“And the sea comes, and summons our lives.”—Pablo Neruda, Chilean poet, diplomat and Nobel laureate
Ulan Bator, Dalian, Seoul, Hanoi, Siem Reap, Bangkok, Kota Kinabalu, Yangon, Dhaka, Kolkata, Tashkent, Beirut, Bogota, San Jose. No, these are not the exotic locations where Pablo Neruda served as a diplomat.
When I entered medical school 22 years ago, I would have never believed anyone who told me so, but this is actually a partial list of the places I have had the privilege to visit—usually lecturing or participating in cancer control missions—in the last seven years since I joined the Johns Hopkins University and its international arm in our medical center in Singapore and our affiliated medical school in Malaysia. In time, interactions with oncologists, patients, and families from around the world expanded my research and practice interests from not only drug development but also into health economics and access to cancer medications in low- and middle-income countries.
The major improvements we have seen over the last several decades in cancer control in Europe and the United States are quite often only an inspiration and hope for the future to those of us who see patients in low- and middle-income countries.
The pharmaceutical industry, governments, nongovernmental agencies, charities and private financiers must work together to improve access to cancer medications in low- and middle-income countries, according to an upcoming review in Nature Reviews Clinical Oncology by me and my co-authors, Dr. Jonas A. de Souza and Dr. Carlos Barrios. Approximately 80% of cancer-related deaths occur in low- and middle-income countries, but the amount these countries spend on cancer care is a tiny fraction of the global total. Strategies that could lower the cost and increase access to cancer medicines for their citizens are described in the Review article.
Low- and middle-income countries spend very little on cancer medications. While the USA and Singapore spend US$20 and $6 respectively for six commonly used drugs, poorer countries in SE Asia spend less than $0.50 on a per capita basis every year. My colleagues and I report that low- and middle-income countries can drive down the costs of drugs by buying generic or biosimilar drugs (generic versions of monoclonal antibodies that are commonly used in modern cancer treatments). For example, use of just two generic chemotherapy drugs in India saves an estimated $64 million a year. Other potential strategies to increase access, each with its own potential benefits and caveats, include implementing universal health care coverage, increasing the use of differential pricing, access programs and health technology assessments, compulsory licensing, and greater participation in clinical trials.
Finally, my colleagues and I stress that it will take the whole world to control cancer in low- and middle-income countries and call for the creation of a global fund and alliance to fight the disease.