Re-engineering public choice in R&D for global cancer control

Transcription

1 Re-engineering public choice in R&D for global cancer control Prof Richard Sullivan MD PhD academia.edu/richardsullivan

2 Lets start with a postmortem in high income countries The Public Policy Challenge

3 Despite new found enthusiasm for NCD and global health the reality is most effort in cancer R&D will have precious little Over impact the last on decade the lives there and have deaths been of most cancer patients over 104 new global cancer health initiatives.. So now everyone seems to want to be the new global cancer control hero but what is the reality? Source: United Nations, World Population Prospects: The 2008 Revision (medium scenario), 2009.

4 In high income countries cancer public policy is framed around cost control.and this is a very toxic subject!

5 Policy nexus in high income countries is between idealism and cancer as the leading edge of biomedical science Fabienne Peter. Health equity & social justice. J Applied Philosophy, (2):

6 Biggest problem in HIC is the lack of R&D around the social determinants of cancer Robert Putnam(1995) Bowling alone: America s Declining Social Capital, J Democracy, 6:65-78.

7 But the reality is that the cancer as a global public health threat is a problem of emerging economies.. Quadrupule disease burden: all socio-economic classes & age cohorts Rapid urbanisation Traditional modifiable risk factor (tobacco, obesegenic) and malnutrition co-exist Radically different affordability issues Nigel Unwin et al (2001) NCD in SSA: where do they feature in the health research agenda? Bull WHO, 79(10):

8 What the key ingredients for a new paradigm? Investment Re-engineering the political economy (public choice) of cancer

9 Investment

10 R&D in cancer (ONCOL) does pretty well problem is that 96% of papers are high-income focused 15 % of research and DALYs Research, % DALYs, % AIDSR ARTHR CARDI DENTA DERMA DIABE HEPAT MALAR MULSC ONCOL PARKI RENAL RESPI Sullivan R and Lewison G. Balancing the global health research agenda. PLoS (in press)

11 How much are we really investing in global cancer R&D? We know that there are around 43,456 researchers Annual spend on R&D is Billion GBP Public 36 Billion GBP Private Most focused on fundamental Science and drug development: 624 NME Phase I-III >1,300 biomarkers

12 So, how much do we really spend on global cancer? High income Transitional 92% 4% 4% Middle / Low

13 96:4 funding gap Most funders very nationalistic Most global R&D has little applicability to needs of LMIC Increasingly strong case for a Global Cancer Fund 1. Lewison G, Tootle S, Roe P, Sullivan R. How do the media report cancer research? A study of the UK s BBC website. Brit J Cancer 2008, 99:

14 Re-engineering the political economy of global cancer research

15 Have we been too quick to announce the death of vertical programs? In an effort to be all things to all people it ends up being nothing to anyone Balthus Pharmacogenetics is dead and warfarin killed it

16 Most public-choice approaches are too generic and central : lack of integration with population & development research UNDP. Human Development Index 2011 Sullivan R and Purushotham A. Avoiding the zero sum game in global cancer policy. E J Cancer 2011, 47:

17 Dramatic global socio-economic changes underway: don t understand how this is going to affect cancer control Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision and World Urbanization Prospects

18 Impact of globalisation on public choice in cancer control: again little direct research in this direction Globalisation cuts both ways (1). Translating benefits of income increases and capital flow into health benefits cannot be taken for granted. NCD risk factors have very tight correlation with mediating factors of globalisation (2). (1) David Doller. Is globalisation good for your health? Bull WHO 2001, 79: (2) David Woodward et al. Globalization and health. Bull WHO 2001, 79:

19 Research aimed at understanding real needs of a cancer control as complex adaptive system is needed 1 Fries, JF. (1989) Compression of morbidity. Near or far? Milbank Quarterly, 66(2):

20 The issue though is that we have many players in too small a political space Socio-Demographic Challenge

21 New research paradigm must be about delivering affordable cancer care in emerging and middle income countries Striking a balance between idealism & fatalism Fatalism Darwinian selection of private and public cancer research enterprise Idealism Evidenced based policy-making AND audit. R&D new investment mechanisms and models of care, e.g. Institute-Country long term collaborations Build initiatives on existing infrastructure Create a Global Cancer Fund Low cost, hardened technologies