Closing the Cancer Divide: a Blueprint to Expand Access in Low and Middle Income Countries 181111

8/2/2019 Closing the Cancer Divide: a Blueprint to Expand Access in Low and Middle Income Countries 181111

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Closing the Cancer Divide:A BLUEPRINT TO EXPAND ACCESS

IN LOW AND MIDDLE INCOMECOUNTRIES

A Report of the Global Task Forceon Expanded Access to CancerCare and Control in Developing

Countries

Overview


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HARVARD

School of Public Health

HARVARD

Medical School

Global Task Force on Expanded

Access to Cancer Care and

Control in Developing Countries

= global health + cancer care


3/18

Applies a diagonal

approach to avoid

the false dilemmasbetween disease silos

(CD/NCD) thatcontinue to plague

global health

Closing the Cancer Divide:A BLUEPRINT TO EXPAND ACCESS IN LMICs


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115+ authors

56 countries

20+ cases

Francine,Claudine, Abish,

Anite, Juanita

HARVARD


HARVARD

Medical School

UICC

LIVESTRONG


5/18

Closing the Cancer Divide:A Blueprint to Expand Access in LMICs

I: Much should be doneII: Much could be done

III: Much can be done

1: Innovative Delivery

2: Access to Affordable Medicines,

Vaccines & Technologies

3: Innovative Financing: Domesticand Global

4: Evidence for Decision-Making

5: Stewardship and Leadership


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Cancer is a disease of both rich and poor;

yet it is increasingly the poor who suffer:

Exposure to risk factors

Cancers of infectious origin

Death from treatable cancer

Stigma and discrimination

Avoidable pain and suffering

The Cancer Divide:An Equity Imperative


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The most insidious example of the

cancer divide is pain control

The gap in access to pain control is

tremendous: ranging from 54

milligrams per death in pain from

HIV/AIDS or cancer in the poorest

decile to almost 97,400 in the richestdecile of the worlds countries.

-GAPRI/UICC data


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Investing In CCC:

We Cannot Afford Not To

Health is an investment, not a cost

Tobacco: a huge economic risk of 3.6% lower GPD p.a.

Total economic cost of cancer, 2010: 2-4% of global GDP

Prevention and treatment:

potential world savings of $ US 131-850 billion mostlyvia productivity gains and reduced suffering

1/3-1/2 cancer deaths are avoidable

2.4-3.7 millions deaths

80% in LIMCs


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Investing In CCC:

The costs to close the cancer divide

may be less than many fear: All but 3 of 29 LMIC priority, candidate cancer

chemotherapy and hormonal agents are off-patentgenerics: many available for under $100 per course

Cost of drug treatments for cervical cancer, HL, and

ALL in children in LMICs:

One year of incident cases: $US 280 million

Pain medication is cheap

Prices drop:

HPV 2011: $US 100 per dose to PAHO $14 and GAVI $5


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The Diagonal Approach toHealth System Strengthening

Harness synergies that provide

opportunities to tackle disease-

specific priorities while addressing

systemic gaps in order to optimize

available resources and bridge thedivides lived by patients.


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Health Systems Strengthening:

Opportunities for Diagonal Strategies

Prevention healthy lifestyles:

Tobacco control: helps prevent certain cancers, reduce

CVD and respiratory diseases

Survivorship care:

Reducing stigma promotes gender equity

Pain control and palliation

Reducing barriers to access is essential for cancer, for

other diseases, and for surgery.


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Innovations in Delivery

Optimal tasking

Infrastructure shifting

ICTs and telemedicine St. Judes IOP

Uganda Program on Cancer andInfectious Diseases with FHCRC

Mexicoharnessing primary carefor breast cancer care and control


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Global and Domestic Financing

Levarge GAVI and Global Fund to promote,pool and invest new monies

RMNCH provides models for international

partnership and commitment-building Recent diagonal initiatives are promising

pink ribbon red ribbon

Several LMICs have integrated CCC into nationalinsurance programs:

Mexico, Colombia, Dominican Republic, Peru, China, India,

Taiwan, Rwanda


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Increase Evidence forDecision Making

Strengthen cancer registries inLMICs

Develop and apply novel researchand monitoring methodologies

Expand health services andimplementation research


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Stewardship and Leadership

UNHLM: Harness opportunities and fill gaps

Lack of public goodsglobal and domestic

Leverage global institutions WHO, IARC, UICC

UNICEF, Global Fund, GAVI, private sector

Strengthen capacity in-country: facilitate localmulti-stakeholder Commissions


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MOBILIZE all public and

private stakeholders in

the cancer, health anddevelopment arenas to

close the cancer divide


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Closing the Cancer Divide:A BLUEPRINT TO EXPAND ACCESS

IN LOW AND MIDDLE INCOMECOUNTRIES

HARVARD


HARVARD

Medical School

A Report of the Global Task Forceon Expanded Access to Cancer

Care and Control in DevelopingCountries

Overview


18/18

Adults

Breast

Cervix

Prostate

Testis HL

N HL

Leukaemia

All cancers

Source: Knaul Arreola Mendez estimates based on IARC Globocan 2010

Children

LOW

INCOME

HIGH

INCOME

Survi

val

inequalitygap

LOW

INCOME

HIGH

INCOME

100%

The Opportunity to Survive (M/I) Should

Not Be Defined by Income

In Canada, almost 90% of children with leukemia survive. In

the poorest countries only 10% survive.

Closing the Cancer Divide: a Blueprint to Expand Access in Low and Middle Income Countries 181111

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