1. I am a Cameroonian. For the past ten years I have been involved in the care of children living with diabetes in Yaoundé Cameroon. “Changing Diabetes in Children” program has been very important for us: creation of childhood diabetes clinics within government hospitals, training of health care personnel, early diagnosis and free diabetes care offer to children living with diabetes in Cameroon. This program is suppose to end in December this year and we are trying to sustained it. We are hoping more involvement from the ministry of health; continue insulin supply from Novo Nordisk, glucometers and strips from Roche; involving other partners for education.
    I was really surprise by the paper written by Rebecca Barlow-Noone. She wrote:
    ” Novo Nordisk’s ‘Changing Diabetes’ Aid Programme Exacerbates Issues of Insulin Access, and Must End for Compulsory Licensing to be Effective”.
    Who is Rebecca B-L?
    Looking at the biography, she is not Cameroonian, she has never been in Cameroon nor in other African countries. She is not involved in any diabetic support program in Cameroon or Africa. She is not supporting in children living with diabetes in Cameroon. She has no experience about drugs safety, drug licensing.
    How is this lady aware of the problem in Cameroon? What interest?
    How can she give a point of view in blog without discussing with the patients benefiting from the intervention, the parents, patient association, responsible of the Ministry of health in Cameroon and also local responsible of the project?
    How can a person asked for an immediate arrest of an intervention who has contributed to reduction of mortality of children from 80% to 10%? What solutions for children?
    Is this lady happy to see our children dying massively because of lack of diagnosis and care?
    Something is wrong about this lady. I don’t believe she is mad or a bad person.
    I hope that the administrator of this blog will give us opportunity to react to such a misconduct and give the truth about the CDiC project in Cameroon and also about insulin issue. It is more complicated and cannot be solve in a blog.
    Best regards.



    Rebecca Barlow-Noone

    8th July 2017

    To Marc Djotanne

    Thank you very much for your comment; it has highlighted a key part of my post which I must clarify.

    My call is not for an ‘immediate arrest’ of pharmaceutical aid, but for a transfer where sustainable access to supplies can be achieved without reliance on a single company.

    As you point out, the program (which has provided an amazing source of care for children with diabetes) is due to end – which in my opinion is outrageous, and puts unnecessary pressure on patients who rely on the program.

    In the short term, I hope the Ministry of Health, Novo Nordisk and Roche step in to prevent the loss of support in Cameroon. However, it should not be the responsibility of people working in diabetes care, such as yourself, to request the continuation of access to diabetes supplies every time a company decides to end a program. Diabetes care must be continuous, and it should not be in the hands of Novo Nordisk to determine when it ends.

    My main concern with CDiC is that Novo Nordisk is establishing a monopoly, so when they inevitably pull out of Cameroon, dependence is established on their products; which will most likely incur a high cost.

    In my post, I suggest that compulsory licensing and biosimilar usage will offer a cheaper alternative to Novo Nordisk’s care, which would enable widespread access to insulin when pharmaceutical companies decide to terminate care. Evidence of cost-savings through compulsory licenses has been extensively documented. This would stop patients from being left uncertain on how long access to supplies will last, and will take the power away from Novo Nordisk as the sole supplier of insulin.

    Since Novo Nordisk is against the establishment of compulsory licensing (as it would undermine their high costs and ruin their monopoly), their aid may not continue if the government pursues the usage of biosimilars; but for securing long-term access to insulin, I believe this is the only credible option for the Ministry of Health in Cameroon to take.

    However, I strongly agree that this is not an issue which can be solved in a blog; my purpose was to bring the unstable care in Cameroon to light, as so little information exists about diabetes care in Cameroon online. Whilst the program has been a success for the past 7 years, I want to do all I can to make sure care continues for people with diabetes by making the issue as widely known as possible.

    Finally, I would like to express my interest in your work in Yaoundé. How are you involved in the CDiC program? As already mentioned, very little information exists online, and I would be grateful to hear about your work in more depth.

    Best regards

    Rebecca Barlow-Noone