By Jennifer Dent | President & CEO, BVGH
Cancer is one of the leading causes of death worldwide, and alarmingly, both cancer incidence and mortality are on the rise in Africa. By 2040, the number of deaths in Africa due to cancer is predicted to double.
In contrast, cancer mortality in the United States has fallen by 27% since 1991, thanks in large part to innovative cancer treatments, early detection, and lower smoking rates. These advances, in turn, were enabled by high-quality research on more effective, safe and targeted cancer therapies; new technologies to detect cancer at its earliest, most treatable stages; and better strategies to help smokers quit and keep youth smoke-free.
The U.S. National Institutes of Health (NIH) and other large agencies distribute sizable sums of funding annually to cancer researchers. For example, the NIH’s National Cancer Institute awarded more than $2.45 billion in research project grants during fiscal year 2018. Unfortunately, the benefits of this research have not yet translated to improved cancer patient outcomes in Africa.
By 2040, the number of deaths in Africa due to cancer is predicted to double.
Our analyses have revealed comparatively limited investment in cancer research at African organizations, which likely contributes to Africa’s substantial cancer disparities.
According to the NIH Fogarty International Center’s World RePORT, an online database of global research investments, between 2015 and 2016 (the latest time period for which complete data are available), the NIH and nine other funding agencies[1] collectively funded 10,974 research organizations in 174 countries. Three countries accounted for nearly half (5,129) of the grantees: United States, United Kingdom, and Canada. Less than 10% of grantees (1,007) were located in Africa. Of those, nearly a quarter (234) were based in the Republic of South Africa, a country that is relatively wealthy compared with other African nations but whose population is less than 5% of the continent’s total.
Of the nearly 11,000 research organizations funded between 2015 and 2016, almost one-third (3,258) received funding for projects with “cancer” in the title, abstract, or keywords. The number of Africans and North Americans who died from cancer in 2018 was roughly the same, but there were more than five times as many grantees (1,448) with a cancer research project in the United States, Canada, and Mexico than in all African countries combined (266). While these data do not account for the amount of research funding nor project size and scope, they do highlight the disparity between cancer’s toll on Africa and the number of African organizations funded to conduct cancer research.
Similarly, BVGH and others have highlighted the lack of cancer research focused on patients of African descent, which may also contribute to poorer outcomes – not just in Africa, but also worldwide. For example, when disaggregating United States cancer mortality statistics by race and ethnicity, death rates are 24% higher for African American men and 14% higher for African American women than their Caucasian American counterparts.
Recent diagnostic and therapeutic advances in oncology have benefited from our improved understanding of cancer genetics and biology. Much of this knowledge comes from basic and clinical research supported by the NIH and other large funders. Yet a disproportionately higher number of Caucasian patients are enrolled in cancer clinical trials compared to individuals of African descent. Shockingly, patients of African descent represented only 4% of participants in cancer clinical trials that led to approval of a drug by the U.S. Food and Drug Administration (FDA) in 2018. In addition, the studies that have been done in African ethnicities have revealed important differences in tumor biology that can limit therapeutic options or affect response to treatment. For example, the rate of triple-negative breast cancer, a particularly aggressive disease requiring innovative genetic testing and targeted therapeutic treatments, is higher in African and African American women than in Caucasian women.
Research on cancer conducted in high-income countries and focused on Caucasian patients will no doubt lead to better care for individuals in low- and middle-income countries and people of diverse backgrounds across the globe. But if we do not study the particular clinical challenges of diagnosing and treating cancer in low-resource settings, nor the efficacy of those interventions in populations of non-European descent, health and survival disparities will persist.
Death rates are 24% higher for African American men and 14% higher for African American women than their Caucasian American counterparts
BVGH launched the African Access Initiative (AAI) in 2017 to complement efforts by African Ministries of Health to address the growing burden of cancer in their countries. AAI’s African Consortium for Cancer Clinical Trials (AC3T) has the ambitious goal of empowering African scientists and institutions to conduct cancer clinical trials in African patients at world-class standards. AC3T not only provides access to lifesaving, FDA-approved medications and diagnostic technologies, but it also enables the generation of high-quality data on their safety and effectiveness in patients of African descent – data that can be used to improve cancer care and outcomes in Africa and beyond.
With our network of 39 AAI hospitals across six African countries, our industry partners Pfizer Inc. and Takeda Pharmaceutical Co., Ltd., and our international cohort of academic experts, BVGH is well positioned to connect talented African investigators to the resources they need to conduct cancer clinical trials. BVGH has begun collecting detailed data on select AAI hospitals to understand and eventually promote their clinical trial capabilities through AC3T.
BVGH’s targeted programs are already building cancer care and research capacity in Africa, such as an upcoming multidisciplinary prostate cancer workshop in Abidjan, Côte d’Ivoire that BVGH is coordinating with the American Society of Clinical Oncology (ASCO) and the Ivorian National Cancer Control Program. The Ivorian organizers of this workshop will use this training as an opportunity to help launch clinical research in Côte d’Ivoire under the Men of African Descent and Carcinoma of the Prostate (MADCaP) Network.
Through AAI, BVGH is empowering more African-driven cancer research to accelerate progress against the disease and improve cancer patient outcomes in Africa.
[1] Bill & Melinda Gates Foundation, Canadian Institutes of Health Research, European Commission, European and Developing Countries Clinical Trials Partnership, Institut Pasteur, Medical Research Council, Swedish International Development Cooperation Agency, Swedish Research Council, and Wellcome Trust.