Thrilled to be back at the conference this year, I think this is the third time I’ve been over the last five years. It’s great to see the progress the conference has made.
It’s a very important initiative to bring radiation therapy access in Africa. Radiation therapy remains one of the most economic ways of treating cancer and we still have countries in Africa that don’t have access and even countries where there is access there’s underpenetrated access to the technology that can really save lives. There has been a major shift in disease burden in developing countries in the last decade or two. A decade ago we were always talking about infectious disease and the mortality rates of infectious disease; cancer is now the leading cause of death in many African countries, the second leading cause of death in many more. So the good news is we’re getting a handle in these countries on infectious diseases but now we need to move the healthcare resources to non-infectious diseases, of which cancer is certainly at the top, if not number one, number two, in the list. We’ll talk a little bit about that.
One of the things that’s exciting is to see the growing public awareness around cancer. Cancer in many places in Africa is still very much a disease with a bad reputation and, as a result, people sometimes are afraid of getting care when they could be treated. Then what happens is they wait until some much later stage. So the challenge in Africa is education on many levels – patient education, clearly clinical education, government education. The Union for International Cancer Control has done a really nice job at helping countries put together cancer plans and then companies like ours are doing a lot to design product that is lower cost and much higher value. For example, we introduced a product that requires about half the cement to shield and about half the electrical cost so some of the input costs around the product are much lower and the operating costs of the machine are much, much lower.
Not a marketing exercise here but just to say that all the companies are really doing a lot to bring the highest available cancer treatment at the lowest possible cost. I think the vision we all need to work on is why couldn’t a cancer patient in a village in India, a village in Africa, get the same quality of treatment that they might get here in Boston or New York or Toronto or London. That’s the vision that we all need to be working on; that’s one we’re excited to work on at our company.
Can we make the equipment and training more cost-effective? What training is involved?
That’s a really good question. The first part of the question on the business model side is not going to be one thing, it’s going to be a whole bunch of different things. What works in Kenya may not work in Uganda, may not work in Morocco, may not work in some other country in Africa. So it’s going to be a whole bunch of different business models. We’ve seen a variety of public private partnerships, we’ve seen a variety of government funded activity and we’ve seen a variety of private industry initiatives. I think all three have a very legitimate place in the market and we’ll continue to see grow.
One of the things that all three of them have in common is the need for education and training. It’s very interesting, ten years ago we had two training centres in the world, today we have 24. As we grow and as we try to meet the needs of the local populations we’re trying to get the customer training much closer to the customer. So in Africa we have three or four training sites where we bring people. We’ve worked very successfully with government and private foundations to try to provide access to that training, to bring clinicians, physicists, therapists and even in some cases referring physicians into an awareness of what radiation therapy is and provide and how to do it.
What’s your vision for the next 5 years?
Our vision is very exciting. First of all our growth in sub-Saharan Africa, for example, has been really quite dramatic. At the same time picking up other emerging markets across the world – Vietnam, Southeast Asia, Latin America, Eastern Europe, Southeast Europe – we’re seeing tremendous growth in these markets and great interest by public health systems to invest in their cancer capability. So certainly as we move forwards in these geographies as they age, cancer does tend to be a disease of the aged, these tend to be younger populations. It’s estimated that in emerging markets the population over age 60 will double between now and 2030 so we’re talking about a very significant population moving into their cancer age cohort so we’re definitely going to see more disease.
So it’s steady as she goes, we’ve got to keep having small wins, small wins breed more wins. Then as those wins take off you get a geometric impact in the market, the business models work, the care works, you start to change some of the social issues around some of the cancers. For example, cervical cancer is one of the leading causes of death among women in some African countries – that’s a cancer that we know how to beat but it’s a very difficult cancer at late stage. But if we can get that cancer at stage 1 we can treat it and, even better, it’s a cancer that with immunisation we can virtually eliminate. So there’s a lot of education opportunities and we have to hit on all cylinders from education, business model, working up through the system, gaining credibility.
That’s one of the things that’s happening. We have several centres in Africa who have come up to speed very quickly in radiotherapy, some of them doing 60-100 patients a day on an accelerator, demonstrating terrific credibility of the therapy for providing cure and hope. That’s the business we’re all in in fighting cancer.
Tell us about the work you did in the Obama task force.
It was very exciting, a number of years ago I was the only healthcare executive in the US appointed to the Doing Business in Africa business council that President Obama started. It was such an important council that President Trump, in fact, continued it. I was the only healthcare representative in all of American industry, in both pharma and medical technology to be on that task force. There were some really eye-opening observations and conclusions that the task force developed and we made a lot of recommendations to President Obama around cancer care and around some of the commitments of the US government.
I’d say two big things came out of it, one is with the USAID, an organisation in US government, an NGO in the US government. In fact, it’s a government organisation, it’s not an NGO but it’s an organisation that helps organisations get educated around new technology. So we were able to work with Uganda and get a training grant from USAID to truly bootstrap their radiation therapy infrastructure, a very important first step. So there are things like that that have been spawned.
Then, maybe most importantly, one of the challenges in Africa is still infrastructure and we don’t think of it sometimes. From a radiation therapy perspective we all get in our pathway and are very focussed on radiation therapy but probably the most important health thing we can do in Africa is to bring electricity to communities. The US government has committed to really help out and would like to bring electricity to many millions of households in Africa. You don’t think about it but where there’s electricity there’s less crime, where there’s electricity you can have a surgical light and really core healthcare services that are missing without electricity. Especially as we think about building long-term infrastructure, one of the questions the US government had was should we spend a whole bunch of money developing advanced laboratories for the detection of the Ebola virus. Now that’s a really important initiative and maybe there should be one in Western Africa, or something like that, so for sure that’s an important initiative. But to duplicate that resource everywhere is probably not a very good spend of the money when we’re still missing basic education on bacterial and viral health in the community. We could be much more responsive if there was a basic infrastructure around infectious and non-infectious disease at a basic health level. Then we can build the referral system into things like radiation therapy with time.
So it’s important to remember that both initiatives are going on. We need good basic health and we need good speciality health. Clearly, we’re in the business of speciality health in radiation therapy and that infrastructure is growing, it’s getting more credibility, it has terrific effectiveness and people are more and more recognising that. Some of the initiatives behind the first women in Africa have been very important in getting the word out and driving some of the cultural change and education. But at the same time we also have to make sure there is good fundamental clinical health in Africa and that was an area where the US government is playing an important role in providing electricity and training at that family practice level.
