[Ip-health] The Lancet blog: WHO takes a big step to promote cancer treatment worldwide

Jarvis, Jordan Jordan_Jarvis at hms.harvard.edu
Mon May 18 07:21:40 PDT 2015

Dear IP health colleagues,

Please see the The Lancet blog released today on WHO changes to the Essential Medicines List for cancer.


Best wishes,

Jordan Jarvis
Executive Director, YP-CDN
Research Fellow, Harvard Global Equity Initiative

WHO takes a big step to promote cancer treatment worldwide
18th May 2015

Jordan Jarvis & Sandeep Kishore
Jordan D. Jarvis M.Sc is a research fellow at Harvard Medical School and Executive Director of the Young Professionals Chronic Disease Network (YP-CDN, www.ncdaction.org<http://www.ncdaction.org/>). Sandeep P. Kishore MD/PhD is a resident physician at the Yale School of Medicine and President of the Young Professionals Chronic Disease Network.

Even in countries like the USA, where the most current cancer treatments are readily available, cost is a serious barrier. In lower-income settings, pricey cancer medications can be impossible to obtain. Guest bloggers Jordan Jarvis and Sandeep Kishore discuss the expansion of WHO’s “essential medicines” list to include some high-priced cancer medications and the potential impact it may have on accessibility.

Everyday, people around the world living with cancer go without life-saving treatment despite the fact that, for many of these conditions, effective treatments exist. The reality is that large populations in low income and high income countries alike are unable to gain access to these treatments at prices they can afford.

This will soon begin to change.

On May 8th the World Health Organization added 16 new anti-cancer medicines to the Model List of Essential Medicines (WHO EML). The list is used by governments worldwide as a guide to set their own policies on which medicines should be “essential” and by UN organizations and philanthropic groups as a global standard to guide drug donations. Essential medicines are those that should be available and affordable at all times.

Experts who gathered to update the WHO list affirmed that there is “urgent need to take action to promote equitable access and use of several new highly effective medicines, some of which are currently too costly even for high-income countries."

In 2012, two teams of experts petitioned the WHO to include imatinib for the treatment of chronic myeloid leukemia and trastuzumab for the treatment of HER2+ breast cancer on the WHO EML. The consideration of these applications for two highly effective cancer treatments kickstarted a rigorous review process of the cancer section of the WHO EML through the Union for International Cancer Control (UICC) and its partners.

Our view, as petitioners for the addition of trastuzumab and imatinib to the WHO EML, is that this is a watershed moment for the global NCD community, including patients and front-line providers. The move by the WHO helps re-define essentialitybased on clinical need-- and not cost or cost-effectiveness alone.

People living with cancer have celebrated the additions of life-saving cancer medications to the WHO EML as a basic human right. Manon Ress, with the Union for Affordable Cancer Treatment (UACT) offered, “As a breast cancer patient whose life was saved for the last four years thanks to access to trastuzumab, the addition of this drug on the WHO EML was wonderful news. Twenty percent of breast cancer patients, those who are HER2+, could have had the same luck! However, the WHO needs to take this type of action much sooner, and not wait until the end of the patent term. In the future, we need to delink the price of all new drugs from the cost of R&D, from the beginning.”

The addition of high-priced cancer medications -- along with patented medicines for hepatitis C and tuberculosis-- on the same day is reminiscent of decisive moves by the WHO to add anti-retrovirals (ARVs) for treatment of HIV/AIDS in 2002, despite their cost.

The tension on whether to add expensive medications has largely centered on the debate of addressing the individual’s right to health versus population health—that is, on a limited health budget, should the government assist high-cost breast cancer patients to receive life-saving treatment, or should the cost of that treatment be spent on interventions that benefit a larger population? Jonathan Mann and AIDS advocates demonstrated that these are mutually reinforcing. Although definitions vary, the right to health is defined in the WHO constitution as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Repeatedly, national courts have affirmed the right to AIDS treatment, leading to government provision of HIV treatment in Venezuela and Argentina, for example. The WHO EML serves as a lever for national change.

“The EML is an essential tool for countries, regulators and procurers—such as Médecins Sans Frontières (MSF)—alike,” says Dr. Jennifer Cohn, Medical Director, MSF Access Campaign. “The inclusion of medicines just added to the EML sends an important signal that initial high prices should not be a barrier preventing countries from considering use of medicines that can have an important public health impact.”

But, there is still much work to be done. Governments must align their own national essential medicines list (NEMLs) with the global standards endorsed by the WHO, bearing in mind national disease burdens. And, this will involve, where needed, spurring generic competition and invoking flexibilities enshrined in the World Trade Organization’s Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement.

The Young Professionals Chronic Disease Network (YP-CDN) has begun a next generation movement to do just that. In late March, we partnered with the American Cancer Society to host a workshop at Harvard University that focused on equipping young, passionate advocates from India, Rwanda, Kenya, Nigeria and the U.S. with evidence-based advocacy skills and knowledge to work toward improved cancer care and control policies.

YP-CDN members are now focused on aligning national essential drug priorities with WHO standards for cancer treatment, to ensure inequalities are minimized. Our efforts involve pressure for government accountability, changes to financing and pre-payment structures, and other initiatives to enable all people with cancer (high or low prevalence) the chance of survival without pain or suffering. Emmanuel Sanwuok, a YP-CDN member in Ghana, remarked that “...Those opportuned to be in positions should be proactive and lead efforts and push the necessary knobs to ensure governments act accordingly.”

Oluwafunmilola James, a YP-CDN local leader and breast cancer advocate with the organization Breast Without Spot (BWS) in Lagos, Nigeria, says, “Even though a high proportion of the cancer medicines in the former WHO EML have not been included in the Nigerian EML yet, it’s at least very heart-warming to know that when the Nigerian Government eventually comes round to paying more attention to cancer control, one of our very first tasks will definitely be to advocate for the need to follow the WHO example by updating the Nigerian EML to include these cancer medicines.”

We believe that the rare alliance of people living with NCDs, next generation technical experts and advocates in a modern grassroots NCD movement will help embolden governments to follow the WHO’s lead. Advocates on the ground are leading the way. Dr. Kalyani Menon-Sen, the Indian-based Coordinator for the Campaign for Affordable Trastuzumab explains, “...Access to so-called "designer drugs" like Trastuzumab has so far been restricted to those who are able to pay the ridiculous prices demanded by patent-holders. That must change. Now that it is declared an "essential medicine", it strengthens our hands in demanding that it be provided through the public health system."

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