物?！读~刀》雜志2010年的一項(xiàng)研究發(fā)現(xiàn)，莫桑比克10%的藥物支出是用于胰島素。

These costs are often passed on to consumers, who also struggle to pay for the treatment. A WHO survey of 24 mostly low- and middle-income countries found that a month's supply of insulin costs more than a fifth of take-home pay for a worker in Accra, Ghana.

這些費(fèi)用通常會(huì)轉(zhuǎn)嫁到消費(fèi)者身上，他們也很難支付治療費(fèi)用。世衛(wèi)組織對(duì)24個(gè)國(guó)家(主要是低收入和中等收入國(guó)家)的調(diào)查發(fā)現(xiàn)，在加納的阿克拉，一個(gè)月的胰島素供應(yīng)要花掉一名工人實(shí)際工資的五分之一以上。

Globally, the list price for insulin varies by country — and limited market competition keeps the prices high, according to Médecins Sans Frontières, which has been campaigning to improve access to the treatment.

無國(guó)界醫(yī)生組織表示，在全球范圍內(nèi)，胰島素的標(biāo)價(jià)因國(guó)家而異，有限的市場(chǎng)競(jìng)爭(zhēng)使價(jià)格居高不下。無國(guó)界醫(yī)生組織一直在努力改善胰島素治療的可及性。

"You have the three big pharmaceutical companies that dominate the global insulin market, which is unprecedented when you look at how medicine markets work around the world," says Christa Cepuch, a regional pharmacist for MSF.

無國(guó)界醫(yī)生組織的地區(qū)藥劑師克里斯塔·塞普赫表示：“有三大制藥公司主導(dǎo)著全球胰島素市場(chǎng)，當(dāng)你看看世界各地的藥品市場(chǎng)是如何運(yùn)作的時(shí)候，這是史無前例的。”

The top insulin manufacturers are Eli Lilly and Company, Novo Nordisk and Sanofi. Together, they control 96% of insulin by volume worldwide — and can choose to raise prices when they want to. In the U.S., for example, the list price of a 10-mL vial of Humalog, manufactured by Eli Lilly and Company, went from $35 in 2001 to about $275 per vial in 2017.

最大的胰島素制造商是禮來公司、諾和諾德和賽諾菲。他們加在一起，控制著全球96%的胰島素-并且可以在他們想要的時(shí)候選擇提價(jià)。例如，在美國(guó)，由禮來公司生產(chǎn)的一瓶10毫升的Humalog的標(biāo)價(jià)從2001年的每瓶35美元上漲到2017年的每瓶約275美元。

The WHO's pilot program is designed to put non-brand versions of insulin on the market — geared toward the developing world. It centers on a process called "prequalification," which the WHO developed in 2001. It's a system that allows drug manufacturers to get a stamp of approval from the WHO.

世衛(wèi)組織的試點(diǎn)計(jì)劃旨在將非品牌版本的胰島素推向市場(chǎng)-面向發(fā)展中國(guó)家。它的中心是世衛(wèi)組織在2001年制定的一項(xiàng)名為“資格預(yù)審”的程序。這是一個(gè)允許藥品制造商獲得世衛(wèi)組織批準(zhǔn)的系統(tǒng)。