CIosing the CIosing the Cancer Divide Cancer Divide: :

A BLUEPRINT TO A BLUEPRINT TO EXPAND EXPAND ACCESS ACCESS

IN LOW AND IN LOW AND MIDDLE MIDDLE INCOME INCOME
COUNTRIES COUNTRIES
A A Report Report of of the the GIobaI GIobaI Task Task Force Force
on on Expanded Expanded Access Access to to Cancer Cancer
Care Care and and ControI in ControI in DeveIoping DeveIoping
Countries Countries
Overview Overview
Applies a diagonal
approach to avoid
the false dilemmas
between disease silos
(CD/NCD) that
continue to plague
global health
Closing the Closing the Cancer Divide Cancer Divide: :
A BLUEPRINT TO A BLUEPRINT TO EXPAND EXPAND ACCESS ACCESS IN IN LMICs LMICs
W authors
W countries
W 20 cases
W Francine,
Claudine, Abish,
Anite, 1uanita
HARVARD
School of Public Health
HARVARD
Medical School
W UICC
W LIVESTRONG
C|os|ng the Cancer D|v|de
A 8|uepr|nt to Lxpand Access |n LMICs
I: Much should be done
II: Much could be done
III: Much can be done
1: Innovative Delivery
2: Access to AIIordable Medicines,
Vaccines & Technologies
3: Innovative Financing: Domestic
and Global
4: Evidence Ior Decision-Making
5: Stewardship and Leadership
Recommendations to
Improve GIobaI Equity and
CIose the Cancer Divide
1) kCMC1L prevent|on po||c|es
2) LkAND access across Lhe cancer
care conLrol conLlnuum
) S1kLNG1nLN nat|ona| hea|th
systems
4) LLVLkAGL g|oba| |nst|tut|ons
S) MC8ILI2L a|| pub||c and pr|vate
stakeho|ders |n the cancer arena
ancer is a disease oI both rich and poor;
yet it is increasingly the poor who suIIer:
W Exposure to risk Iactors
W ancers oI inIectious origin
W Death Irom treatable cancer
W Stigma and discrimination
W Avoidable pain and suIIering
The Cancer Divide:
An Equity Imperative
2
Adults
Breast
Cervix
Prostate
Testis
HL
N HL
Leukaemia
All cancers
Source. Knaul, Arreola, Mende:. estimates based on IARC, Globocan, 2010.
Children
LOW
INCOME
HIGH
INCOME
S
u
r
v
i
v
a
l

i
n
e
q
u
a
l
i
t
y

g
a
p
LOW
INCOME
HIGH
INCOME
00
The Opportunity to Survive (M/I) ShouId
Not Be Defined by Income
n Canada almosL 90 of chlldren wlLh leukemla survlve n
Lhe pooresL counLrles only 10 survlve
1he most |ns|d|ous examp|e of the
cancer d|v|de |s pa|n contro|
1be qop lo occess to polo coottol ls
ttemeoJoos tooqloq ftom 54
mllllqtoms pet Jeotb lo polo ftom
nlv/Alu5 ot coocet lo tbe pootest
Jeclle to olmost 97400 lo tbe tlcbest
Jeclle of tbe wotlJs cooottles
CAlkl uoto tbook to Meq O8tleo
Invest|ng In CCC
We Cannot Afford Not 1o
W ealth is an investment, not a cost
W WEF: chronic disease is a leading global economic risks
W Tobacco is a huge economic risk: 3.6 lower GPD
W Total economic cost oI cancer, 2010: 2-4 oI global GDP
W Prevention and treatment oIIers potential world savings oI $
US 131-850 billion mostly due to productivity gains and
reducing suIIering
1/31/2 of cancer deaLhs are avoldable"
2437 mllllons deaLhs
80 ln L,Cs
3
The DiagonaI Approach to
HeaIth System Strengthening
W #ather than Iocusing on disease-speciIic vertical
programs or only horizontally on system constraints,
harness synergies that provide opportunities to tackle
disease-speciIic priorities while addressing systemic
gaps.
W Optimize available resources so that the whole is more
than the sum oI the parts.
W Bridge the divides as patients suIIer diseases over a
liIetime, most oI it chronic.
4
nea|th Systems Strengthen|ng
Cpportun|t|es for D|agona| Strateg|es
W Prevention - healthy lifestyles:
Tobacco control: helps prevent certain cancers, reduce
VD and respiratory diseases
W Survivorship care:
#educe stigma: also associated with gender and ethnicity.
W Pain control and palliation
#educing barriers to access is essential Ior cancer, Ior
other diseases, and Ior surgery.
Stewardship: Improve regulatory
Irameworks to remove non-price
barriers to pain control.
2 Delivery: arness platIorms by
integrating cancer prevention,
screening and survivorship into M,
S#, IV/AIDs, social welIare/anti-
poverty programs.
Diagonal Strategies
CIosing the Cancer Divide:
A BIueprint to Expand Access
in LMICs
III: Much can be done:
-express suppressed demand
6: Innovative Delivery
7: Access to AIIordable Medicines, Vaccines &
Technologies:
8: Innovative Financing: Domestic and Global
9: Evidence Ior Decision-Making
10: Strengthening Stewardship and Leadership
Access to drugs and other
inputs (w/ Jono Quick)
W All but 3 oI 29 LMI priority, candidate
cancer chemotherapy and hormonal agents are
oII-patent generics: many available Ior under
$100 per course, and most under $1000
W For the same cancer medicine world market
prices commonly vary 4x; sometimes 10x
W Non-price barriers are signiIicant and can be
reduced
W Frugal innovation

Invest|ng In CCC
1he costs to c|ose the cancer d|v|de
may be |ess than many fear
W CosL of drug LreaLmenLs for cervlcal cancer PL and ALL
ln chlldren ln L,Cs
unmeL needs $uS 113 mllllon
Cne year of lncldenL cases $uS 280 mllllon
W aln medlcaLlon ls cheap
W rlces drop Pep 8 vacclne 1982 launch prlce of
+$100 now $020
GIobaI Financing
(w/ Rifat Atun)
W Innovative Iinancing institutions such as Global
Fund and GAVI can be leveraged Ior and ND
W These existing innovative Iinancing mechanisms
could be used to pool and invest new monies
W #MN platIorms provide models Ior broad-based
international partnership and commitment-building
Ior cancer and ND.
W #ecent initiatives are promising - pink ribbon red
ribbon as they work diagonally

Domestic Financing
Several counLrles have lnLegraLed CCC lnLo
naLlonal lnsurance programs and Lhls means
slgnlflcanL markeL expanslon by expresslng
prevlously suppressed demand
W ,exlco
W Colombla
W uomlnlcan 8epubllc
W eru
W Chlna
W ndla
W 1alwan
W 8wanda
Increase Evidence for
Decision Making
W Strengthen cancer registries in
LMIs
W Develop and apply novel research
and monitoring methodologies
W Expand health services and
implementation research

Stewardship and
Leadership
W Public goods are lacking both global and domestic
W arness the opportunities and Iill in gaps post UN LM NDs
W ancer leadership role in advocacy and institution-building
W Develop Irameworks and targets post UN LM
Cancer - UICC-WCD
W Strengthen capacity in-country:
Facilitate local multi-stakeholder, inter-
institutional, all-sector Commissions
W Leverage global institutions health and other
WO, IA#, UI
UNICEF, Global Fund, GAVI, OECD, private sector
W IdentiIy a small set oI issues and achievable goals
10
UICC-specific
recommendations
WCD is a springboard with tremendous potential to promote
better stewardship and leadership
1. Through an annual or bi-annual global cancer progress report
based on measurable goals, UI could turn existing eIIorts around
the Declaration into more powerIul tools Ior civil society to exert
change.
A Global ancer Watch with a scorecard could include reIlections
and indicators oI progress.
Each report:
-Indicators oI progress by country
-Focus: 1-2 topics (palliative care, cancer, #
2. Establish a clearinghouse of programs, policies and projects
public, private and civil society - to promote global learning: UI
CIosing the CIosing the Cancer Divide Cancer Divide: :
A BLUEPRINT TO A BLUEPRINT TO EXPAND EXPAND ACCESS ACCESS
IN LOW AND IN LOW AND MIDDLE MIDDLE INCOME INCOME
COUNTRIES COUNTRIES
HARVARD
School of Public Health
HARVARD
Medical School
A A Report Report of of the the GIobaI GIobaI Task Task Force Force
on on Expanded Expanded Access Access to to Cancer Cancer
Care Care and and ControI in ControI in DeveIoping DeveIoping
Countries Countries
Overview Overview