Biotechnology has had a dramatic impact on how insulin is manufactured, and how much it costs to produce it. This paper examines the political, economic and social impact of biotechnology on the global insulin market. It provides an assessment of claims made by manufacturers since the early 1980s that insulin produced using recombinant DNA technology would enhance affordability, safety, effectiveness, and access to this vital medicine. This study utilises primary and secondary sources, historical and current, over the period 1921 to 2024 including academic and medical journals, archival databases, legal opinions, government reports, newspaper and magazine articles and books, and personal files.

The study finds that biotechnology has failed on each of the counts claimed by the manufacturers, ie, affordability, safety, effectiveness, and access. Instead, it has transformed the global insulin market, leading to a collapse of domestic manufacturing in many countries and the emergence of a powerful oligopoly composed of three corporations: Novo Nordisk, Eli Lilly, and Sanofi. This has jeopardised the welfare of those who need secure access to safe and affordable insulin, particularly — but not only — those in low- and middle-income countries. A growing movement of diabetes activists around the globe is demanding changes to the global insulin market and to government policies.