‘Between availability, affordability and quality ‘ How can the world close the gap in cancer care

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By Dr Ahmadou Samateh and Mr Mukul Bhola

On the 4th of February of every year, the world celebrates “World Cancer Day”, an international day marked to raise awareness on cancer and to encourage its prevention, detection, and treatment with the ultimate goal to significantly reduce illness and death caused by cancer.

The Defeat-NCD Partnership and the Ministry of Health of The Gambia join the rest of the world in solidarity to raise awareness about cancer and call on partners to support their efforts to scale-up cancer care.

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It is well known that cancer is a serious global health problem. According to International Agency for Research on Cancer, it is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020. The economic impact of cancer is significant and increasing.

It results in the loss of economic resources and opportunities for patients, families, employers, and society overall. These losses include financial loss, morbidity, reduced quality of life, and premature death. In 2020, global oncology spending totalled US$ 167 billion.

Prevention of cancers and other non-communicable diseases (NCDs) is reliant on wide community awareness, socio-economic conditions and norms, availability of preventive vaccines, and the overall policy framework in countries to reduce and control risk factors.

Early detection and effective, timely cancer treatment can significantly reduce mortality. When identified early, cancer is more likely to respond to treatment and can result in a greater probability of survival and less morbidity, as well as less expensive treatment. Providing access to quality cancer treatment and care has been a great challenge to most low resource countries. The gaps in terms of knowledge, access, and cost between high and low resource countries is increasing especially with increased innovation and technology introduced in cancer diagnosis, treatment and in palliative care.

Cancer price data are not available in most parts of the world especially for cytotoxic and adjuvant medicines. While prices of palliative care medicines were publicly available in only 33 countries worldwide in a study conducted by The Defeat-NCD Partnership.

While traditional diagnostic imaging and laboratory machines, chemotherapy and radiotherapy are still not available in many low resource countries, new cancer treatment including immunotherapy and targeted therapy are farfetched dreams and expected to take much longer to reach the developing world.

The Gambia reported 1400 new cancer cases in 2021 and 1035 cases in 2020, with a mortality rate of 78% owed to the absence of awareness, late diagnosis, and unavailability of specialised treatment and facilities in the country. Switzerland on the other hand had 60,483 new cancer cases in 2020 with a total 19,036 deaths.

In 2017, The World Health Assembly has passed a resolution on cancer prevention and control using an integrated approach; urging governments to accelerate actions against cancers so as to reduce premature mortality from cancer.

In 2018, The Defeat-NCD Partnership was established at the United Nations General Assembly as a public-private-people partnership anchored in the United Nations to help countries scale-up their national capacity to tackle NCDs including cancer and achieve SDG 3.4.

The Defeat-NCD Partnership’s Essential Supplies Facility is the United Nations practical solution to help countries, especially the poorer ones, to get value-for-money in their procurement of NCD supplies, while ensuring quality and continuity of supplies. The Essential Supplies Facility is responding to the major gaps in the current supply chain system by (i) the provision of technical expertise to improve forecasting, stock, and supply chain management, (ii) support the standardisation of treatment guidelines and improving the availability of NCD medicines and supplies in healthcare facilities, (iii) increase the regulatory harmonisation in low resource countries and national essential medicine lists, and (iv) provide financial assistance through innovative financing solutions to support the procurement of NCD medicines and supplies. 

The Defeat-NCD Partnership has been working hand-in-hand with the Government of Gambia to scale-up cancer care.

The Gambia has a comprehensive plan to establish a cancer treatment specialised department to reduce the burden of the diseases on its citizens and build the national capacity to provide quality treatment and care. This is part of an overall comprehensive multisectoral national strategy and costed action plan for the prevention and control of NCDs.

It is worth mentioning that the Gambia is one of the few countries that integrated the human papilloma virus (HPV) vaccine into their routine vaccination programme reaching a coverage rate of more than 83% across the Gambia. This coverage rate is higher than many high-income countries.

This World Cancer Day multiple activities are being carried out across The Gambia intended to informing and educating the community on cancer risk factors, preventive measures, and benefits of early detection for timely management; intensify cervical cancer screening and breast cancer early detection; and raise advocacy about improving access to quality cancer care for everyone.

Closing the gap and scaling-up cancer care cannot be achieved with traditional interventions. It requires high political will, multisectoral active engagement and support, continued capacity building, and increased financing.

We join our voices today to call on all stakeholders and urge governments of LMICs to take action to close the overwhelming gaps leading to high cancer mortality across the world. Sustained political support and investment for cancer care is urgently needed from health ministries around the world. The best utilisation of available mechanisms including the Defeat-NCD Partnership Essential Supplies Facility, the best utilisation of resources invested in rolling out the Covid-19 vaccine, with improved medical supply chains, health records, and health literacy can enhance efforts to improve cancer care and foster greater global health equality.

Authors

Mr Mukul Bhola, Chief Executive Officer of The Defeat-NCD Partnership at the United Nations Institute for Training and Research

Dr Ahmadou Lamin Samateh, Minister of Health, Government of The Gamb