Pushing for cost effective interventions in lower and middle income countries

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Published: 26 Nov 2018
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Prof Ophira Ginsburg - NYU Langone Health

Prof Ophira Ginsburg speaks to ecancer at the CCLMIC meeting at the Royal Society of Medicine in London, UK.

She opens by describing how important the CCLMIC meeting is, which covers cancer control in 'fragile ecosystems'.

Prof Ginsburg outlines her talk, which will be discussing the strategies for moving forward the cost effective interventions in lower and middle income countries, for example cervical cancer screening.

This is a very interesting conference; I’ve been here before to the Royal Society of Medicine for a global oncology event but this one is quite unique in that it’s focussed on building global collaborations in fragile ecosystems and that includes conflict zones and post-conflict regions. So there are some real experts here in the room with broad expertise in conflict and health and in cancer care and control with representation from every region of the world. There are discussions about the particular issues that act or serve as barriers to healthcare seeking and to improving cancer outcomes, cancer survival really, among indigenous populations around the world.

I’ll be speaking later on cancer in the global health agenda. So it’s been a very exciting year preparing for the UN high level meeting on non-communicable diseases, NCDs, which of course include heart disease, stroke, diabetes, cancer and lung disease. In particular, cancer has played an increasingly important role, not for happy reasons because cancer rates are rising dramatically in terms of incidence and mortality in low and middle income countries. The advocacy efforts for cancer control are now being brought to bear to serve as a catalyst for discussion and action that countries can take. The UN meeting that did happen, the third high level meeting for NCDs, took place at the UN General Assembly this year in September, this year being 2018. This fell also several months after a very important statement by the World Health Organisation Director General, Dr Tedros, who called for the elimination of cervical cancer as a public health issue.
So later today I will be speaking about this and the importance of learning from each other. There has been a lot published now on strategies to prevent and control cervical cancer. We actually know what to do, we even have cost effective solutions that are relevant to the lowest income regions and to areas where resources are very limited in terms of infrastructure and human resources. The WHO has published extensively on these topics and there’s the so-called Best Buys – very cost effective interventions for the prevention and control of NCDs. Among these are cervical cancer prevention with HPV vaccination as well as a menu of options of strategies for cervical cancer screening and treatment of pre-cancers. These are all listed as very cost effective interventions.

So the question I’m asking today is how can we actually move the needle forward in a big way because at the current pace we are going to lose many millions of women over the next 20-40 years. Even if we vaccinated every girl and boy for HPV tomorrow there will still be a huge backlog of adult women who will face a very agonising outcome from cervical cancer if they do not have equitable access to cervical screening and treatment. So I will speak about that and ask the question can we reach that lofty goal of cervical cancer elimination in our lifetime.

Do you think it will be possible?

I think we can reach the goal of cervical cancer elimination. I don’t know if it will happen in my lifetime; I like to think that it will happen in my young nieces’ lifetimes. The main thing here is to focus on the importance of collaborating to make this dream a reality. Many countries that are facing the greatest burden, particularly in sub-Saharan Africa, especially where HIV is still endemic, even if people are treated for HIV it seems still that cervical cancer rates are higher in these communities. They are the least likely populations to have access to cervical screening so they need help and assistance. One of the themes of today’s conference here at the Royal Society of Medicine is how we can work to collaborate, not just by north-south partnerships, high income countries working with low and middle income countries, but also facilitating networks of collaborations between lower resource regions and countries so they can support and learn from each other.