“Armies cannot stop an idea whose time has come.”—Victor Hugo, History of a Crime (translated)
We applaud the presentation of the “State of Oncology 2013” report and Dr. Peter Boyle’s call for a global fund to fight cancer this past week at the ECCO meeting in Amsterdam. Indeed, his call echoes (pun intended) ours, which was put forth in an article in Nature Reviews Clinical Oncology earlier this year,1 and that of countless others who, like us, have been fighting and lobbying for better cancer control in low- and middle-income countries (LMICs) which will continue to bear a growing burden of noncommunicable diseases for decades to come, and which have very limited resources to face such a massive challenge.
We proposed creating a global fund to fight cancer, an international finance facility for cancer control and an alliance organization that would bring together international donors, philanthropic entities, governments, nongovernmental organizations, WHO, and the International Atomic Energy Agency, among others.
The challenge of access to cancer medications in LMICs can only be effectively addressed through a combination of public and private efforts. Throughout the world a growing number of such entities are aiming to improve health care financing and delivery. The most relevant examples for cancer control are those of the GAVI Alliance and its International Finance Facility for Immunisation.
The GAVI Alliance, formerly the Global Alliance for Vaccines and Immunization, is a public–private partnership that has made considerable strides in increasing access to vaccines, including those that prevent cancer, for diseases such as human papillomavirus (HPV) and hepatitis B, in low-income countries. Bringing together all important stakeholders—including industry, donor and recipient governments, the United Nations Children’s Fund (UNICEF), the WHO, the World Bank, the Bill and Melinda Gates Foundation and other philanthropists, research and technical agencies, and representatives from civil society groups—the Alliance has helped immunize an additional 325 million children and likely helped avert 5.5 million future deaths since its foundation in 2000. In cancer care, GAVI has been able to lead negotiations in decreasing the cost of cancer-preventing vaccines in low-income countries, bringing the price per dose of hepatitis B and HPV vaccines down to $0.18 and $5 from $24-$43 and $96-$135, respectively.
Most importantly, the Alliance provides a model to draw inspiration from and build upon. Through engagement and goal setting, recipient countries have incentives to create and develop their health and human capital infrastructures with adequate technical support from the Alliance’s technical partners. Additionally, through the provision of funding, the Alliance creates a functioning market of vaccines for low-income countries, generating interest and solutions from private players.
Finally, GAVI has been the test case for a new approach in innovative funding models, through the creation of the International Finance Facility for Immunisation in 2006, which issues bonds in capital markets that are leveraged by guarantees of future donations. The facility, which is funded by many donor countries—including Australia, France, Italy, the Netherlands, Norway, South Africa, Spain, Sweden, and the UK—has the World Bank as its treasurer and has raised over $3.5 billion in capital markets, effectively more than doubling the amount of funds available to GAVI to pursue its endeavors.
Modeled on the Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI and the International Finance Facility for Immunisation, a Global Fund to Fight Cancer would—through engagement, goal setting and multiple-stakeholder involvement—provide recipient countries with incentives to create and develop their health and human capital infrastructures with adequate technical support. The alliance of funding and technical partners would unify efforts, support the creation and implementation of cancer control plans and make available cancer interventions in a stepwise fashion, led in the most cost-effective way. The alliance could also help create a functioning market for the provision of low-cost interventions where none exists today, fostering innovation and lowering costs. Furthermore, we envisage that the alliance would support negotiations with industry to facilitate the implementation of tiered pricing schemes in low-income countries. An international finance facility would make funds available upfront through the securitization of donor pledges, supporting the activities of the alliance.
Current major challenges to the creation of such a program include the complexities involved, compounded by a lack of political awareness and, therefore, interest and support from industry and other stakeholders. We urge you to discuss this idea in your country and community and encourage you to join our discussion online on the Cancer Control in Low- and Middle-Income Countries page on Facebook
Dare to dream with us that someday the improvements we have seen in cancer care and control in the United States and Europe will also be a reality around the world. The time is now; there’s a lot of work to be done. Join the fight.
- Lopes G de L Jr, de Souza JA, Barrios C. Access to cancer medications in low and middle income countries. Nat Rev Clinl Oncol. 2013;10:314-22. PMID: 23568416.