Resolution On Cancer Hailed By WHO Members, Easily Adopted In Committee

It is not a mystery, cancer has been spreading for decades, in particular in low and-middle income countries, and is not stopping its course in the foreseeable future. Members of the World Health Organization in committee yesterday adopted a resolution to improve prevention, diagnostics, treatment, and palliative care for cancer, in statements stripped of controversy.

The draft resolution [pdf] on cancer prevention and control in the context of an integrated approach was proposed by Brazil, Canada, Colombia, Costa Rica, France, Netherlands, Nigeria, Panama, Peru, Russia, Thailand and Zambia.

WHO members, gathered at the World Health Assembly (WHA) from 22-31 May, also noted a WHO report [pdf] on cancer prevention and control.

The draft resolution was already discussed at the January WHO Executive Board, but IP-related issues came in the way of consensus at that time, such as the delinking of the cost of research and development (R&D) from the end prices of cancer drugs (IPW, WHO, 4 May 2017). In the end, the concept of delinkage had to be removed to get all members’ approval, according to sources.

Call on Governments, WHO, to Act

The resolution calls for governments to undertake 22 actions, including the implementation of national commitments for the prevention and control of cancer, the integration and scaling-up of national cancer prevention and control, and the development of national cancer control plans, which have adequate resources, monitoring and accountability.

The resolution also calls to promote access to vaccinations to prevent infections associated with cancers, to promote cancer research, and to consider innovative financing approaches, which will promote equitable and affordable access to cancer care.

Some 10 actions are requested from the WHO, including the harmonisation of technical assistance provided to countries, and the strengthening of the collaboration with nongovernmental organisations, private sector, academic institutions, and philanthropic foundations to foster the development of effective and affordable new cancer medicines.

The WHO is also requested to prepare a comprehensive technical report to the Executive Board in January 2018 “that examines pricing approaches, including transparency, and their impact on availability and affordability of medicines for the prevention and treatment of cancer.”

Resolution Widely Supported

Colombia, which chaired three informal meetings organised between the Executive Board and the WHA, said the resolution is an opportunity to move forward and promote equitable access to all cancer treatments, technologies, and prevention measures.

The resolution was supported by the majority of countries speaking today in committee, such as India on behalf of the South East Asia region, Zambia on behalf of the Africa region, Japan, Lebanon, the Netherlands, Qatar on behalf of the Eastern Mediterranean region, Zimbabwe, Namibia, Swaziland, Senegal, Australia, Thailand, Morocco, South Korea, Tunisia, Argentina, Venezuela, Togo, and Bolivia.

The debate took place in Committee B, one of two committees charged with going through the agenda, and preparing the decisions to be approved by the World Health Assembly closing plenary today.

Some countries asked to become cosponsors of the resolution, such as Congo, which said cancer is the leading cause of death in the country, the United States, Malaysia, Georgia, Luxemburg, Tanzania, and India.

Poor Countries Hit Hardest

Most countries taking the floor voiced concerns about the growing issue of cancer, leading to premature deaths, suffering, and high economic impact on health budgets.

Many also underlined the fact that low and-middle income countries are hit the hardest by the spread of cancer, due to several factors including the lack of data on the disease burden, and the lack of awareness on cancer prevention. The latter was stated by Zambia, on behalf of the 47 countries of the Africa region.

Zimbabwe said shortages of medicines and lack of appropriate medical technologies are example of barriers that low and middle-income countries experience in their fight against cancer.

Zambia also said some “low hanging fruits” could be harvested, such as awareness raising, vaccination, early diagnosis and treatment, appropriate rehabilitation for cancer survivors, and palliative care. The Zambia delegate called on WHO to keep supporting developing countries, and to help them negotiate lower prices, including radiology equipment, and analgesics for palliative care. The delegate also called for capacity building.

Namibia said prevention is the most affordable response to cancer but palliative care and pain control are often neglected for cancer patients.

India, speaking on behalf of the 11 countries of South East Asia said about 1.1 million people die from cancer, many of them prematurely, while most cancer cases are preventable, treatable, and curable. The Indian delegate noted the rise in childhood cancers, and said establishing national cancer control programmes is hindered by the lack of adequate financial resources.

He called on the WHO and other partners to promote the availability and accessibility of affordable, safe, effective, and quality medicines, vaccines, and diagnostics, including through the use of the flexibilities included in international trade rules (World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights – TRIPS). He also called for the promotion of research and development (R&D) for new cancer drugs and diagnostics that are accessible and affordable.

A number of other countries underlined the lack of affordability of cancer medicines, such as Sri Lanka, and Senegal, which called for a global mechanism for cancer treatments to promote access to chemotherapies and radiotherapies. Others were Thailand, which also called for a pricing mechanism to achieve more affordability, Brazil, Vietnam, Tanzania, and Bolivia.

Delinkage, IP: ‘Elephants in the Room’

While the question of delinking the cost of research and development from the market price of medicines was repeatedly mentioned in discussions on several agenda items at the World Health Assembly, during the discussion on the cancer resolution, the issue seemed to have been carefully avoided by countries taking the floor.

India, on behalf of the countries of the South East Asia region underlined the need to consider the principle of delinkage when promoting R&D of new cancer drugs and diagnostics.

‘What Everyone Needed’

A leading NGO activist on the cancer resolution, Knowledge Ecology International Director James Love, said afterward that compromise among often disparate sides was possible because the final resolution was “What everyone needed, not what everyone wanted.”

In a statement, Love said, “The resolution is an important milestone in focusing the attention of the UN body on the disparities of access to treatment. The most controversial issue in the resolution was the text dealing with pharmaceuticals, and in particular, pricing and access, transparency of R&D costs, and to conduct a feasibility study of delinking R&D costs, including incentives, from drug prices.”

“Going forward, much will depend upon the new leadership at the WHO, as these reforms were previously blocked by the outgoing WHO Director-General Margaret Chan, as well as the level of support for delinkage in Member States,” said Love. “Without decent political leadership on delinkage at the national level, it won’t happen. Fortunately, there is now growing interest in Europe, more support in developing countries (in part due to the positive impact of the UN Secretary-General’s High Level Panel on Access to Medicine), and some encouraging signs in the United States. Several members of the U.S. Congress are now calling for feasibility studies of delinkage, and even some persons in the Trump Administration have signaled some new openness on this issue.”

On September 26, members of the European Parliament will host two days of meetings on delinkage, where the proposal for a Cancer Innovation Fund will be discussed, he said.

 

Image Credits: WHO