Cancer: A looming public health crisis in Africa

Dr Satish Gopal - National Cancer Institute, Bethesda, USA

Why is cancer a looming public health crisis in Africa?

It’s largely based on the marked increase in the number of cases and deaths that’s anticipated over the next several decades. Cancer incidence rates are increasing in many countries. In addition, there’s a significantly growing and aging population in Africa. So, as a result of that, it’s anticipated for example that between 2020 and 2040 there will be a near-doubling in cancer burden, and that’s of course occurring in health systems that are often already overstretched in dealing with many competing health needs. So that’s where most people who describe this as a crisis are deriving that conclusion from.

In addition, I would add that I think current projections may be significantly underestimated for a whole variety of reasons, and they don’t account for the marked economic societal consequences of new cases and deaths. We tend to measure cases and deaths as the burden, but I think the societal fallout from cancer is actually much larger than that, and important new data that is demonstrating some of these broader societal effects.

How can we advance equitable access to medicines across Africa?

This requires a multi-stakeholder movement. So I work at the National Cancer Institute. We’re the largest funder of cancer research in the world, and a lot of what we do is support cancer clinical trials. I believe we’re the largest public funder of cancer clinical trials in the world, and we focus a lot of that investment on cancer trials that really result in patient benefit that would not typically get supported by industry or private sources. This includes trials that might be comparing one agent against another, trials that may be focused on minimising therapy as opposed to maximising therapy.

So evidence is really important, and we certainly believe that and try to support a fairly robust effort to generate evidence around how best to treat cancer, primarily in the US but also worldwide. And then that evidence then has to be translated, and that requires a broader community. It requires cancer advocates demanding that they have the kind of access that they deserve. It requires industry partners who often have proprietary stakes in specific interventions. It requires policymakers and governments to exert policy tools and legislative authority where required to ensure that interventions that are proven to be effective, especially when these have been supported through public investments, that they then are available in service of the public good.

So this is a multi-stakeholder effort where everyone needs to play their part. But evidence generation around what tools are needed, for which populations, in what way, that’s really important to inform the broader access conversation.

Is there anything else you would like to add?

There are many communities of practice focused on specific topics. One that we are newly supporting at the NCI is, again appreciating that cancer is a looming public health crisis, we certainly believe that a well-trained scientific workforce, cancer research workforce, is required to adequately address cancer now and in the future. This is something that has always been a major focus for us at the NCI. This includes major investments to support a domestic cancer research workforce in the United States but also, increasingly, globally. So we have a number of cancer research training programmes that are focused on supporting individuals, early-career investigators who want to dedicate their lives to asking and answering important questions related to cancer.

We know that for Africa specifically many of those questions and answers will be best pursued by people living and working here. So trying to increase the amount of support that NCI is able to provide to remarkable young people who understand that this is a big problem and really want to develop both the skills and acquire the mentorship that’s needed to develop careers focused on cancer research. So there are major new investments in this area at the NCI in recent years that are ongoing, and we hope to do more in the future.

Beyond just individual researchers or individual institutions, the larger question then is how do you create a network amongst people across the continent who are pursuing cancer research careers, so that they may not have access to mentorship in a specific area in their own environment but might be able to acquire that in a different institution, in a different country, where there may be a resource somewhere else that they need access to or where they may have a resource that others may benefit from. So this is where the community of practice concept comes in.

And so we’re thinking now, given our large portfolio of research training investments in Africa, how do we leverage that now to create a community where the whole becomes bigger than the sum of its parts. So, where resources that are being developed, training tools that are being developed, professional networking resources that are being developed, are made available to the entire community, and perhaps even beyond the individuals and institutions that the NCI is directly funding. We’re at an early stage of developing this, but this is where we, in addition to providing direct funding, can play a very important support and co-ordination role to ensure that we’re meeting the needs of the community as it is emerging.