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WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ WELTGESUNDHEITSORGANISATION Date: 08 September 2025 ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ REGIONAL OFFICE FOR EUROPE Ms Helen Sõber BUREAU RÉGIONAL DE L’EUROPE REGIONALBÜRO FÜR EUROPA Adviser ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО European Union Affairs and International Co- Head office: operation Department UN City, Marmorvej 51, Ministry of Social Affairs DK-2100 Copenhagen Ø, Denmark Suur-Ameerika 1 Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Email: [email protected] 10122 Tallinn Website: https://www.who.int/europe Estonia Our reference: Your reference: Notre référence: Votre référence: Unser Zeichen: Ihr Zeichen: См. наш номер: На Ваш номер: Dear Ms Sõber, Global survey to collect current information on security of insulin supply The World Health Organization's (WHO) Department of Noncommunicable Diseases and Mental Health (NMH), in collaboration with the Department of Policy and Standards for Medicines and Health Products (HPS), is currently conducting a crucial global survey to assess the extent of insulin shortages. This initiative is vital for identifying access challenges and preventing the potential discontinuation of human insulin formulations worldwide. We are reaching out to request your assistance in facilitating the completion of this important survey. We kindly ask you to nominate and share the online survey link with the most relevant national or sub-national focal points in your country. These individuals should be responsible for either pharmaceutical procurement or noncommunicable disease (NCD) health programs. The ideal respondents include Ministry of Health officials, national NCD program managers, procurement specialists, pharmacists, or other personnel with data on annual procurement volumes and national shortage mitigation strategies. A summary of the survey questions is attached to this letter to help you identify the most suitable person to complete the online questionnaire. The survey is available for completion at the following link: WHO Survey on the Security of Insulin Supply . (https://survey123.arcgis.com/share/4a04c7438e304dd1abf52a5258c361d0) . We would greatly appreciate it if the survey could be completed by 21 September 2025. Should you or your nominated focal point have any technical questions regarding the questionnaire, please direct them to [email protected] with a copy to Mr. Bashier Enoos ([email protected]) and Ms. Swathi Iyengar ([email protected]). UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email: [email protected] DK-2100 Copenhagen Ø Fax: +45 45 33 70 01 Website: https://www.who.int/europe Denmark Thank you for your continuous support and collaboration. Your participation is essential to this global effort. Sincerely yours, Natasha Azzopardi Muscat Director Division of Health Systems WHO Regional Office for Europe Copy for information to: Ms Agne Nettan-Sepp, Head, European Union Affairs and International Co-operation Department, Ministry of Social Affairs, Suur-Ameerika 1, 10129 Tallinn, Estonia H.E. Ms Riia Salsa-Audiffren, Ambassador Representative of the Republic of Estonia, Permanent Mission of the Republic of Estonia to the United Nations Office and other international organizations in Geneva, Chemin du Petit-Saconnex 28A, CH-1209 Genève, Switzerland H.E. Mr Andre Pung, Ambassador Extraordinary and Plenipotentiary, Embassy of the Republic of Estonia, Frederiksgade 19, 4th floor, 1265 Copenhagen K, Denmark Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 81, 10617 Tallinn, Estonia –2– WHO Survey on Security of Insulin Supply Summary for Regional Office Colleagues Deadline: 30 August 2025 Departments: NMH & HPS, WHO Headquarters Survey Format and Survey Type: Interactive online questionnaire (ArcGIS Survey123 platform) Estimated Time: 45minutes with data collection requiring detailed procurement information for insulin Key Requirement: Access to annual procurement volumes and shortage information for approximately May 2023-2025 Background Context The number of people living with diabetes rose from 200 million in 1990 to 830 million in 2022, with prevalence increasing more rapidly in LMICs. More than half of people with diabetes did not take medication for their condition. WHO's report "Keeping the 100-year-old promise – making insulin access universal" identified key barriers to insulin availability: • Global market shift from human insulin to higher-priced insulin analogues, disrupting overall supply • Suboptimal regulation and pricing policies • Weak procurement and supply chain management • Insufficient financing, health system capacity, and infrastructure Current challenges are intensifying due to recent discontinuation of certain insulin types and delivery methods, potentially limiting patient choice and deepening health inequities. The situation is complicated by growing demand for GLP-1RAs and increasing preference for pen devices. Survey Background & Objectives Insulin access and supply challenges persist in many low- and middle-income countries (LMICs). The recent discontinuation of human insulin formulations has exacerbated these challenges, potentially limiting patient choice and deepening health inequities. WHO is conducting this survey to assess the scale of global shortages and current supply needs. All information will be treated confidentially and used to: 1. Map Shortage Patterns: Analyze frequency, duration, and types of insulin shortages globally 2. Identify Access Barriers: Pinpoint key obstacles hindering stable supply  3. Guide Policy and Action: Develop evidence-based recommendations for national governments and global stakeholders 4. Assess the Supply Landscape: Understand current procurement practices and manufacturer roles in meeting national needs Target Respondents Ministry of Health Officials, National NCD Program Managers, Procurement Specialists, or Pharmacists with access to: • Annual procurement volume data for insulin • Shortage mitigation strategies • Pharmaceutical procurement oversight and understanding of insulin requirements Survey Structure & Data Requirements Section 1: Basic Information • Country identification and respondent role Section 2: Insulin Procurement Assessment Data Required: • Annual procurement volumes (in International Units) for all insulin types: o Human insulin (NPH, Regular, Premixed 30/70) o Analogue insulin (Basal: Glargine, Detemir, Degludec; Bolus: Aspart, Lispro, Glulisine) o Premixed analogues • Procurement status for each formulation (10ml vials, 3ml cartridges, 3ml pens) • Assessment of procurement adequacy vs. patient needs Section 3: Shortages (May 2023-2025) Data Required: • Specific insulin types experiencing shortages • Duration and mitigation measures • Delivery mechanism shortages Section 4: Access Barrier Analysis (Optional) Rating of key factors affecting supply: • Pricing barriers, supply chain weaknesses, financing limitations • Infrastructure constraints, manufacturing discontinuations • Market dynamics, procurement inefficiencies, manufacturer engagement Section 5: Policy (Optional) Data Required: • National diabetes guidelines/policies status • Insulin procurement guidance • Current supply stabilization measures • Recommendations for global supply improvement Recommended Focal Points Primary: National NCD Program Manager or Senior Procurement Specialist with: • Direct access to insulin procurement databases and volume records • Knowledge of shortage events and responses (May 2023-2025) • Strategic oversight of diabetes supply chains Secondary: Ministry of Health Officials with diabetes program oversight Essential: Must have access to annual procurement volume data and shortage documentation. Regional Office Action Required Identify national focal points with: 1. Access to insulin procurement data and volume records 2. Knowledge of shortage events (May 2023-2025) 3. Understanding of national diabetes policies 4. Authority for official country responses Technical Support • Primary: [email protected] • Copy: Mr Bashier Enoos ([email protected]), Ms Swathi Iyengar ([email protected]) Saatja: "AMP" <[email protected]> Saaja: "Helen Sõber - SOM" <[email protected]> Teema: EST Global survey to collect current information on security of insulin supply Kuupäev: 2025-09-15 14:03 Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga. Tundmatu saatja korral palume linke ja faile mitte avada. We sincerely apologize for the late notice. Please see the attached correspondence sent from the World Health Organization, Regional Office for Europe. One or more attachments may be included. The survey is available for completion at the following link: <https://survey123.arcgis.com/share/4a04c7438e304dd1abf52a5258c361d0> WHO Survey on the Security of Insulin Supply . (https://survey123.arcgis.com/share/4a04c7438e304dd1abf52a5258c361d0) . Мы искренне извиняемся за позднее уведомление. См. прикрепленное письмо от Европейского регионального бюро Всемирной организации здравоохранения (один или несколько прикрепленных файлов). Опрос доступен для заполнения по следующей ссылке: WHO Survey on the <https://survey123.arcgis.com/share/4a04c7438e304dd1abf52a5258c361d0> Security of Insulin Supply . (https://survey123.arcgis.com/share/4a04c7438e304dd1abf52a5258c361d0) . Best regards, Access to Medicines and Health Products (AMP) WHO Regional Office for Europe Copenhagen, Denmark WHO Global Survey on the Additional Survey Access Options Security of Insulin Supply Quick Guide Context: WHO previously shared a web link to complete the WHO Survey on the Security of Insulin Supply. Some users have requested the ability to collect and submit data ‘offline’. While we cannot provide a paper version of the survey, users may refer to the summary of questions to facilitate data gathering efforts (Annex). Additionally, users may use the smart phone version of Survey123 to input data over time, save drafts, and submit responses via the mobile application. Please note that because the survey is public, responses are not synced between the browser version of the survey and the mobile version of the survey, so we recommend choosing one method of submission. Instructions to access the WHO Survey on the Security of Insulin Supply on the Survey123 app for Apple iOS- and Android-based mobile phones or Windows-based laptops are below: Instructions: Get Started with Survey123 1. Download the App, “Survey123 for ArcGIS” for your smart phone using the App store, Google Play or the Windows App Store 2. Click “Continue without signing in” WHO Global Survey on the Security of Insulin Supply: Additional Survey Access Options Quick Guide 1  WHO Global Survey on the Additional Survey Access Options Security of Insulin Supply Quick Guide 3. To access survey: a. If using your smart phone, click the QR code button next to the search bar and scan the following QR code: b. Alternatively, if you are using the Windows desktop version of Survey123 OR if you prefer a direct link on your smart phone, click the following link https://arcg.is/8PC5a and select “Open in the Survey123 field app” 4. You will be taken to Survey Form. If you would like to leave the survey to complete later: a. Click the X on the top left corner and select “Save in Drafts.” WHO Global Survey on the Security of Insulin Supply: Additional Survey Access Options Quick Guide 2  WHO Global Survey on the Additional Survey Access Options Security of Insulin Supply Quick Guide b. To return to the survey form and complete submission: Screen 1. Click on the WHO- Screen 2. Click Drafts Screen 3. Click the survey draft you would Insulin supply survey icon in like to complete your “My Surveys” home screen 5. You may collect data regardless of your connection to the internet. a. If you are collecting data offline, use the following steps: Screen 4. Click Save in Outbox Screen 5. Click the WHO-Insulin supply Screen 6. When you are back in Wi-Fi range and to save your completed survey. survey icon to access the survey. would like to submit your survey(s), click Outbox. You will then be returned to your home screen Screen 7. In the Outbox, click Remember to submit any pending surveys Send to upload your completed survey data. when you reconnect to the internet. WHO Global Survey on the Security of Insulin Supply: Additional Survey Access Options Quick Guide 3  WHO Global Survey on the Additional Survey Access Options Security of Insulin Supply Quick Guide b. If you have internet or data connectivity while completing the survey, use the following steps: Screen 8. Click Send Now to upload your survey. For any additional questions, please email [email protected] WHO Global Survey on the Security of Insulin Supply: Additional Survey Access Options Quick Guide 4