Do babies born in certain places have a higher risk of dying of cancer?
The CEO and president of St. Jude Children’s Research Hospital James R. Downing believes they do: “Location is the biggest predictor of whether a child lives or dies from cancer.”
This statement may sound surprising. Cancer is cancer, right? Yes, but what cancer treatment a child receives depends on the country they live in.
Here, we will discuss how oncology medication access inequalities affect outcomes, why disparities happen, and share the initiation of a program by the World Health Organization (WHO) designed to tackle this challenge head-on.
Why Do So Many Children (Outside of Affluent Nations) Die from Cancer?
Only 20-30% of children in low-and middle-income countries (LMICs) survive cancer compared to 80% in high-income countries.
These numbers constitute one of the most significant inequalities among all types of cancer, as children in LMICs represent approximately 90% of the global cancer burden.
What’s the reason behind these outrageous disparities?
The Pan American Health Organization (PAHO) Regional Advisor on Cancer, Dr. Mauricio Maza, explains, “The gap in survival rates is primarily because of limited access to affordable, quality-assured medicines.”
A recent report by the WHO substantiates this affirmation – 71% of LMICs report general shortages of cancer medicines.
James R. Downing adds, ”Almost every child affected by cancer in LMICs will have interrupted care due to an inconsistent supply of medication.”
Why are cancer medicines for children so scarce in LMICs?
Is It All About Money?
Due to limited budgets, many countries only cover a small proportion of childhood cancer services, including medicines.
LMIC medicines inventories have on average less than 50% of the deemed essential cancer medicines children need according to international standards.
Budget constraints translate into buying small volumes of medicines— often by fragmented facilities within a country—resulting in paying higher prices for fewer quantities of drugs because pharmaceutical companies offer better prices when selling higher volumes.
But money, in pediatric oncology care, as in life, is not all that matters. Other factors also influence medication availability.
Structural Issues
Effective communication and referral systems to streamline the forecasting of medicines within their territories are major pain points in LMICs.
Dr. Eva Steliarova-Foucher is a WHO scientist investigating cancer disparities across the globe. In a recent talk with Breaking Cancer News, she commented:
‘’Coverage of the childhood population by cancer registries in LMICs is inadequate, which means that the reported incidence rates are based on a small fraction of the population. This hampers a better understanding of the true distribution of children impacted by cancer in the community, which is indispensable for improving care.”
The information bottleneck causes a situation where the demand for medicines fluctuates from month to month as reports and needs from different locations arrive infrequently, impacting distributors as they don’t know how much to stock, causing shortages and treatment interruptions.
Workforce shortages and lack of appropriate training also produces challenges around prescription decisions, as workers in isolated treatment centers may lack awareness about pricing, availability, and coverage, augmenting the chance of children not receiving appropriate medicines.
As we can see, delivering the medications children need to fight cancer in LMICs is a multifactorial effort, so, improving its functioning requires a village.
The WHO and its allies have decided to take matters into their own hands.
A Collaborative Solution
The disparity in children’s survival rates resulting from income differences led to the development of the WHO Global Initiative for Childhood Cancer (GICC) aiming to improve global survival rates to 60% by 2030.
The WHO and its allies (UNICEF, St. Jude Children’s Research Hospital, and PAHO) believe that the systemic barriers to optimal childhood cancer medicines access won’t be resolved without international help, so they launched a collaborative program, the Global Platform for Access to Childhood Cancer Medicines, to address them.
The program’s goal is simple yet ambitious: to provide quality and affordable pediatric cancer medicines in an uninterrupted way to LMICs.
Here’s how the partnership works.
The Alliance in Practice
The WHO and St. Jude created the platform for medicines acquisition, funded by $200 million provided by St. Jude to buy generic medication for childhood cancers at no cost to LMICs.
PAHO and UNICEF provide the expertise and human resources to act as procurement agencies for 35 drugs (coming in 69 formulations, from 15 manufacturers), while Childhood Cancer International and the International Society of Paediatric Oncology serve as technical advisors.
The first challenge the program tackles is buying power.
When UNICEF and PAHO buy medication for several countries as consolidated entities, they can pool different needs into larger purchase orders that are easier (and cheaper) to manufacture by pharmaceutical companies, resulting in better bulk prices.
Studies have found that bulk buying through a central agency in LMICs diminishes the price of cancer medicines for children.
There are also regulatory advantages. By working with multilateral organizations, countries can identify regulatory constraints and address them early before they disrupt care continuity. This alliance will help LMICs adopt modern clinical guidelines by standardizing what medicine children are prescribed for each type of cancer, reducing medicine pool selection, and facilitating decision-making for physicians and access to families due to continuous stock.
The platform will help modernize information-gathering processes within countries so nations better understand what medicines their children need and accurately forecast and order them while avoiding shortages.
Dr. Steliarova-Foucher adds, ”International collaboration to improve population-based cancer registries is crucial to collecting high-quality information and enabling data-driven decision-making.’’
One of the pillars of this partnership is to help LMICs modernize how they receive, store, transport and administer pediatric oncology medicines. So, the program’s resources dedicated to strengthening supply chains will reduce operational gaps that translate into suboptimal patient care.
Update: The Program Initiates
On February 11, 2025, it was announced that the distribution of childhood cancer medicines through the Global Platform commenced in Jordan, Uzbekistan, Ecuador, Mongolia, Nepal, and Zambia. In the rest of 2025, Sri Lanka, Senegal, Pakistan, Moldova, Ghana, and El Salvador will also receive much-needed pediatric oncology medicines.
The program’s goal is to reach 50 LMICs in the next 5-7 years, transforming the lives of 120,000 children.
Doing What Is Right
We recently observed International Childhood Cancer Day on February 15.
Its global nature reminds us that children, no matter where they are born, deserve the same chance to beat cancer. Providing them with medicines to do it is a challenge the world, as a whole, must address.
