Most of the world has almost no cancer care

If the FDA and EMA have both approved a cancer drug, a smaller country should be able to approve it in three months using their reports rather than starting over.

A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.

A handful of ageing research reactors make most cancer isotopes. Coordinating their maintenance and funding reserve capacity would prevent the shortages that stop treatments.

Cancer kills more people in poorer countries than HIV, TB and malaria combined, but has no global fund. A pooled fund for diagnosis, essential medicines and radiotherapy would change what ministries can afford to build.

Countries buying radiotherapy machines one at a time pay high prices and get poor service. A single global buyer negotiating for dozens of machines a year could cut prices and demand long-term support.

Copy the model that transformed HIV, TB and malaria care: a pooled international fund that pays for radiotherapy machines, pathology labs and essential cancer medicines where there are none.

Companies could choose to sell a new cancer drug at cost worldwide and instead be paid from a pooled fund according to how much health it actually delivers.

Small European countries have started negotiating cancer drug prices together. A bloc of large middle-income countries would have far more bargaining power.

Hospitals in poorer countries often run out of basic, cheap chemotherapy for weeks. A shared live map of stock levels would let buyers and donors act before a child's treatment is interrupted.

Cheap, essential chemotherapy drugs like cisplatin run out because making them is not profitable enough. A non-profit maker could guarantee supply at a fair price.

Children with cancer, and their families, need symptom relief and support from diagnosis, not only at the end. Every children's cancer unit should have a palliative team, and most in poorer countries have none.

Frequent tiny doses of cheap old chemotherapy pills have shown surprising benefit in some cancers. A single large trial network in India and Africa could find out where this works and where it does not.

Cancer patients have had treatments delayed because basic chemotherapy drugs ran out. Keeping a national stockpile, like for flu antivirals, would prevent this.

Most cancer deaths are in low and middle income countries, where scans and endoscopies are scarce. A cheap methylation blood test tuned to liver, stomach, oesophageal, cervical and breast cancer could fill the gap.

Let validated AI make the first read on routine, high-volume samples like cervical smears and standard breast biopsy stains, so scarce pathologists spend their time on the difficult cases.

Training a specialist doctor takes ten years or more. Mid-level clinicians can be trained in eighteen months to run protocol-based cancer care under supervision, and there are far more of them.

Immunotherapy patents start expiring around 2028. Guaranteeing in advance to buy cheap copies for poorer countries would make sure manufacturers build the capacity.

Design a radiotherapy machine from scratch for hospitals with patchy electricity, heat and few engineers, and publish the design so several companies can build it cheaply.

Dozens of countries have no radiotherapy machine at all. Combine long-term finance with a machine designed to be cheap, robust and maintainable where power and engineers are scarce.

Nasopharyngeal cancer is common in southern China and is caused by a virus. A blood test for viral DNA finds it early, and a large study showed better survival. Scale it up.

The lutetium used in approved prostate and neuroendocrine cancer treatments is made from an enriched metal that comes mostly from Russia. Making it elsewhere would secure supply.

Seven in ten cancer deaths are in poorer countries, yet almost all trials happen in rich ones. Funders would commit a share of money for trials designed and led where the burden is.

Governments could pay a company a large one-off sum for the rights to a highly effective cancer drug, then let anyone make it cheaply for everyone.

Many children and adults in poorer countries stop curable cancer treatment because families cannot afford the bus fare or food while in hospital. Small, reliable payments during treatment prevent this.

When a hospital's real limit is the number of chemotherapy chairs and nurses, guidelines should favour treatments given by mouth or in fewer, shorter visits, if they work about as well.

Millions of community health workers already visit homes for vaccines and maternal care. Training them to recognise cancer warning signs, guide patients through the system and support home pain care would reach people no hospital does.

Mouth cancer is common where tobacco is chewed and is visible to the naked eye. Health workers with a phone camera and AI could find it early in villages.

A trial in India found that adding a very small dose of an immunotherapy drug, about a twentieth of the usual amount, to chemotherapy improved survival in head and neck cancer. If confirmed, this could make immunotherapy affordable for millions.

Thousands of oncologists trained in poorer countries now work abroad. A structured programme could let them join weekly video case conferences for hospitals back home, improving decisions at almost no cost.

The nerves at the top of the nose lead directly into the brain, bypassing the barrier. Nasal delivery of drugs, and even immune cells, has worked in animals.

Many countries have one oncologist for millions of people. Train nurses and general doctors to deliver protocolised cancer care with software checks and remote specialist oversight.

About one in eight cancers is caused by an infection we can vaccinate against, cure or eradicate. A concerted global programme could make those cancers rare within a generation.

In many places, joining a trial can leave the patient or hospital paying for the ordinary care that goes with it. Making all insurers and public systems cover those costs removes a hidden barrier.

Use AI translation plus expert checking so that when a cancer guideline changes, doctors in every major language see the change within a month rather than years.

Africa's new continental medicines agency could assess cancer drugs once for 55 countries. It needs oncology reviewers and a reliance rule to do it.

Wikipedia is the most-read medical reference on Earth. Pay expert editors to keep its cancer pages accurate, current and available in the languages most patients speak.

A drug that improves appetite and lean weight in cancer wasting is approved in Japan but almost nowhere else. Reviewing the existing evidence could widen access quickly.

Companies get longer monopolies for rare and paediatric cancer drugs. That reward should come with a commitment to sell at cost in low-income countries.

Most children with cancer in rich countries are cured; most in poor countries are not, often because cheap drugs are missing. A global platform now ships quality drugs free; scaling it to 50 countries would be one of the highest-value cancer interventions available.

Most people in poorer countries die at home without any professional support. A simple kit of medicines and supplies plus a few hours of training for a family member could make dying far less painful.

Women can collect their own sample for the virus that causes cervical cancer; those who test positive can be treated the same day with a simple heat device. Done nationally, this could eliminate a disease that still kills hundreds of thousands of women a year.

Some new medicines reprogramme immune cells inside the body with an injection, skipping the factory entirely. Test whether that makes CAR-T affordable and available in ordinary hospitals.

Instead of making cell therapy from each patient's own cells in a factory, inject a particle that reprograms immune cells inside the body, made in bulk, so a dose costs thousands rather than hundreds of thousands.

A drug approved in the US may take five years to reach a patient in Poland or never reach Nigeria. A live public tracker would show exactly where and why it is stuck.

Cancer treatment guidance changes constantly and takes years to reach many clinics. Make guidelines live documents that software can read, updated as evidence arrives and adapted to what each country can afford.

Uganda makes liquid morphine from powder in a simple facility and lets trained nurses prescribe it, giving pain relief to patients that no doctor will ever reach. Other countries could copy this within a year.

Cervical cancer cannot be cured by external radiotherapy alone; it needs internal radiation, which many hospitals lack. A cheaper internal-radiation unit using a long-lived source could be placed in every regional centre.

A cheap, old antipsychotic at a low dose is one of the best anti-sickness drugs for chemotherapy. Make sure every cancer unit in the world uses it.

You cannot fix what you cannot count. Every donor-funded cancer programme should fund and require a population-based cancer registry so results can be measured over time.

Giving radiotherapy in five larger doses over one week instead of 15-25 smaller doses is proven safe for breast and prostate cancer and could treat three times as many patients on the same machines.

Companies can license their patents to generic makers for poorer countries through a UN-backed pool, as happened for HIV. Only one cancer drug has been licensed so far; the whole essential list should be.

Vans equipped with ultrasound, biopsy kits, cervical screening and a link to a distant pathologist could bring a cancer diagnosis, and for cervical pre-cancer immediate treatment, to villages far from any hospital.

In places where sophisticated machines break down, a modern version of the older cobalt radiotherapy unit, upgraded with image guidance, could treat more people reliably while infrastructure catches up.

Instead of one overwhelmed national cancer hospital, organise care in tiers: district hospitals diagnose and give simple treatment, regional centres give chemotherapy and surgery, and the hub handles radiotherapy and complex cases.

Most of the world's people who die in cancer pain have no access to morphine, a drug that costs pennies, because of restrictive national rules. Fixing the rules, not inventing new drugs, is the answer.

The engineered virus that delivers the CAR gene costs tens of thousands of dollars per patient and is controlled by a few suppliers. A non-profit supplier with open licences would cut that cost sharply.

Trained nurses following strict written protocols can safely run chemotherapy clinics for common cancers, with an oncologist available by video for decisions and problems.

A phone app that works without internet and guides a general doctor or nurse through diagnosing and treating common cancers with the drugs actually available locally.

Medical physicists, who keep radiotherapy machines accurate and safe, are scarcer than oncologists in many countries. Remote quality checks with local technologists could let one physicist safely oversee several machines.

Companies and charities give or discount cancer drugs in poorer countries, but nobody records whether the patients did well. Make a simple outcome record part of every programme.

Guidelines paid for with public or charitable money would be published under an open licence so any hospital system, app or country can build them in without permission or fees.

A registry-in-a-box would be a free, ready-to-run cancer registry system, working on phones and without constant internet, so any hospital anywhere can start counting and following its cancer patients.

Train and pay people who have been through cancer to guide newly diagnosed patients through the system, especially where oncologists and nurses are scarce.

Palliative care given early alongside cancer treatment improves quality of life and sometimes survival, and most of the world has no access to it or to morphine. Make both universal.

Governments and donors should buy guaranteed working hours from radiotherapy vendors, with remote monitoring and regional spare-parts depots, instead of buying machines that then sit broken.

Most of the world's cancer patients live in countries that host almost no registrational trials. Including sites there, and paying to build them up, would make results apply globally and speed local access.

Countries buying cancer drugs alone pay more and face shortages. Buying together, as they already do for childhood cancer drugs and vaccines, cuts prices and secures supply.

Buy essential cancer drugs for many countries at once and license newer ones to generic makers, as was done for HIV, so prices fall to what those health systems can pay.

Project ECHO is a weekly video class where district doctors and nurses present real cases to a specialist team, learn by doing, and build a network. It worked for hepatitis C and could work for cancer.

The WHO set three simple goals for breast cancer: most cancers found early, diagnosis within 60 days, and most patients finishing treatment. Every country should publish how it is doing on each, every year.

Cheap, essential chemotherapy drugs such as cisplatin keep running short because there is little profit in making them. A publicly-backed non-profit manufacturer would guarantee supply at a fair price.

India has shown CAR-T can be made for a tenth of the US price. Public production in large middle-income countries could make it available to millions who are currently excluded.

Cytisine costs a few dollars per course and works about as well as varenicline, but is unavailable in most countries. Global approval and procurement would make quitting affordable.

The Lancet Commission defined a cheap basic package of drugs, equipment and staff for palliative care. Countries expanding health coverage should include it as a guaranteed benefit.

Half of cancer patients need radiotherapy and most of the world cannot get it. Commit to low-cost machines, automated planning and trained staff so that access is universal by 2040.

Surgeons often cannot see where a tumour ends. Fluorescent dyes and AI-read imaging in the operating theatre can show them, cutting repeat operations. Make this routine everywhere.

When a trusted regulator approves a cancer drug for a rare genetic target, other countries should recognise that approval within months instead of repeating years of review.

Radioactive cancer drugs decay while they travel and get stuck at borders. Regional production and simpler transport rules would get more doses to patients on time.

Rather than sending a handful of trainees to Europe or America, build a few large training centres in Africa and South Asia that train the whole team together, with local case mix and local costs.

Many cancer specialists trained in poor countries emigrate. Combine service bonds, salary supplements, guaranteed working equipment and academic time so that staying is a career, not a sacrifice.

Hospitals without enough physicists could upload scans to a shared planning centre, where AI drafts the treatment plan and remote experts finish and check it within a day.

Where women cannot return for results, test for HPV and treat any precancer the same day with a battery-powered heat probe. This is the fastest route to WHO's cervical elimination target.

One radiotherapy session relieves bone pain as well as ten, according to many trials, yet most patients still get the longer course. Making one session the default would spare patients trips and free machines.

Many countries have one pathologist per million people. Putting a slide scanner in each district lab and sending images to a pooled group of pathologists could give a cancer diagnosis in days instead of months.

Cancer units in poorer countries lose treatment days, spoil drugs and damage machines during power cuts. Solar panels with batteries sized for the cancer unit would remove that failure point.

Surgery cures more cancers than any other treatment, but most district hospitals refer everything to a distant centre. Train and mentor general surgeons to do common cancer operations well, with specialists checking results.

Instead of paying per dose, a country would pay a fixed annual fee and treat every eligible patient with immunotherapy. This has worked for hepatitis C drugs and antibiotics.

One dose of HPV vaccine protects as well as two or three. Halving the doses frees supply to vaccinate far more girls, boys and young adults.

When a cancer drug is added to the WHO essential medicines list, the maker should publicly commit to a low price and reliable supply for poorer countries, or the listing is withheld.

Hepatitis B causes most liver cancer worldwide, and cheap tablets suppress it. Treating everyone infected, not just those with liver damage, would prevent many cancers.

When morphine is unavailable, patients get nothing. Some cheap alternatives, such as methadone or tramadol, may work for cancer pain but have not been properly tested in these settings.

When universities license cancer discoveries to companies, the contract would reward companies that price fairly and sell in poor countries, and penalise those that do not, using the royalty rate as the lever.

Indian trials have shown that tiny daily doses of old oral chemotherapy drugs can help patients with head and neck cancer at a cost of a few dollars a month. These regimens should be proven and adopted worldwide.

In Kerala, trained community volunteers, backed by nurses and doctors, provide most home palliative care to the dying. The model reaches more people at lower cost than any clinic-based service and could be copied.

Cheap copies of key antibody drugs exist but many countries cannot check their quality. A WHO quality stamp plus large pooled orders would make them safe to buy and very cheap.