Cancer’s dangerous mythologyThis year, World Cancer Day will focus on dispelling damaging myths about the disease. The theme - illustrated in the tagline “Cancer ? Did you know?” - offers an opportunity to reflect on cancer’s true consequences and enhance global prevention and treatment efforts.
One prevailing myth is that cancer is primarily a developed-country problem. But, while it is true that cancer is pervasive in wealthy countries, people in the world’s poorest countries lose more years of life to the disease. As medical advances and technological developments have helped cancer patients in high-income countries to live longer - to the extent that some forms of cancer have effectively become chronic conditions - those in low-income countries continue to die young.
Besides being unjust, this is deeply tragic. Having eluded killers like malaria and AIDS, one should not then be killed prematurely by cancer - especially a form of cancer that could have been prevented with something as simple and as affordable as a vaccine.
The often-overlooked link between vaccines and cancer highlights a second common misconception: fate alone (and perhaps smoking) determines who gets cancer. In fact, one in six cancer cases worldwide is caused by a known infectious agent, with the proportion rising to one-third in some countries in Sub-Saharan Africa. The four main culprits are hepatitis B and C, human papillomavirus (HPV), and Helicobacter pylori, which are collectively responsible for 1.9 million cases of liver, cervical, and gastric cancer annually.
Cervical cancer now kills more women than childbirth, claiming a life every two minutes. Of the 275,000 women who die of cervical cancer annually, 85 percent live in the world’s poorest countries. After all, cervical cancer tends to target the most vulnerable in particular, such as women infected with HIV. If left unchecked, the number of cervical cancer deaths is set to rise to 430,000 annually by 2030.
Then there is hepB, which is over 50 times more infectious than HIV and often passed from mother to child before or shortly after birth, increasing the likelihood of liver cancer later in life. An estimated two billion people alive today have been infected with hepatitis B, while 350 million people are chronically infected. Of these, roughly one-quarter will die from hepatitis B-related liver cancer or cirrhosis (a consequence of chronic liver disease).
The good news is that powerful tools are available to avert many of these deaths. Existing HPV vaccines can prevent up to 70 percent of cervical cancer cases, and new vaccines are in the pipeline that will improve this record further. Likewise, hepB vaccines are 95 percent effective at preventing infection and its chronic consequences.
Vaccines protecting against Helicobacter pylori and hepatitis C are in development (although the latter is proving particularly challenging). Even an Epstein-Barr virus vaccine, which would protect against some kinds of lymphoma, is achieving promising results.
But paying for and delivering these vaccines to the most vulnerable citizens of low-income countries poses a significant challenge. Although the World Health Organization (WHO) has recommended including the hepatitis B vaccine in routine immunization since 1992, its high price initially hindered its uptake in some developing countries. More recently, the same problem threatened to hinder the adoption of HPV vaccines.
But the GAVI Alliance intervened to ensure that this is no longer a concern with hepatisis B, and it is unlikely to occur with HPV.
Since its launch in 2000, the GAVI Alliance has sought to increase access to life-saving vaccines for the world’s poorest children. In partnership with the World Bank, the WHO, Unicef, and the Bill & Melinda Gates Foundation, it has used innovative financing tools to raise funds for global immunization programs, while working with industry to lower the prices of vaccines.
By including the hepatisis B vaccine as part of a pentavalent (five in one) vaccine, the Alliance has already facilitated its delivery to children in 70 countries as part of routine immunizations. The Alliance is now working to make the HPV vaccine available to more than 30 million of the world’s poorest women and girls by 2020; as part of this effort, and coinciding with World Cancer Day, it has launched demonstration programs in eight developing countries.
A growing body of evidence shows that vaccines’ benefits extend beyond preventing illness and death. They have also been found to aid infants’ cognitive development and children’s educational attainment, thus boosting countries’ economic-growth potential. In the fight against cancer, medical advances can shave precious percentage points off of mortality rates, which implies that improved access to vaccines can have a massive impact, slashing the number of future cases in developing countries for just a few dollars per dose.
People in rich countries are undoubtedly familiar with the maxim that prevention is better than cure. But, given the ready availability of vaccines in developed countries, the focus of prevention efforts has shifted to changing cancer-causing lifestyles.
Meanwhile, people in developing countries lack access to simple and effective tools for preventing several of the most common cancers. Improving access to vaccines is crucial to addressing global inequity and reducing the widening gap of wealth. This requires, first and foremost, dispelling the myth that one cannot “catch” cancer.
Copyright: Project Syndicate, 2013
*The author is CEO of the GAVI Alliance.
by Seth Berkley