Cancer is a leading cause of death in every corner of the world. Currently, around 65% of all cancer deaths occur in developing countries, where cancer rates are also rising. Yet many cancers are now curable – provided local healthcare systems can swiftly identify people with cancer and treat them effectively. National governments shoulder the main responsibility for putting these systems into place.
Growing cancer crisis
Growing awareness of the crisis in cancer care in poorer countries has pushed the role of pharmaceutical companies – the developers and owners of cancer medicines – into the spotlight. Some companies have been criticised for aggressively defending oncology patents in poor countries, or for putting high price tags on their newest cancer drugs. Reports are also emerging of worthwhile public–private initiatives to improve cancer care.
To move the debate forward, greater clarity was needed. The Access to Medicine Foundation has systematically mapped which pharmaceutical companies are already taking action to improve access to cancer care in poorer countries, where and for which cancers. It has compared this analysis against each company’s oncology portfolio, including whether it has medicines on the WHO’s Essential Medicines List (EML). The EML identifies medicines that are essential for a basic healthcare system to function.
“We now know which projects are up and running, which tells us a great deal about how companies see their role when it comes to cancer care in countries with weaker health systems,” says Jayasree K. Iyer, Executive Director of the Access to Medicine Foundation. “With this information at our fingertips, the conversation can move forward – to forge more partnerships in this space. I hope that this analysis will inspire pharmaceutical companies to get more involved in improving access to cancer care.”
The Access to Medicine Foundation has mapped whether and how large pharmaceutical companies are improving access to cancer care in low and lower-middle-income countries. It reports on the actions of 16 of the world’s largest research-based pharmaceutical companies by revenue. This includes five of the six largest players in the global oncology market: Roche, Novartis, Bristol-Myers Squibb, Johnson & Johnson and Pfizer (in order of revenue). The global oncology market is expected to grow from USD 105 billion to USD 150 billion by 2021.
Together, the 16 companies are implementing 129 separate access initiatives for cancer patients. Roche engages in the highest number of initiatives across the board. Roche is also the market leader in oncology revenues globally.
The majority (71) of initiatives relate to some form of capacity building – aiming to improve the knowledge, skills, infrastructure or technical capabilities of a local cancer care system. These programmes are very varied. A sizeable group aims to build capacity in either cancer diagnosis (16) screening (14) and/or early detection (5). The ability to catch cancer early and give an accurate diagnosis is critical for improving cancer survival rates. The most comprehensive initiatives either combine different access strategies, multiple types of activity per project, or address several forms of cancer.
The most comprehensive programmes – examples
AstraZeneca’s Project Phakamisa in South Africa aims to improve access to a range of hormonal treatments for breast and prostate cancer through pricing actions, awareness raising, providing patient support and training volunteers and healthcare professionals. Volunteers from AstraZeneca’s Phakamisa project march to raise awareness of breast and prostate cancer symptoms in South Africa.
Bristol-Myers Squibb and Pfizer are working with a range of partners in a Women’s Cancer Initiative in the Americas. It focuses on breast and cervical cancer and aims to improve national treatment programmes, patient registries and education, while also addressing cancer awareness, screening and early detection.
Eli Lilly is working with Kenyan NGO AMPATH to address access to gynaecology-oncology and general oncology. Its objective is to equip an oncology outpatient center at MOI University Hospital in Eldoret, Kenya, hire medical staff, train local healthcare professionals and create a research and training institute focused on cancer.
A little over a quarter of initiatives address pricing (36 initiatives). Many of these are organised in patient access or support programmes (PSPs and PAPs), which generally provide some form of discount or donation directly to patients enrolled in the programme. Companies are also bringing financial reserves to bear: the study found 17 cases of companies providing philanthropic financial support to cancer care programmes.
Female cancers receive attention
Female cancers, haematological cancers and colorectal cancer gain most attention – more initiatives aim at breast cancer (42 initiatives) and cervical cancer (27) than other cancer types. Among women in developing countries, this reflects the most common cancer types. Among men, however, the most common cancers in developing countries are lung and liver cancer, which seem less represented. The companies in scope have many products for lung cancer.
Companies are engaging in more initiatives in Kenya, China, India, Indonesia and the Philippines than in other countries. This is likely due to the fact that these countries have stronger healthcare systems, broader networks of organisations already addressing cancer care, or more opportunities to have a greater impact on people’s health. Conversely, countries such as Sierra Leone, Somalia and Burundi currently have no cacer access initiatives in place, despite having high cancer mortality rates. This can partly be explained by the fact that these countries have weaker health systems and less attractive markets.
Portfolios lead on breast, lung and prostate cancer products
The 16 companies have a total of 171 cancer medicines and two preventive vaccines in their portfolios. They have the most products for breast, lung, prostate cancer and haematological malignancies (in that order). The companies have 55 cancer or cancer-related products that are on the WHO Model Essential Medicines List (EML). Only 11 EML products (from three companies: AstraZeneca, Novartis and Roche) are incorporated into an access initiative.
“Providing access to cancer care is a huge challenge. How can companies contribute? More than 40 cancer medicines have been singled out by the WHO on its Essential Medicines List as being critical to any cancer care system. Making these products available and affordable in sufficient quantities is a great place to start. With governments in the lead, pharma companies can play a unique role in shifting the dial on cancer care.” – Jayasree K. Iyer, Executive Director, Access to Medicine Foundation.
The Access to Medicine Foundation is an independent non-profit organisation based in the Netherlands. It is funded by the Bill & Melinda Gates Foundation, UK AID and the Dutch Ministry of Foreign Affairs.