Archive for May 2016
By: Nivedita Sengupta, Ph.D.
According to American Cancer Society more than 8 million people worldwide die from cancer every year. The number of deaths worldwide from communicable diseases like malaria, HIV and AIDS is insignificant compared to the number of global deaths from cancers which is expected to cross the 13 million mark by 2030, making cancer the leading cause of death worldwide. Cancer as a non-communicable disease has long been considered a disease of developed countries, where people are more likely to succumb to long-term chronic diseases rather than dying from infectious diseases. However, according to statistics from the World Health Organization (WHO) and American Cancer Society, of the 14.1 million new cancer cases reported worldwide in 2012, 6.1 million were from developed countries compared to 8 million in developing countries – and these numbers are still rising. The number of new cancer cases in developing countries is predicted to rise to 13.1 million by 2030. These discrepancies between developed and developing countries are also apparent in childhood cancers. Childhood cancers account for less than 1% of the total cases in developed countries but about 4% in developing countries. Considering that reliable data on incidence are only available for a fifth of the world population consisting of people in mostly high-income countries, the actual statistics on cancer in developing countries may be even higher making cancer a significant and growing health burden in developing countries.
Escalation of cancer cases in developing countries over the past years has resulted in an increase in cancer-related health care costs, building up a global financial burden due to cancer. In 2010, $290 billion was spent to treat 13.2 million new cancer cases worldwide and this spending is projected to increase to $458 billion by 2030. Despite a wealth of data on how to diagnose and treat cancer, funding for cancer remains a low priority in context of health spending for both developing countries and for the nations providing donations. Only 5% of global resources devoted to cancer are spent in developing countries. In 2014, total global funding for development assistance for health was $35.9 billion, and only 2% of that amount was allocated for assistance in the area of non-communicable diseases of which cancer is only one aspect. This sets up an untenable situation as developing countries do not have the resources to tackle the rising human cost of cancer within their borders and necessitates significant global interventions and funding.
One potential in-country way to combat and prevent many of the deaths from cancer could be by raising awareness of the signs and symptoms of cancer among the general population, as well of awareness of proven ways to prevent cancer. A 2007 study on breast cancer in Malaysia found that 52.2% of newly diagnosed patients have stage III and IV cancers due to a lack of awareness of the signs and symptoms of cancer leaving them to seek treatment further into the disease progression. Most of these women were from rural Malaysia, with little or no education. Earlier screening for these and other cancers could help prevent cancer deaths. The major cancer types found in the developing countries are breast, cervical and colorectal cancer. Many of these cancers respond to treatment if detected early and treated adequately. However due to lack of cancer diagnosis facilities, by the time cancer is detected in these poor people it progresses to a stage where palliative care becomes the only option. In another example, potentially up to 20% of cancer deaths in developing countries could be prevented by immunization against HBV and HPV infections. Public-private global health partnerships like GAVI Alliance have partly facilitated the availability of HPV vaccines in the poor countries such as Kenya, Ghana, Madagascar, Malawi, Niger, Sierra Leone and the United Republic of Tanzaniato. However, poor people living in the middle income countries like China, Malaysia, India and Brazil are excluded from this initiative due to their country’s slightly higher income.
Another significant problem needing attention is a lack of proper infrastructure (in terms of equipment and people) for cancer treatment in developing countries. Currently, treatment options in developing countries are very limited and expensive. In developed countries people can have better health care coverage and access to up-to-date cancer care facilities and treatment, in addition to dedicated cancer research centers and specialists. Most developing countries have limited treatment centers with proper infrastructure and oncologists. According to the International Atomic Energy Agency (IAEA), even though 85% of the world’s population resides in developing countries, the average number of pieces of therapy radiation equipment in developing countries is only 0.4 units per million inhabitants, compared to more than six units per million inhabitants in developed countries. The few developing countries who are privileged enough to have access to radiotherapy equipment face considerable financial burdens in then providing the necessary training, equipment set-up and maintenance, protocols and quality control for proper usage of these machines for cancer treatment. Oncology and palliative care training is limited in medical schools and very few doctors and nurses can afford to have training outside their country resulting in lack of sufficiently trained staff in developing countries to deal with the increasing load of cancer cases.
Even treating cancer patients at all can be difficult in developing countries. Apart from expensive cancer drugs themselves, pain medications for palliative care like morphine are not easily available in these countries. Statistics show that 99.9% of cancer patients in developing countries are dying with untreated pain. 84% of the morphine used globally goes to the developed countries, leaving just 16% for the rest of the world. This is not because of limited morphine production but rather mainly because of onerously complicated and expensive narcotic supply regulations set by the International Narcotics Control Board (INCB). The structure of surveillance and accountability requirements implemented by INCB makes it almost impossible for poor nations to comply because of poor infrastructure and lack of educated people to handle issues necessary to comply with the regulatory needs. Moreover, country specific regulatory laws make it harder for the doctors to prescribe these medicines. All patients in need of pain relief could be helped if proper laws are implemented to gain access to pain medication and palliative care.
Drug companies themselves can help to address these health disparities in developing countries. On March 31st 2016, GlaxoSmithKline (GSK) CEO Andrew Witty announced a series of new patent policies designed to make innovative GSK medicines available to more people living in under-developed and developing countries. The new polices have a special focus on improving access to cancer drugs specifically. In the policy, GSK plans to stop filing for patents on its molecules in 50 of the least developed and low-income countries. In developing lower-middle-income countries, GSK will continue to file for patents but will grant licenses to generics manufacturers. This will enable easier access to cheaper generic versions of GSK’s drugs in those countries for the treatment of cancer. Furthermore, GSK will submit patents on future cancer drugs it develops to the United Nations-backed Medicines Patent Pool (MPP). The MPP deals in large-scale licensing agreements between drug developing companies and generics manufacturers thus enabling greater access to medicines in up to 127 developing countries. GSK has been applauded for this venture and the initiative also reveals the growing awareness among people regarding the magnitude of disparities in cancer care around the world. However experts says that a lot more still needs to be done in terms of improving access to needed medications. Ironically, most of the world’s poor live in ‘middle income’ countries such as China, India and Brazil that are not included in these polices and therefore will not gain anything from these new measures.
To reduce the death burden due to cancer in developing countries significant funding is needed, and one key challenge is how to obtain that funding. International advocacy is required to mobilize the international community and individual governments to take action. A number of influential international advocates like the UN, WHO and IARC are already active and trying to form partnerships with international health professionals, non-government organizations (NGOs), and funding organizations to bridge the gap between funding and treatment. By taking the necessary steps in proper direction to strengthen cancer prevention, early detection, treatment and palliation, much can be done to help improve cancer control in developing countries.
By: Steven Witte, B.Sc.
Located less than 90 miles apart, Cuba and the United States share many of the same environmental and public health challenges. Invasive species such as lionfish, African catfish, and marabou are threatening native species. Oil drilling in the Gulf of Mexico poses a potential risk for an environmental disaster, and tourism is threatening coral reefs and other important ecosystems. And recently, the Zika virus and chikungunya have been spreading throughout the Caribbean. It is predicted the viruses may make their way to Cuba and eventually even parts of the United States. By working together, these two countries could develop better strategies to solve these problems. But cooperation between the US and Cuba has been extremely difficult for several decades because of strained relations between the two nations.
In the past, American and Cuban scientists have successfully collaborated together. In the mid-nineteenth century, the Smithsonian Institution in Washington, DC, established ties with two Cuban institutions in Havana: the Economic Society of Friends of the Country, and the Royal Academy of Medical, Physical, and Natural Sciences. Soon after, Jesse Lazear and Carlos Finlay, scientists from the USA and Cuba, respectively, collaboratively made crucial discoveries concerning the transmission of yellow fever, leading to effective preventive measures. During the Cold War, however, diplomatic relations between the United States and Cuba were severed. Further, embargoes were put in place preventing trade between the countries. As a result, Cuba could no longer receive funding or equipment from the United States, except in very specific circumstances. It also became difficult for American scientists to travel to Cuba for meetings, thus affecting scientific relationships.
Re-establishing scientific collaborations with Cuba would benefit both the US and Cuba in a number of ways. Vaccines or drugs are currently unavailable for Zika and Chikungunya viruses, and the best option is to closely monitor the spread of these diseases. Sharing data with Cuba, which already has observation programs in place, would help identify outbreaks and develop responses. The Cuban biotechnology industry has many products that could be used by Americans – for example, Cuba is an important producer of vaccines, exporting them to many other countries. More recently, a company in Cuba has developed a drug for treating severe diabetic foot ulcers, which can prevent the need for amputations. Other companies have products to prevent or treat many diseases that impact U.S agriculture and cattle, such as a vaccine for serious tick infestations. Cuba would benefit from scientific expertise in America, as well as funding and equipment that could be provided, as many of the research institutions in Cuba currently operate on small budgets. Allowing Cuban scientists to attend conferences in America would provide a healthy exchange of knowledge and expertise.
Over the past several decades, many attempts have been made to re-establish scientific relationships with Cuba. During President Jimmy Carter’s administration, the National Science Foundation (NSF) considered establishing links with Cuban research institutions and tried to finance joint research projects, but these goals were never realized. More recently, the Center for Science Diplomacy of the American Association for the Advancement of Science (AAAS) has made several visits to Cuba to promote scientific cooperation. In 2014, the AAAS and the Cuban Academy of Sciences signed a historic agreement in which both organizations agreed to work together on four scientific areas: infectious diseases, cancer, antimicrobial resistance, and neuroscience. Following this agreement, Cuban and American scientists met in Washington, DC, and discussed plans to create further agreements on collaborations for ocean science research and conservation. In 2015, President Barack Obama’s administration re-established diplomatic ties with Cuba. Although this is beneficial for fostering scientific relationships, many barriers still remain. The trade embargo is still in effect, for example, and it is still difficult for scientists to travel to Cuba. However, progress has been made. The United States has enacted policy to allow Cubans to get educational grants and scholarships. And scientific equipment can now be donated to Cuba, unless it has potential military applications.
Going forward, several ideas have been proposed to foster scientific relationships between Cuba and the United States. High-level governmental agreements could go a long way in enabling scientific collaboration. Non-governmental organizations (NGOs) that work internationally in partnership with governments to try and solve global problems could also catalyze shared scientific programs. For example, the Clinton Climate Initiative has partnered with the governments of several island nations and helped them reduce their dependence on fossil fuels by using renewable energy. Others have suggested that the United States shut down its Naval base in Guantánamo Bay, and re-purpose the facilities as a marine research institution and peace park.
Regardless of the form it takes, cooperation between scientists in Cuba and the United States could benefit both countries as they address emerging environmental, public health, and biomedical problems. In addition, cooperation through science could pave the way to peaceful cooperation in other arenas between both countries, as they re-establish connections following several decades of unfavorable relations.