Why a collaborative approach between regulators, governments and industry needs to continue beyond Covid-19
India ranked joint-first in oncology research, except for the Philippines, among all 10 countries studied in a recently released report, Cancer preparedness in the Asia Pacific: Progress towards universal cancer control. Though the report highlighted that India’s strong national screening programmes for breast and cervical cancers and strong policies aimed at discouraging unhealthy diets and harmful alcohol consumption, as well as promoting physical activity, India’s overall rank is a low eight out of the 10 countries surveyed on the Index of Cancer Preparedness – Asia Pacific. Thus we still have a long way to go.
Rachel Frizberg, Area Head Asia Pacific, Roche Pharmaceuticals gives more details to Viveka Roychowdhury on the key learnings from countries in the APAC region, while V Simpson Emmanuel, General Manager – India, Roche Products India expands on the India-specific scenario
The COVID-19 pandemic has focused all attention, resources on COVID-19 care to the detriment of cancer patients and future infrastructure investments in cancer care. Does the Index of Cancer Preparedness – Asia Pacific give any guidelines, road map on how such systems can be ring-fenced during future pandemics, natural disasters leading to a high load on healthcare infrastructure?
The 2020 Index of Cancer Preparedness Asia Pacific outlines several areas of focus to help individual countries evaluate and build more sustainable health systems. The report highlighted that India could benefit from the implementation of a national cancer control plan and clinical cancer guidelines to boost overall cancer preparedness. Other key opportunities include increasing the country’s skilled cancer workforce, improving the number of radiotherapy machines and expanding coverage for cancer medicines.
Strains on health systems have become even more acute during the current pandemic, which has impacted cancer care across the healthcare continuum – around 42 per cent of countries surveyed by the World Health Organisation (WHO) have had partially or completely disrupted services for cancer treatment during this time.
In response, healthcare systems are rapidly reorganising cancer services and healthcare workers are adopting new ways of working, to ensure that patients continue to receive essential care while minimising the risk of exposure. COVID-19 has shown us that digital technology can play a critical role in addressing gaps in service availability. Places like Thailand and Hong Kong are reaching more patients in need through the launch of virtual clinics and teleconsultations for remote areas. Australia and China are harnessing AI technologies to aid faster, more accurate diagnosis.
Although the pandemic is an unprecedented public health crisis, it has underlined the importance of sustainable, accessible and high-quality health systems. It has been encouraging to see regulators and government bodies being increasingly flexible and willing to work closely with the industry. We should continue to leverage this collaborative approach to strengthen health systems in the interest of patients, supporting personalised healthcare, smarter regulation and rapid access to evidence-based innovation.
If we can keep these new ways of working long-term, we can accelerate progress towards new treatments in cancer, rare diseases, and other urgent areas of need.
Are there any successful practices followed by countries with socio-economic-demographic profiles similar to India, which our country can consider adopting /adapting? Are there practices from India, which have served as models of care in other countries?
There are several lower and middle-income countries (LMICs) – the Philippines, Indonesia and Vietnam – included in the 2020 Index of Cancer Preparedness Asia Pacific that provides key learnings. Indonesia, in particular, is making positive progress against some key cancer care focus areas. This is attributable to the country’s introduction of cancer research policies or programmes, increased universal health coverage (UHC) programmes and investment in healthcare spending.
The current pandemic has also led to innovations in service and care delivery for patients. For instance, telehealth solutions have emerged as a source of support for patients, caregivers and healthcare providers.
An example of this is our partnership with the City Cancer Challenge. The initiative, set up by the Union for International Cancer Control, aims to tackle the growing burden of NCDs, especially in LMICs and support cities across the world to speed up access to quality cancer services. Under the initiative, a global telementoring program was launched to connect cities with centres of excellence on topics such as training for multidisciplinary cancer care delivery and virtual tumour boards. These types of innovative solutions could help overcome challenges in countries like the Philippines, Indonesia and even India, where unique geographies and capacity restraints limit healthcare delivery in remote areas.
In terms of learnings from India, a good example is a work done by the Tata Memorial Centre (TMC) to optimise patient pathways during the COVID-19 pandemic. Their triage mechanism helped identify high-risk patients who needed in-hospital care and those who could be cared for in smaller set-ups or closer to home. They also successfully used their teleconsultation platform to offer patient consultations online rather than requiring patients to travel to the hospital.
While there are clearly cross-country learnings to be shared, we also know in a region as diverse as the Asia Pacific, achieving equal access to health and cancer care does not have a ‘one-size-fits-all’ solution. That’s why, like Roche, we are working to identify the specific challenges facing each country and partnering with policymakers to develop tailored approaches to support their cancer preparedness efforts and build more sustainable health systems.
How can pharma companies play a more proactive role in improving the cancer preparedness index, on the cost, access and availability front?
There is an urgent need to address huge inequities in access to healthcare around the world – particularly in low- to middle- income countries (LMICs) – and achieving Universal Health Coverage (UHC) is gaining global momentum as a solution. We believe that UHC is a key way to address these inequities and promote wider access to quality medicines – and the pharma industry can play an important role in realising that future.
As Roche, we collaborate across the healthcare ecosystem to advance UHC and work with our partners to build health infrastructure, leverage new technologies and increase access to a quality standard of care to improve the lives of patients across the region. We partner across the supply chain and at different health service delivery points to execute tailored solutions.
To address the barriers to achieving UHC – from lack of basic healthcare facilities and trained medical professionals to limited resources to pay for healthcare – we need to work in partnership with governments, healthcare professionals, payers, NGOs and other organisations to increase access to healthcare innovation. Life-changing innovation in medicine is only meaningful if it reaches those who need it. Roche is committed to facilitating increased access to cancer treatment innovation through cross-sector collaboration to improve the lives of cancer patients both now and in the future.
What are the collaborations that a country like India needs to consider to improve its cancer preparedness, as resources will be even more scarce due to COVID-19, to cope with the increasing burden of cancer care? At a policy level for public-funded cancer care as well as what avenues can private care, systems look at?
While progress is undoubtedly being made in the fight against cancer across APAC, there is still a long way to go. Excess cancer mortality remains a serious concern for LMICs.
We believe that digital and personalised healthcare can play an important role in addressing these concerns and in advancing UHC – making health systems more sustainable, efficient and accessible and allowing policymakers to better optimise resources. There is a clear need to establish strong, cross-sector partnerships to collaborate on research and invest in areas like big data analytics and personalised medicine to significantly improve patient outcomes. These innovative partnerships can help countries make smarter, data-driven healthcare decisions.
In Taiwan, for instance, Roche is partnering with the government to foster personalised healthcare with a focus on tailoring cancer treatment to individual patients. The objective is to provide targeted treatment through precise genomic analysis and to reduce unnecessary medical expenses while improving the quality of healthcare.
To address the burden of cancer care – in India for instance – there is an urgent need for a comprehensive cancer control plan at the state level, which also covers information and tracking systems so that cancer patients go through their diagnosis and treatment journey without any dropouts. Policies that facilitate bringing innovative treatments to the market faster will also be highly beneficial for patients. In the private sector, there is a need for cancer centres of excellence that are focused on delivering better outcomes through systematic measurement and continuous improvement.
How can health insurance help reduce the burden of cancer care and improve levels of cancer preparedness?
Cancer not only takes lives but can also result in severe economic hardship for those diagnosed. Most at-risk are the poor and under-insured. Health insurance and innovative finance models are critical for improving cancer care.
In India, private insurance products that are targeted at cancer should be made more easily available. Steps can be taken to implement recommendations made by the IRDA for standard inclusions in all health insurance products. Public insurance (ABPMJAY and state) must include newer, more effective therapies that can improve survival and quality of life for cancer patients in India. It should also explore innovative models for financing cancer treatment to reduce the personal financial impact.
Ultimately, to overcome cancer care challenges longer-term, advancing progress towards universal health coverage will help address existing gaps in access to care and promote wider access to quality medicines – particularly in LMICs.
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