Beyond the oligopoly: Cosmolocal insulin production and regulatory sandboxes in Uganda

Insulin is essential for the survival of people living with type 1 diabetes, yet it remains inaccessible to many, particularly in low- and middle-income countries, where monopolistic pricing, fragile supply chains, and regulatory barriers compound challenges of availability and affordability. Cosmolocal production, in which knowledge and protocols are shared globally while physical production is rooted in local communities, offers a potential alternative. This article explores whether such a model might empower Uganda to re-localise insulin manufacturing, and considers the regulatory conditions necessary for it to be viable. We argue that ‘regulatory sandboxes’ represent a plausible legal mechanism for creating those conditions, enabling regulatory bodies to tailor oversight arrangements to novel production models without compromising safety imperatives.