A call to action: Addressing cancer in developing countries

The toll of death and suffering from cancer in developing countries has increased sharply in recent decades. So has the disparity in the allocation of resources for cancer care and control between rich and poor countries. More than 4 million of the 7.6 million cancer deaths in the world each year now occur in developing countries. The result is a drastic "5/80 disequllibrium" in which only 5 percent of the global resources allocated for cancer go to the developing countries that bear more than 80 percent of the burden of disease. 

"The time has come to challenge and disprove the widespread assumption that cancer will remain untreated in poor countries," argues a "Call to Action" published in The Lancet on August 16. The article was written on behalf of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. The four principal authors included: Paul Farmer, chair of the Department of Global Health and Social Medicine at Harvard Medical School, Chief of the Division of Global Health Equity at Brigham and Women's Hospital, and co-founder of Partners In Health; Julio Frenk, Dean of the Harvard School of Public Health and former Minister of Health for Mexico; Felicia Knaul, Director of the Harvard Global Equity Initiative; and Lawrence Shulman, Chief Medical Officer and Senior VP for Medical Affairs at the Dana-Farber Cancer Institute. Among the other task force members who signed the Call to Action were Lance Armstrong, Princess Dina Mired of Jordan, and Sanjay Gupta of CNN.

"Cancer has been totally neglected in the renaissance of the global health agenda," says Frenk. He and the other article authors stress that a global movement to address cancer in developing countries is morally imperative, medically possible and economically feasible. “The chance to survive [cancer] should not be an accident of income or geography,” says Knaul, who herself is a survivor of breast cancer. “We have treatments that can cure [cancer] patients, extend their lives and palliate patients, that are easily available in developed countries, but not available in low and middle income countries,” adds Shulman.

Farmer adds that lessons learned from addressing other conditions that have disproportionately affected poor countries, such as HIV/AIDS, could guide a global movement to address cancer. “When we first started looking at treatment and care for AIDS patients in the late-1980s and ‘90s, there was virtually no significant international policy that included treatment,” he says. “And very few policy plans, nationally, that included treatment. We said, ‘we don’t have a plan, but a plan must be made.’  It is urgent -- AIDS had just become the leading infectious killer of young adults in the world.”

Farmer and PIH helped launch the world’s first program to provide free, comprehensive HIV care and treatment in an impoverished setting, rural Haiti. This initiative helped pave the way to the global movement to address the HIV/AIDS epidemic—including backing from the international community to address the HIV/AIDS epidemic in poor countries, the formation of new sources of funding (notably, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the US President’s Emergency Plan for AIDS Relief), and coordination of financing and purchasing strategies to help lower drug and streamline supply chains for drugs and diagnostic supplies. “We must draw from these previous experiences in our response to cancer,” says Paul. "We need to mobilize the same kind of political will and economic resources for cancer that fueled a global health renaissance around AIDS, TB and malaria,” agrees Frenk. And do it quickly, they add.

	Zanmi Lasante made sure that girls in the HPV vaccination program (to protect against cervical cancer) were able to continue their three-course Gardisil vaccination following the earthquake.

“We’ve seen enormous delays because of arguments that it is too difficult, too expensive, that there is not adequate infrastructure, that there were not specialists to deliver services,” says Farmer. “Yes there are serious logistic and programmatic challenges, but none of them are insuperable.” He points to the accomplishments of PIH’s sister organization in Haiti, Zanmi Lasante (ZL). Despite the recent devastating earthquake earlier this year, ZL staff helped ensure that 78 percent of girls who had been enrolled in an HPV vaccination program to prevent cervical cancer prior to the earthquake, had still received the full three-course vaccination in the months following the tragedy. “To me that is a beacon of hope… We cannot and will not stop our work on cancer prevention and care [in Haiti],” he adds. “Cancer doesn’t go away because of an earthquake.”

“In order to avoid any more deadly delay, because people are dying in enormous numbers and with great suffering, we have to develop a consensus among public health policymakers, leaders of national health policy, that there is a great deal that can be done in prevention, diagnosis and care,” he says. The Lancet piece concludes with an urgent call to action to the international community to address cancers in developing countries with a bold research, financing, and implementation agenda.

Read the full article in The Lancet.