Cancer, the New AIDS? Expanding Access to Treatment for a Silent Epidemic

Cancer, the New AIDS? Expanding Access to Treatment for a Silent Epidemic

[Lucy Sakala at the Salima District Hospital in Salima, Malawi.] {Photo: © Dominic Chavez.}Lucy Sakala at the Salima District Hospital in Salima, Malawi.Photo: © Dominic Chavez.

Lucy Sakala, an HIV counselor in Malawi, knows well the toll infectious diseases like AIDS take on people in her country. She also knows the anguish of a silent epidemic: Lucy has cancer. She benefitted from surgery and chemotherapy.  But recently she learned that she needs combination chemotherapy and radiotherapy, neither of which is available in Malawi and both of which would be unaffordable for her even if they were. It is a brutal paradox that today in poorer countries someone caring for an AIDS patient, for whom treatment is adding years or decades of life, may themselves suffer and die from an illness for which treatment has been around far longer than for AIDS—or for which, like Lucy’s cervical cancer, affordable prevention exists.

 

Faced with this paradox, the Harvard public health community and Dana Farber Cancer Institute created the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. This group of international experts, of which MSH is a member, recently convened a symposium to release a comprehensive report on the stunning gap between rich and poor countries in cancer burden, expenditures, access to treatment, and mortality. The report, Closing the Cancer Divide:  A Blueprint to Expand Access in Low and Middle Income Countries, argues for a health systems approach and supports the movement for universal health coverage.

Today there are millions of Lucy Sakalas around the world. At the Task Force symposium, 18-year-old Rwandan cancer survivor Claudine Humure said bluntly, “Most people in Africa with cancer die without ever having received treatment.” Only one in twenty cancer patients in Africa receives needed chemotherapy. This is unacceptable. Closing the Cancer Divide provides evidence and concrete examples that much needs to be done, much can be done, and much must be done to close the divide.

Much Needs to Be Done

The global community has acted as if cancer is not a major problem in low- and middle-income countries (LMICs). We were wrong. More than half of newly reported cancers and two-thirds of deaths occur in poorer countries. Just two cancers—breast and cervical—result in more deaths than maternal mortality. Nearly 80 percent of life-years lost to cancer are in poorer countries, yet they have only five percent of global resources for cancer. People in these countries not only experience the overwhelming burden of cancer, but most who suffer from terminal cancers do so without any pain relief, and many leave behind families impoverished by the costs what care they have received.

Much Can Be Done

Some believe expanding cancer care in LMICs is not possible and not affordable. They are wrong. Up to 60 percent of cancers in low- and middle-income countries could be prevented. For less than US$0.16 per person year, countries like China and India could accelerate efforts to control tobacco, which accounts for more than 30 percent of cancer deaths. One of the key lessons from the AIDS response, however, is that prevention must go hand in hand with treatment. Addressing cancer stigma in Jordan, Her Royal Highness Princess Dina Mired, honorary co-president of the Task Force and director general of the King Hussein Cancer Foundation in Jordan, observed at the release of the Task Force report that, “Once we provided treatment then people started to believe.”

We can do many things to expand access to cancer treatment. Increasing transparent exchange of information and competitive pooled procurement has reduced the price of HPV and hepatitis B vaccines, and many other medicines, by more than 90 percent. The same can be true for the majority of cancer treatment agents. The first ever report on Cancer Medicines Prices in Low and Middle Income Countries (PDF) was released with Closing the Cancer Divide. This report shows prices for the same medicine vary as much as ten-fold or more, suggesting substantial opportunity for savings with improved procurement.

And that is just the beginning of what we can do.

  • We can develop international guidelines for cancer treatment.
  • We can pursue differential pricing for cancer medicines, vaccines, and technologies.
  • We can support international efforts in innovative financing and health system strengthening.
  • We can revise the World Health Organization (WHO) list of model essential medicines to include cancer medicines and vaccines.
  • We can promote financial protection in poorer countries—China, India, Mexico, Rwanda and others have already added cancer to universal health coverage programming.
  • We can build coalitions of diverse stakeholders at all levels and across all sectors.

These measures can reduce the price of cancer treatment by strengthening the efficiency of health systems and the capacity of governments to regulate those systems. Closing the Cancer Divide provides a blueprint that includes core elements across the entire spectrum of cancer care and control: prevention, early detection, treatment, and palliation.

Some believe expanding cancer care takes resources away from other diseases. They too are wrong. As several commentators have observed, health systems should be built for the needs of people, not for individual diseases. Cancer and other chronic non-communicable diseases will rise inexorably as people living with HIV & AIDS live longer on treatment, as more children live to adulthood because bed nets and early treatment have reduced malaria deaths, and as fewer women die in childbirth.

Much Must Be Done

The myths surrounding efforts to expand cancer care—not a problem, not affordable, not possible, will divert resources from higher priorities—once held back progress in AIDS. Yet we have seen remarkable success expanding access to HIV & AIDS services. We can do the same for cancer. Closing the cancer divide would be a broad investment in the health, as well as the economic and social well-being, of people throughout the world.

Jonathan D. Quick, MD, MPH, is President and Chief Executive Officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.

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