My talk is on improving access to childhood cancer medicines. There is this new platform, not necessarily new, by the WHO and St Jude’s Children’s Research Hospital, the Global Platform for Access to Childhood Cancer Medicines. The essence of the platform is for low- and middle-income countries like Nigeria to improve access to childhood cancer medicines. We’ve not seen so much movement on the platform until recently where countries like Nepal and Uzbekistan just signed to the platform. So my presentation is on developing an implementation framework for Nigeria to be able to access that platform.

What are some of the challenges in accessing childhood cancer medicines in developing countries?

Let me set some context. Childhood cancers are one of the very manageable cancers but in low- and middle-income countries we have 30% of children surviving childhood cancers as opposed to 80% in high-income countries and from the data available to me over 400,000 cases of childhood cancers are reported every year and 90% of that happens in low- and middle-income countries. So there are a lot of reasons why this happens but one of the key challenges is access to treatment, access to medicines. There are a lot of reasons why this is prevalent in low- and middle-income countries, one of which is low insurance for accessing medicines and healthcare.

So, for instance, in Nigeria insurance for healthcare is 5% coverage and that is mostly in the public sector. Childhood cancer medicines and all cancer medicines in general are quite expensive so most people have to pay out of pocket to access this care and to have access to these medicines. The costs are huge and they become catastrophic at the end of the day. So people don’t have the money to be able to afford these medicines. So, for instance, in Nigeria where four in ten people live in abject poverty, how someone like that that has a child with childhood cancer would be able to afford the medicines.

Then we also have issues with the supply chains, so these medicines are not available in many places and we don’t even have cancer treatment centres in many places, most of them are in the developed regions of the country or in the urban areas. Then those in the rural areas are neglected. So these are some of the challenges that make access to childhood cancer medicine difficult.

How do you think these challenges can be overcome, and what is being done globally?

I made reference to the Global Platform for Access to Childhood Cancer Medicines by St Jude’s hospital and WHO, that’s one way to help this problem. High income countries and international organisations like the WHO coming together to say how can we help these children and then launching this platform, which is a $200 million platform, to provide these medicines, that’s one way.

Another way is for countries where this thing is endemic to see how to set their priorities right in terms of managing the scarce resources available and then seeing where to improve access for these children; coming up with programmes and partnering with different organisations, for instance the Global Initiative for Childhood Cancers; building your capacity to be able to improve access to these medicines; training the health professionals available in the country; providing the supply chain routes for these medicines; developing your infrastructure and making sure that things are in place, at least the basic things are in place, for children to access these medicines; having some form of way to improve primary care, even in the communities, for easy and earlier detection of these cancers. So if these things are put in place then we can start to see some improvements in access.

So when platforms like the Global Platform comes in, or wants to come in, to your country, they can see that some of those basic things needed, some of those basic infrastructure are already in place and they can look at ways to improve this infrastructure and to scale up your efforts in improving access.

Do you have any examples you’d like to share from Nigeria?

In terms of enabling environments, improving the infrastructure and the system to accommodate childhood cancers, prior to now the Nigerian Cancer Control Plan didn’t include childhood cancers. But there is a new plan now from 2023-2027 that includes childhood cancers. During the course of my research on this topic I spoke to paediatric oncologists who attested to the fact that prior to recent developments they were not involved in cancer, in decision making around policies and cancer control and care. But now they are being involved more, so they are invited to the table to contribute to paediatric cancer treatment and all of that.

So we are seeing some promise, we are seeing some light at the end of that tunnel. That’s one of the emerging stories from countries like Nigeria where paediatric oncology, childhood cancers, are being taken more seriously now. We hope that the Global Platform for Access to Childhood Cancer Medicines will come in and see how to support countries like Nigeria. There is always this notion that people from high-income countries know better and all of that; while that might be true in some cases but the local expertise should not be shunned. These people understand the cultural context – the physicians working in Nigeria, they work very hard with little or no resources and they are able to do a lot. So they have some knowledge that can help platforms like this to achieve their aim. So we shouldn’t disregard their knowledge, we shouldn’t disregard their expertise. We should shun all forms of epistemic injustice and then use the knowledge of these people, these paediatric cancer doctors that have been working in Nigeria, to see how to improve access to these medicines, to see how to help these children. So these people have the expertise, they go for the training outside the country, they know their stuff and this platform and other platforms can come in to see how to use this local expertise to help these children.

How can pharmacists be implemented more in cancer care, specifically their role in improving cancer care in LMICs?

Pharmacists have significant roles to play beyond just dispensing oncology medicines. I’m a pharmacist myself, I went through six years of training so I know how [??], I know how in depth that training was. I can’t go through all that training and just come and dispense medicines at a service delivery point, I know a whole lot about pharmacology and all of that. So pharmacists have knowledge that can be explored to improve access to medicines, improve access to care.

Along the entire continuum of cancer control from health promotions, screening, all the way to survivorship, palliative care, there are things pharmacists can do. I’ve been reading a lot of literature in countries like in Europe there are pharmacists that help in screening and diagnosis of even colorectal cancer, even dermatological cancers. There are pharmacists that help in supportive care, in pain management. There is a whole lot more we can do apart from dispensing medicines.

I’ve been at this conference and maybe I’m not looking in there but I haven’t seen any pharmacists here, I haven’t seen any programme on the agenda specifically [??] pharmacists. This is something we need to look into. I wouldn’t blame the UICC or anyone but it’s my call to action for pharmacists to get more involved in things like this and these conversations. You can’t have this much training and then not use it to improve the lives of people that need your expertise for their care. So pharmacists have a huge role to play from screening, from diagnosis, to supportive care, and we should take advantage of avenues like this to show our capacity, to present on what we can do, to come up with innovative ideas, to try new things, to pilot new things and show that they work and they are effective. If we are able to show this then we can make a case as to why our inclusion is paramount and how what we come up with can be scaled up.