Each year in May, the World Health Organization (WHO) hosts the World Health Assembly (WHA) in Geneva, Switzerland where Ministers of Health from the 194 member states meet to review work and set goals related to promoting health and easing the burden of disease worldwide.
With the Union for International Cancer Control (UICC), Roche co-hosted a side event on “Cancer in the Middle East: The role of public-private partnerships as a health systems response.” The event also served as a launch of the first study of its kind to assess all aspects of breast cancer care in five Middle East countries. The "Health Systems in Action: Breast Cancer in the Middle East" (HIBA) study, conducted by researchers from the Harvard T.H. Chan School of Public Health in collaboration with country experts, was sponsored through an unrestricted grant by Roche. Dr. Peter Hug, the Head of Roche Pharma EEMEA Region covering Eastern Europe, Middle East and Africa joined the panel discussion and shares here his perspective on partnering to solve cancer challenges in emerging markets.
Written by Peter Hug, Head of Roche Pharma EEMEA Region
At Roche, we believe that everyone who needs our medicines should have access to them, which drives our approach to working with partners to improve healthcare systems.
As a leader in oncology, Roche has a commitment to improving cancer care across the globe, and we partner with others in the healthcare system to address access and funding needs. Nowhere are these needs more pronounced, and the challenges to meeting them more difficult, than in emerging markets.
At this year’s World Health Assembly, WHO focused on universal health coverage and the increasing burden of non-communicable diseases, which includes, of course, cancer. The discussions highlighted how to work with civil society and the private sector to develop healthcare solutions - themes that are fully aligned with Roche’s commitment to improving cancer care and healthcare access.
Our colleagues operating in the approximately 90 countries of Roche’s EEMEA region aim to address the multi-dimensional challenges of access by focusing on four key areas: awareness, diagnosis, healthcare capacity and funding. Each market is unique, however, and there is no one-size-fits-all approach. The HIBA study highlights the specific realities of breast cancer care in the Middle East and proposes evidence-based policy options that we hope will help improve breast cancer outcomes for patients in that region in the future.
Cancer is on the rise
The Middle East has the fastest-growing incidence of cancer in the world - it’s the second leading cause of death in those countries, and the burden will almost double by 2030. That puts incredible pressure on the healthcare systems in the region.
This increased incidence of cancer is driven by a number of factors. People are living longer, which makes the occurrence of disease more likely. There are also behavioural issues - more fast food, a more sedentary lifestyle - that cause obesity and Type II diabetes, which lead to more cancer. But the reasons behind some of the increases, such as elevated breast cancer rates in younger women compared with the West, are still unknown. And diagnosis of these often more aggressive cancer types often comes late.
The Middle East faces particular challenges providing cancer care that often have to do with infrastructure, culture, and access to screening and healthcare. I have visited immaculate facilities with state-of-the-art equipment in some countries but too few physicians and technicians. In other markets we see large expatriate communities of workers who are not fully covered by insurance in their adopted homes. In some countries, people don’t have nearby access to screening facilities, or can’t afford to travel long distances for care. And women, who are disproportionately affected by cancer, may have instilled cultural beliefs and fears - that they will be stigmatized for their disease, or that it is an inevitable fate - that prevent them from seeking treatment.
Understanding the country first
To tackle these challenges, we need to understand the particularities of the healthcare systems in a given country and find a tailored solution for each one. This is difficult, because when you need to design a cancer policy in a country, you need data, and there is often little available - which is why research like the HIBA study to understand breast cancer in the Middle East is so important.
At Roche, we see our role as facilitators who can bring various parties together to find solutions to fit the particular healthcare access needs of a country. Our specific role may include providing diagnostic tools, funding the education of physicians, providing research grants, making commercial arrangements, or being the liaison between non-governmental organizations (NGOs), governments, patient and physician associations, healthcare providers, and other players.
To address some of the Middle East challenges raised by the HIBA study, we can bring to bear our learnings and experiences from other parts of the world. When we’ve brought partners together, as we did in the Ivory Coast, we helped create a comprehensive approach to healthcare that follows the patient step by step, working out the obstacles, eventually ensuring that even the poorest of the poor can have access to biologic treatments for cancer that they didn’t have before. We’ve replicated that approach in a number of sub-Saharan Africa countries, including the Sudan, Ghana, Kenya, and Nigeria.
Making a difference
We’ve had some partnerships that have made a profound difference in people’s lives.
In Pakistan, a country of 200-plus million people, few can afford biologic medicines. Roche worked with the government and NGOs to create a patient support program that launched in August of 2017. Since then, more than a thousand low-income people have been given access to treatment, which is a fantastic start.
In Dubai, Roche partnered with the Health Authority and a leading international health insurer, AXA, to develop a funding solution for screening and treatment for colorectal, breast, and cervical cancers. Working together, a supplementary insurance for expatriates was developed by charging a small additional amount on the premium employers pay for each employee, which is pooled into a central fund. Now, all Dubai residents can be treated for cancer.
In Morocco, women with breast cancer often have to travel long distances across underserved areas like the Sahara to be diagnosed and given biologic treatment, and then they must return for follow-up. With no place to stay, and little means to travel, two-thirds of the women abandoned a drug that could prolong their lives. Through a foundation led by the Princess Lalla Salma of Morocco, the country has built accommodation centers where patients can stay with family members until they finish treatment; the dropout rate is now down to 20%. If you provide the right support, you increase compliance and the impact of treatment.
We want to make sure that Roche’s role as a facilitator in helping build the healthcare systems in these countries, and our partnerships, result in solutions that are sustainable. We’re not into short-term gains. It is increasingly recognized that global health problems are far too complex for one group to tackle them. With public-private partnerships, we can enable local institutions to grow, build capabilities and, and eventually run effective healthcare systems that advance access to cancer care. It is indeed our hope to achieve access for all.