Mind the gap: Where are we still falling short in the global fight against cancer?
As long as humans have been able to write, they have not just penned poetry and stories – they have written about sickness and suffering. The oldest description of cancer is contained within a 5,000-year-old Ancient Egyptian papyrus, which summarized its potency with the devastating conclusion: “There is no treatment”. And although this bleak statement is no longer universally valid today thanks to modern medicine, cancer remains the second leading cause of death worldwide, and worryingly, rates are increasing dramatically among the young.
Everyone in every society has been touched in some way by cancer, and many more people could benefit if we were better able to fight its spread. The WHO estimates that a staggering 30-50% of cancer cases are preventable if individuals avoid risk factors and governments implement prevention strategies, while early diagnosis and treatment have been proven to significantly improve outcomes.
Moreover, scientific developments increasingly mean that beating cancer should not just be a dream, but a reality:
readily available vaccinations can prevent some forms of cancer, AI technologies are set to enhance screening capabilities, and innovative new treatments like stem cell therapy or immunotherapy are promising to be increasingly effective and less toxic than chemotherapy.
Doing this is dependent on access to healthcare, which globally is by no means a given, even in developed countries: recent data from the Gates Foundation suggests that universal health coverage, a key indicator of progress towards the Sustainable Development Goals (SDGs), is woefully off-track in the context of the 2030 targets. This is why the adoption of the Political Declaration on universal health coverage, which was signed off by governments following the UN General Assembly (UNGA) last week, is such an important aspiration. In this declaration, world leaders reiterated their commitment to achieving universal health coverage by 2030, putting health back on the high-level political agenda mid-way through our journey towards the SDGs. I hope this will reinvigorate governments in translating their public promises into concrete actions – and it is up to all of us to hold them accountable in delivering the results we so sorely need.
The agreements made in the course of UNGA, however, have only scratched the surface. Today I will look at how we can address some of the geopolitical divisions that currently constitute major barriers to the fight against cancer across the world – and what global pharmaceutical companies like Bayer can do.
It's not fair: The global disparity in cancer care
For many years, it was a commonly touted truism that cancer was a disease primarily afflicting the wealthy West. This was not true 20 years ago, and it is even less true today: in 2020, 70% of the 10 million cancer-related deaths worldwide occurred in low- and middle-income countries. This is partly explained by demographic change (growing and ageing populations), and partly by the boom in what are termed “modifiable risk factors” by the medical community: as low- and middle-income countries experience economic growth, their populations also swiftly and widely adopt lifestyle changes that have been linked to higher rates of cancer, most notably wider consumption of processed and ultra-processed foods, and lower levels of physical activity. And of course, smoking remains the most significant preventable cause of cancer worldwide, a trend driven in large part by persistently high smoking rates in the developing world.
Low- and middle-income countries are reacting to the threat of this growing burden. The vast majority of countries have already developed a national cancer control plan based on WHO/ICCP recommendations, for instance. In addition, many low- and middle-income countries are beginning to narrow the cancer are equity gap in other ways, a good example being the initiatives that are gradually increasing access to clinical trials in Africa. Historically, African countries have often been excluded from clinical cancer trials, for reasons including low resources, poor infrastructure, and concerns over data quality and post-trial access to participants. This has further contributed to cancer inequities by limiting optimal cancer prevention or treatment decisions for individuals of African descent, as well as depriving the region of innovative cancer therapies and opportunities for improving oncology infrastructure.
However, in recent years, pan-African and national regulatory bodies have invested significant resources in harmonizing the conduct of clinical trials, thus increasing the attractiveness of the region to clinical trial sponsors. Moreover, partnerships with international organizations (like the European and Developing Countries Clinical Trials Partnership), as well as the establishment of pan-African networks like the African Research Group for Oncology, are boosting African countries’ own research capabilities and their capacities in conducting clinical trials.
While the will is clearly there to address the rising burden of cancer, however, low- and middle-income countries are often unable to pump adequate resources into this mammoth task.
They frequently struggle with a lack of universal healthcare coverage, low health expenditure, low financial incentives for drugmakers, and a dearth of qualified medical specialists; as a consequence, access to cancer care is at best limited, and at worst available only to a tiny and wealthy elite. Diagnosis is often far too late for effective treatment, innovative and effective medicines are not widely available, and patients may simply be unable to afford the direct and indirect costs of treatment.
Actions at both global and local level are needed
Tackling cancer in low and middle-income countries against this backdrop is a huge challenge – but by no means insurmountable. According to public health specialists, implementing robust and effective tobacco control efforts, as well as broadening the reach and scope of childhood vaccination programs against hepatitis B and human papilloma virus, would reap enormous benefits in the fight against cancer in low- and middle-income countries at minimal cost. Further actions necessary at governmental level are promoting avoidance of high-risk behaviors through public health awareness campaigns; investing in the primary care clinicians and infrastructure needed for early diagnosis and treatment; and dismantling regulatory hurdles for innovative therapies.
Pharmaceutical companies can help tear down barriers to cancer care, most notably by ensuring access to medicines in low- and middle-income countries – for instance by incentivizing managers to perform on health equity goals, having access strategies tailored to developing economies, and investing in multi-stakeholder collaborations to strengthen health systems.
At Bayer, for instance, we have built these measures into our strategy, and have rolled out clinical trial capacity building and patient assistance programs in underserved communities. Specifically targeting global inequities in cancer care, we also have a dedicated Oncology Sustainability Initiative, under which we are running eight in-country programs in several low- and middle-income countries. We are proud that several of these have been referenced in the White House Cancer Moonshot, an internationally resonant initiative by President Biden to mobilize efforts that will prevent cancer deaths and improve the lives of those affected by it. Our “moonshots” include the following:
Recommended by LinkedIn
Through other partnerships, we are pioneering digital platforms that can accelerate and widen access to quality and targeted healthcare services. For example, our “My rights, my choices” flagship program with UNFPA India harnesses the power of AI in providing sexual and reproductive health services, with the program aiming to reach 6 million people by 2027 and to be integrated into the local healthcare system. Bayer’s partnership with Zuri Health is similarly innovative, providing patients in sub-Saharan Africa with affordable access via website, mobile app and mobile messaging services to a virtual hospital, pharmacies, labs and diagnostic options, and telemedicine services. Such examples provide an exciting template for how digitized healthcare could widen access to cancer treatment too.
Public-private collaborations like these have proven to be a game-changer in addressing global health issues.
We saw the urgency with which all members of the global drug development community including health authorities, other branches of governments, biopharmaceutical industry, health care professionals and other stakeholders engaged on the common goal of accelerating the development of vaccines as well as treatment options for the COVID pandemic. This showed us the power of multi-stakeholder collaboration as well as the vulnerability of certain segments of the population in accessing quality care. Cancer is an area where the lessons learned can be applied in further accelerating the development of novel therapies and also in delivering equitable access to cancer care for all.
Another kind of crossfire: when war and cancer collide
Conflict is an additional factor that undermines oncology efforts, both by severely disrupting care for cancer patients, and by hampering or even halting cancer studies. It also deepens inequities in health and cancer care, given that conflict fundamentally threatens development in low- and middle-income countries. The state of oncology in Ukraine exemplifies this; the country’s healthcare system already faced challenges prior to Russia’s unprovoked invasion in 2022, and is now under further pressure due to damage to medical facilities and energy suppliers, shortages of medicine, and the requirement for healthcare services to shift their focus to emergency care. Consequently, Ukrainian cancer patients face an impossible decision: staying put and taking their chances on a healthcare system buckling under the strains of war; or fleeing their home country and grappling with health systems which may not have access to Ukrainian medical records, with different treatment regimens, and with language barriers that may hinder their ability to communicate properly effectively with healthcare professionals.
Ensuring continuity of care in conflict zones
Cancer care must continue in the face of geopolitical conflict. Medical providers often take extraordinary risks by staying on the ground and providing care. This dedication must be reinforced by continued access to oncology infrastructure, medicines and therapies. War-afflicted countries need to establish safe zones for treatment of cancer and other chronic illnesses, coordinate with humanitarian organizations, digitize patient records to allow easy exchange of data with countries taking in refugees, and restore medical facilities as a matter of urgency.
Countries hosting large numbers of displaced cancer patients must help fill in the gaps, address language barriers and communicate with their counterparts in the war-torn country. Oncology products should also be added to medicine categories such as the EMA’s critical medicines list to ensure they are included within the scope of emergency responses and to mitigate shortages during conflicts. Reimbursement and emergency protocols should be aligned among refugee-accepting countries so the burden of extra care is more fairly shared.
Healthcare companies have a significant role to play in ensuring continuity of cancer care in conflict zones – by providing technical assistance to local providers (e.g. training in cancer diagnosis and treatment), by offering cancer treatments that are more suitable for deployment in conflict situations (e.g. more stable and transportable drugs), and by maintaining clinical trials despite the difficult backdrop.
At Bayer, we are proud to have contributed to keeping up the march against cancer in Ukraine, for instance, where we have continued our ongoing clinical trials, provided oncology therapeutics, and helped restore the infrastructure of the Chernihiv Medical Center of Modern Oncology. We have also recently launched a project aiming address the burden of prostate cancer in Ukraine, which will kick off with a train-the-trainer program and the development of patient material. Initiatives like these strengthen the efforts of governmental and humanitarian organizations to help ensure that cancer patients are not left behind in times of war.
Halting cancer’s progress requires public-private commitments
Universal health coverage will help prioritize equity and access to care – but it is just the start of beating cancer worldwide. Previous public health catastrophes (the HIV-AIDS epidemic, malaria, tuberculosis, Covid-19) have only been overcome with political will and international cooperation. They have also been overcome because they have seen innovative financing mechanisms like the Global Fund.
While there are budgetary constraints that would stand in a way of such a dedicated instrument, governments must consider the growing future burden of cancer as a national priority: it causes not just human suffering on a vast level, but also entrenches systemic inequalities by killing or incapacitating household providers, or by draining families of their savings in covering treatment costs.
Only through concrete commitments from companies and health organizations, as well as collaborations between pharmaceutical and healthcare players, governments and supra-national agencies, can we build the capacities needed to subdue this scourge of humanity.