Global Health and Cancer Care

Transcript

00:00 --> 00:02Welcome to Yale Cancer Answers
00:02 --> 00:04with Doctor Anees Chagpar.
00:04 --> 00:05Yale Cancer Answers features the
00:05 --> 00:07latest information on cancer care
00:07 --> 00:09by welcoming oncologists and
00:09 --> 00:11specialists who are on the forefront
00:11 --> 00:12of the battle to fight cancer.
00:12 --> 00:15This week it's a conversation about
00:15 --> 00:17global oncology with Doctor Saad Omer.
00:17 --> 00:19Doctor Omer is the Harvey and
00:19 --> 00:21Kate Cushing professor of medicine
00:21 --> 00:22and infectious diseases at
00:22 --> 00:24the Yale School of Medicine,
00:24 --> 00:25where Doctor Chagpar is a
00:25 --> 00:27professor of surgical oncology.
00:58 --> 01:00Saad, maybe we can start off by you
01:00 --> 01:02telling us a little bit about
01:02 --> 01:04yourself and what it is you do.
01:04 --> 01:05I'm the director of the Yale
01:05 --> 01:06Institute for Global Health.
01:06 --> 01:08I'm an infectious disease epidemiologist
01:08 --> 01:11who has had the privilege of working
01:11 --> 01:13in multiple countries and have done
01:13 --> 01:15studies in multiple places both in
01:15 --> 01:18the US and outside the US.
01:18 --> 01:23My own work is focused on infectious
01:23 --> 01:26diseases and as you know
01:26 --> 01:29there are several cancers now
01:29 --> 01:32that have an association with
01:32 --> 01:34infectious agents and the
01:34 --> 01:37most prominent one of them is
01:37 --> 01:40the HPV or human Papilloma Virus
01:40 --> 01:43association with cervical cancer.
01:43 --> 01:46So some of my work has focused
01:46 --> 01:47on HPV vaccines,
01:47 --> 01:49but you know I work broadly on
01:49 --> 01:51all sorts of infectious diseases.
01:52 --> 01:54So let's talk a little bit about
01:54 --> 01:56the global implications
01:56 --> 01:59for cancer. Just recently
01:59 --> 02:01we heard in the news that a lot of
02:01 --> 02:04the global work that had been done
02:04 --> 02:07and a lot of the global strides
02:07 --> 02:10that had been made in terms of HIV,
02:10 --> 02:12malaria, and TB took a bit of
02:12 --> 02:14a hit during the pandemic,
02:14 --> 02:18and a number of world leaders are now
02:18 --> 02:20really refocusing their efforts on
02:20 --> 02:23shoring up those efforts once again.
02:23 --> 02:26Can you tell us a little bit
02:26 --> 02:29about the impact of the pandemic?
02:29 --> 02:31on cancer worldwide?
02:32 --> 02:37One of the things that's
02:37 --> 02:41concerning about cancer is how
02:41 --> 02:43patchy our understanding is with
02:43 --> 02:45the true nature of disruptions
02:45 --> 02:48that happened during the pandemic.
02:48 --> 02:50And it wasn't just due to shelter
02:50 --> 02:52in place or shutdown orders.
02:52 --> 02:54They were very short lived
02:54 --> 02:55in most of the world.
02:55 --> 02:59There has been an ongoing
02:59 --> 03:01disruption in screening
03:01 --> 03:06and treatment of cancer,
03:06 --> 03:08but the data are a bit patchy
03:08 --> 03:11and then that's one of those things
03:11 --> 03:13where whenever you
03:13 --> 03:15are able to measure especially
03:15 --> 03:18in low resource settings you find
03:18 --> 03:20that there has been a disruption
03:20 --> 03:22in essential services disruption
03:22 --> 03:24and screening which was already
03:24 --> 03:28not stellar in a lot of
03:28 --> 03:29low resource settings and we
03:29 --> 03:32do not know the full scale of
03:32 --> 03:34the impact and so you
03:34 --> 03:37know that's one side in terms of
03:37 --> 03:38screening and treatment,
03:38 --> 03:41but on the prevention side
03:41 --> 03:45in terms of the vaccination side,
03:45 --> 03:48HPV vaccine has taken a huge hit in
03:48 --> 03:50terms of the delay and introduction
03:50 --> 03:53in new countries and also decline
03:53 --> 03:56in coverage of the vaccine and
03:56 --> 03:58that is going to have
03:58 --> 04:00long term consequences.
04:01 --> 04:04Saad, when we think about the
04:04 --> 04:06HPV vaccine one of the things is that
04:06 --> 04:10even in the US we know that we've
04:10 --> 04:13seen cervical cancer rates decline as
04:13 --> 04:15there has been more of an uptake in
04:15 --> 04:20vaccine here, but it's still not 100%.
04:20 --> 04:23And one can only imagine that
04:23 --> 04:25in low to middle income countries,
04:25 --> 04:28the uptake rate even at baseline,
04:28 --> 04:30forgetting about the impact of
04:30 --> 04:31the pandemic and everything else,
04:31 --> 04:34may have been lower than it has
04:34 --> 04:35been in the US.
04:35 --> 04:38Can you talk a little bit about that
04:38 --> 04:40and about what are the etiologic
04:40 --> 04:41factors that play into that?
04:41 --> 04:44I mean, is cost an issue, cultural issues?
04:44 --> 04:45Access, what?
04:45 --> 04:50What are the issues and what have we
04:50 --> 04:53seen in terms of HPV vaccine worldwide?
04:54 --> 04:59So the situation with the HPV
04:59 --> 05:02vaccine introduction and uptake and
05:02 --> 05:06now what we are calling backsliding,
05:06 --> 05:08is a little bit nuanced.
05:08 --> 05:11So initially you know as usual the
05:11 --> 05:12vaccine was initially introduced
05:12 --> 05:14in high income countries and
05:14 --> 05:17the US was one of the earliest
05:17 --> 05:20countries where it was introduced,
05:20 --> 05:24very quickly entities like GAVI,
05:24 --> 05:27the Vaccine Alliance, and full disclosure,
05:27 --> 05:30I'm on their board.
05:30 --> 05:33Which is an entity that
05:33 --> 05:35brings together governments
05:35 --> 05:38and government funding as well
05:38 --> 05:40as private donations,
05:40 --> 05:43large private donations from entities like
05:43 --> 05:45the Gates Foundation to provide access
05:45 --> 05:48to life saving vaccines around the world.
05:48 --> 05:51So Gavi got involved and prioritized
05:51 --> 05:53as part of their
05:53 --> 05:56current strategy that was supposed to
05:56 --> 05:58be implemented a couple of years ago,
06:00 --> 06:03right before the pandemic to
06:03 --> 06:06increase access to the vaccine,
06:06 --> 06:07a couple of things happened.
06:07 --> 06:10There was a shortage in supply and
06:10 --> 06:13production and so that impacted
06:13 --> 06:15the speed of introduction.
06:15 --> 06:21But also the early pilots in countries
06:21 --> 06:24like India suffered from misinformation
06:24 --> 06:26and disinformation and misunderstanding
06:26 --> 06:30and some kind of intentional
06:30 --> 06:32pushback from some circles.
06:32 --> 06:37And so with that legacy
06:38 --> 06:41we went into as the global community
06:41 --> 06:43into the pandemic where these problems
06:43 --> 06:46were compounded by the fact that
06:46 --> 06:48you can't introduce new vaccines
06:48 --> 06:50in more and more countries during
06:50 --> 06:53the pandemic which are not COVID-19
06:53 --> 06:55because everyone was focusing on
06:55 --> 06:57COVID and just barely maintaining
06:57 --> 06:59routine immunization of existing vaccines,
06:59 --> 07:00but also
07:00 --> 07:02there was a backsliding,
07:02 --> 07:06there was a reduction in
07:06 --> 07:07this vaccination and
07:07 --> 07:09then so for HPV vaccine,
07:09 --> 07:12the vaccination rates declined
07:12 --> 07:15even in the few countries where
07:15 --> 07:17it was available, by 15%
07:29 --> 07:31where these vaccines were already being used.
07:31 --> 07:33But what we need to remember
07:33 --> 07:34that 2/3 of girls,
07:34 --> 07:38if you are just focusing on girls and women,
07:38 --> 07:41live in countries without HPV vaccine.
07:41 --> 07:43And the pandemic has hurt this
07:43 --> 07:45new introduction in these countries
07:45 --> 07:47of HPV vaccine.
07:47 --> 07:49And so therefore the coverage of
07:49 --> 07:51this cancer preventing vaccine
07:51 --> 07:53is barely 12% around the world.
07:53 --> 07:55And so this is concerning.
07:56 --> 07:58One of the things
07:58 --> 07:59that you mentioned is
07:59 --> 08:02really a touch point and that
08:02 --> 08:05is that when the HPV vaccine
08:05 --> 08:06was initially introduced,
08:06 --> 08:08particularly in India,
08:08 --> 08:11there was a lot of misinformation
08:11 --> 08:13around that and that was due to
08:13 --> 08:15a number of things,
08:15 --> 08:18but you know a lot of these
08:20 --> 08:23are scary stories and
08:23 --> 08:25cultural issues and disinformation
08:25 --> 08:27kind of made it out into the
08:27 --> 08:30media and it was thought that
08:30 --> 08:33really played a role in terms of
08:33 --> 08:36reducing the uptake of that vaccine.
08:36 --> 08:39I wonder now that we've seen kind
08:39 --> 08:41of the same misinformation with
08:41 --> 08:45COVID and I'm hoping that a lot of
08:45 --> 08:48that has been dispelled whether you
08:48 --> 08:51anticipate that now HPV vaccine
08:51 --> 08:54might be able to gain hold again,
08:54 --> 08:56after we've kind of dispelled a
08:56 --> 08:58lot of the myths around vaccines or
08:58 --> 09:00whether you think the HPV vaccine
09:00 --> 09:03holds a special place because part
09:03 --> 09:05of the misinformation had to do with
09:05 --> 09:07how the clinical trials were run and
09:08 --> 09:11part of the misinformation had to do with
09:11 --> 09:13sexual practices and so on.
09:13 --> 09:15So what do you think is going to
09:15 --> 09:17be the state of affairs for the
09:17 --> 09:19vaccination rates going forward?
09:19 --> 09:21Do you think that our
09:21 --> 09:24experience now with COVID vaccine
09:24 --> 09:27and seeing how effective it was
09:27 --> 09:30will help HPV vaccines or do you
09:30 --> 09:32think that HPV is still going to
09:32 --> 09:35to be hit pretty hard in terms
09:35 --> 09:37of getting public uptake?
09:37 --> 09:42There was a bit of a naivety on
09:42 --> 09:44the part of global public health community
09:44 --> 09:48when this vaccine was initially introduced.
09:48 --> 09:50So it was introduced in pilots
09:50 --> 09:52starting in India and other places.
09:52 --> 09:55And there was the assumption
09:55 --> 09:58that if you just brought the vaccine closer
09:58 --> 10:01to people than they will vaccinate,
10:01 --> 10:04it wasn't proactively paired with
10:04 --> 10:07an educational and informational
10:07 --> 10:10component of that introduction program
10:10 --> 10:13of the public health authorities and
10:13 --> 10:16entities that were introducing this vaccine
10:16 --> 10:19and many parts of the world did not pair
10:19 --> 10:22that with a behavioral response to this,
10:22 --> 10:24and they did not anticipate proactively
10:24 --> 10:26that there will be misunderstandings
10:26 --> 10:29and misinformation and disinformation.
10:29 --> 10:31And so first of all,
10:31 --> 10:32there is a legacy of that.
10:32 --> 10:33But going forward,
10:33 --> 10:37I think you would be incredibly naive again,
10:37 --> 10:40if we don't move forward with a sort of
10:40 --> 10:43comprehensive behavioral response.
10:43 --> 10:47If we do that and we do that with
10:47 --> 10:50respect to communities that have
10:50 --> 10:55questions and answer them and make an
10:55 --> 10:57effort to make sure that people are
10:57 --> 10:59empowered with information but also
10:59 --> 11:01proactively use behavioral science to
11:01 --> 11:04make sure that the vaccines are promoted
11:04 --> 11:06appropriately and so and so forth,
11:06 --> 11:09I think we can make a dent in
11:09 --> 11:11preventing this disease,
11:11 --> 11:15this horrible disease, through vaccination,
11:15 --> 11:17but it's not going to happen
11:17 --> 11:18on cruise control.
11:18 --> 11:20It will require efforts from various
11:20 --> 11:23partners and it will require thoughtfulness
11:23 --> 11:25and it will require, frankly,
11:25 --> 11:32activism from groups that are impacted by
11:32 --> 11:35HPV and most importantly,
11:35 --> 11:35cervical cancer.
11:35 --> 11:36And so,
11:36 --> 11:39so that kind of an approach
11:39 --> 11:42where you are not just deploying it
11:42 --> 11:44from a technical side but also you
11:44 --> 11:46have a community engagement component,
11:46 --> 11:48you have a behavioral science
11:48 --> 11:49component to it,
11:49 --> 11:52but also activism from communities
11:52 --> 11:56who should be an interest
11:56 --> 11:59group who want to prevent cancer.
11:59 --> 12:02And so I think it will take an all hands
12:04 --> 12:06on deck situation as we expand
12:06 --> 12:08vaccination against HPV.
12:12 --> 12:15And that especially will play where
12:15 --> 12:19the HPV vaccine is already available.
12:19 --> 12:20What about the communities
12:20 --> 12:21where it's not available?
12:21 --> 12:23Why isn't it available?
12:23 --> 12:26Why is it that 2/3 of women are
12:26 --> 12:28living in countries where the
12:28 --> 12:30HPV vaccine is not available?
12:30 --> 12:32Is cost an issue?
12:32 --> 12:34Is Gavi not providing it?
12:34 --> 12:37Tell us more about what we
12:37 --> 12:39can do to expand the access
12:39 --> 12:41to this vaccine worldwide,
12:41 --> 12:43because it seems that it's
12:43 --> 12:45incredibly effective against a
12:45 --> 12:48malignancy that nobody wants to get.
12:48 --> 12:50We should be able to
12:50 --> 12:52get the world's people,
12:52 --> 12:55not just women, but boys and girls
12:55 --> 12:58vaccinated.
12:58 --> 12:59Yeah, that's
12:59 --> 13:00a really good question.
13:00 --> 13:05So it was an issue, cost was an issue.
13:05 --> 13:07But not anymore.
13:07 --> 13:10So GAVI has decided and had decided
13:10 --> 13:12before the pandemic to introduce
13:12 --> 13:14this vaccine and help countries
13:14 --> 13:16introduce and no external entity
13:16 --> 13:18can introduce it on their own.
13:18 --> 13:22It's a country level decision and it's the
13:22 --> 13:24communities that have to want it to do this.
13:24 --> 13:29But Gavi came in and said that it will be
13:29 --> 13:34a priority for introduction in countries,
13:34 --> 13:37but around that time there was a shortage
13:37 --> 13:41of this vaccine globally that has since been eased.
13:42 --> 13:45Now the ball is in the court of those who
13:45 --> 13:47are responsible for implementing rather
13:47 --> 13:50than those who are responsible for
13:50 --> 13:52supplying and providing resources for it.
13:53 --> 13:55Yeah, it sounds like we've
13:55 --> 13:57heard the story of
13:57 --> 13:59first there was a shortage and then
13:59 --> 14:01it's getting it into the communities.
14:01 --> 14:03It sounds like this is a repeat
14:03 --> 14:05of something that we've seen
14:05 --> 14:07with the COVID vaccine as well.
14:07 --> 14:09We're going to pick up this
14:09 --> 14:10story learning more about global
14:10 --> 14:12oncology right after we take a
14:12 --> 14:14short break for a medical minute.
14:14 --> 14:15Please stay tuned to learn more
14:15 --> 14:17with my guest, Doctor Saad Omer.
14:18 --> 14:20Funding for Yale Cancer Answers
14:20 --> 14:22comes from Smilow Cancer Hospital,
14:22 --> 14:24where their liver cancer program
14:24 --> 14:26brings together a dedicated group
14:26 --> 14:28of specialists whose focus is
14:28 --> 14:30determining the best personalized
14:30 --> 14:31treatment plan for each patient.
14:31 --> 14:34Learn more at smilowcancerhospital.org.
14:37 --> 14:38Breast cancer is one of the
14:38 --> 14:40most common cancers in women.
14:40 --> 14:41In Connecticut alone,
14:41 --> 14:43approximately 3500 women will be
14:43 --> 14:46diagnosed with breast cancer this year,
14:46 --> 14:48but there is hope thanks to earlier
14:48 --> 14:49detection, noninvasive treatments,
14:49 --> 14:52and the development of novel therapies
14:52 --> 14:53to fight breast cancer.
14:53 --> 14:55Women should schedule a baseline
14:55 --> 14:57mammogram beginning at age 40 or
14:57 --> 14:59earlier if they have risk factors
14:59 --> 15:01associated with the disease.
15:01 --> 15:03With screening, early detection,
15:03 --> 15:05and a healthy lifestyle,
15:05 --> 15:07breast cancer can be defeated.
15:07 --> 15:09Clinical trials are currently
15:09 --> 15:11underway at federally designated
15:11 --> 15:12Comprehensive cancer centers such
15:12 --> 15:15as Yale Cancer Center and Smilow
15:15 --> 15:17Cancer Hospital to make innovative
15:17 --> 15:19new treatments available to patients.
15:19 --> 15:20Digital breast tomosynthesis,
15:20 --> 15:22or 3D mammography,
15:22 --> 15:24is also transforming breast
15:24 --> 15:26cancer screening by significantly
15:26 --> 15:28reducing unnecessary procedures
15:28 --> 15:30while picking up more cancers.
15:30 --> 15:33More information is available
15:33 --> 15:34at yalecancercenter.org.
15:34 --> 15:36You're listening to Connecticut public radio.
15:37 --> 15:39Welcome back to Yale Cancer Answers.
15:39 --> 15:41This is doctor Anees Chagpar
15:41 --> 15:43and I'm joined tonight by my guest,
15:43 --> 15:44Doctor Saad Omer.
15:44 --> 15:46We're talking about his work
15:46 --> 15:47in global health and oncology.
15:47 --> 15:49And right before the break,
15:49 --> 15:52we were talking about the HPV vaccine,
15:52 --> 15:54which is incredibly effective not
15:54 --> 15:57only in preventing cervical cancer,
15:57 --> 15:59but a whole host of other cancers,
15:59 --> 16:01anal cancer, head neck cancer.
16:01 --> 16:05And the issues that that vaccine has
16:05 --> 16:09faced in terms of global uptake and how
16:09 --> 16:13so many women and men quite frankly,
16:13 --> 16:16who get these types of cancers
16:16 --> 16:18reside in countries where this
16:18 --> 16:20vaccine is currently not available.
16:23 --> 16:26Another viral etiologic agent
16:26 --> 16:32to which we have a vaccine that also is
16:32 --> 16:38related to cancers is hepatitis and HBV.
16:38 --> 16:39Tell us a little bit more about that,
16:39 --> 16:42what is the vaccination status
16:42 --> 16:45worldwide with hepatitis B vaccines
16:45 --> 16:47and is that making an impact?
16:48 --> 16:51Yeah, it is making an impact.
16:51 --> 16:55We have had observational studies that have
16:55 --> 16:59shown the impact of hepatitis B vaccine.
16:59 --> 17:04Several countries have introduced this
17:06 --> 17:09vaccine in their routine immunization
17:09 --> 17:12schedules often and that's really
17:12 --> 17:15helpful often as a multivalent vaccine,
17:15 --> 17:16often as a combination vaccine.
17:16 --> 17:19So it's easier to deliver these vaccines
17:19 --> 17:22the fewer shots you
17:22 --> 17:25have to deliver the less cumbersome it
17:25 --> 17:27is in terms of what we call cold chain,
17:27 --> 17:29meaning keeping the vaccines
17:29 --> 17:30at the right temperature,
17:30 --> 17:32delivery access and all of that stuff.
17:32 --> 17:34So with that inclusion and
17:34 --> 17:36with that kind of a focus
17:36 --> 17:42in several countries we have had an impact
17:42 --> 17:47on getting this vaccine into kids arms,
17:47 --> 17:50at a very early stage.
17:50 --> 17:51However, there are a few
17:51 --> 17:53things in several countries
17:53 --> 17:57it's a relatively recent development in
17:57 --> 18:01terms of getting high immunization rates.
18:01 --> 18:03But early indications from early adopters
18:03 --> 18:05are countries where there's vaccine
18:05 --> 18:08was introduced a while ago,
18:08 --> 18:10we have seen an impact on
18:10 --> 18:12cancer incidence, etc.
18:12 --> 18:14And so that's encouraging,
18:14 --> 18:15not surprising.
18:15 --> 18:16But you still measure,
18:16 --> 18:19you still sort of assess the impact.
18:19 --> 18:22So because it takes time from infection
18:22 --> 18:25to cancer for these kinds of pathways,
18:25 --> 18:27it it takes time to show the impact,
18:27 --> 18:31but there's still a big chunk
18:31 --> 18:33who are unvaccinated,
18:33 --> 18:36so we will unfortunately see for a few years,
18:37 --> 18:38that cohort go through the
18:38 --> 18:40system and that is unfortunate.
18:40 --> 18:41Obviously
18:42 --> 18:45if hepatitis B vaccination is successful,
18:45 --> 18:47one wonders about the
18:47 --> 18:50concept of pairing it with HPV,
18:50 --> 18:52which has been to my understanding,
18:52 --> 18:54less successful in terms of getting uptake.
18:54 --> 18:56What do you think about that concept
18:56 --> 18:58of just saying, you know what,
18:58 --> 19:00this is a package of vaccinations
19:00 --> 19:02that your kids get at schools?
19:02 --> 19:03Or when they reach a certain
19:03 --> 19:05certain age and this is,
19:05 --> 19:06you know, a community effort.
19:09 --> 19:11Yeah, I think that's a good idea.
19:11 --> 19:14We already packaged, it's hep B
19:14 --> 19:16vaccine with childhood vaccines
19:16 --> 19:19and we vaccinate earlier for HEB,
19:19 --> 19:23whereas for hepatitis, for HPV,
19:23 --> 19:28human papilloma virus vaccine, we vaccinate.
19:31 --> 19:34These people are pre teens
19:34 --> 19:37at that age before
19:37 --> 19:39puberty in certain countries,
19:39 --> 19:42a lot of countries during teen years.
19:43 --> 19:46But most importantly
19:46 --> 19:48you could have catch up campaigns that
19:48 --> 19:51are combined for those two vaccines.
19:51 --> 19:53But I think the current strategy
19:53 --> 19:55of vaccinating kids earlier in
19:55 --> 19:57life for habits so that they are
19:57 --> 20:01protected from the whole scope
20:01 --> 20:03of this illness because
20:03 --> 20:04the earlier it happens,
20:04 --> 20:07earlier hepatitis B infection happens,
20:07 --> 20:09the more likely it is for people
20:09 --> 20:11to develop cancer later in life.
20:12 --> 20:13A little bit of a hybrid strategy
20:13 --> 20:14would be helpful,
20:14 --> 20:16but pairing it with other routine vaccines,
20:16 --> 20:19what it does for HEP B is makes
20:19 --> 20:21it routine. For HPV,
20:21 --> 20:24I think as the adolescent
20:24 --> 20:26vaccine platform picks up,
20:26 --> 20:29we will have to and we should
20:29 --> 20:31pair it with other vaccines.
20:31 --> 20:32With meningitis vaccine,
20:32 --> 20:34which is done in the US and with
20:34 --> 20:36some success that if you pair
20:36 --> 20:37it with other vaccines.
20:37 --> 20:39Unfortunately in other countries,
20:39 --> 20:40in many countries,
20:40 --> 20:42especially in low and middle
20:42 --> 20:44income countries where by the way
20:44 --> 20:46the biggest burden of cancer is
20:46 --> 20:49that there are no vaccines that
20:49 --> 20:52are given during teenage years.
20:52 --> 20:55So as that portfolio expands,
20:55 --> 20:57I think it will be helpful to pair
20:57 --> 20:59the HPV vaccine with that as well.
20:59 --> 21:02And it brings
21:02 --> 21:03up a good point,
21:03 --> 21:06which is that the largest burden of
21:06 --> 21:09of cancer these days is occurring
21:09 --> 21:12in low to middle income countries.
21:12 --> 21:15And when we look at future forecasts
21:15 --> 21:18it's thought that that's where the most
21:18 --> 21:22increase in the burden of cancer will be.
21:22 --> 21:24And there are some
21:24 --> 21:25statistics that say
21:25 --> 21:28in terms of mortality
21:28 --> 21:31cancer claims more lives than
21:31 --> 21:38HIV, TB and other issues.
21:38 --> 21:42Sorry. And and other issues,
21:42 --> 21:44infectious issues in low to
21:44 --> 21:47middle income countries combined.
21:47 --> 21:48And so you know,
21:48 --> 21:50one wonders as we put more resources
21:50 --> 21:52into the infectious elements in
21:52 --> 21:55these low to middle income countries,
21:55 --> 21:58what do you think should be
21:58 --> 22:00the case for cancer?
22:00 --> 22:04How do we increase the awareness of NGO's,
22:04 --> 22:05of governments,
22:05 --> 22:08of others about the growing cancer burden
22:08 --> 22:10in low to middle income countries?
22:10 --> 22:13So that really rises to
22:13 --> 22:16the same level as HIV and TB.
22:17 --> 22:19Yeah, I think as someone who primarily
22:19 --> 22:21works on infectious diseases
22:21 --> 22:23including overlaps with
22:23 --> 22:25infectious causes for cancer,
22:25 --> 22:29I am a big believer of focus on things
22:29 --> 22:31like cancer and cardiovascular diseases
22:31 --> 22:36in terms of our global investments in
22:36 --> 22:40global public health and and treatment.
22:40 --> 22:43I think the world can walk and chew gum.
22:43 --> 22:45It doesn't have to
22:45 --> 22:47be an either or situation.
22:49 --> 22:54It doesn't have to be a situation where
22:54 --> 22:58you either have to
22:58 --> 23:00prevent mortality through malaria,
23:00 --> 23:01which is horrible for a lot of
23:01 --> 23:03communities and in the world,
23:03 --> 23:06or HIV or tuberculosis, etc,
23:06 --> 23:08and sort of ignore cancer
23:08 --> 23:09and cardiovascular disease.
23:09 --> 23:11I think we can and we must
23:11 --> 23:12and we should do that.
23:12 --> 23:16And I believe entities such
23:16 --> 23:18as the Global Fund for TB,
23:18 --> 23:22malaria and HIV that provides resources
23:22 --> 23:25to low income countries through funding
23:25 --> 23:26from the US government,
23:26 --> 23:28other developed and developing
23:28 --> 23:29country governments,
23:29 --> 23:32they pool their resources and provide
23:32 --> 23:33treatment for these diseases.
23:33 --> 23:37And the GAVI, the Global Vaccine Alliance,
23:37 --> 23:39which focuses on vaccines,
23:39 --> 23:43a similar model are templates
23:43 --> 23:46for a global cancer moon shot,
23:46 --> 23:48both in terms of not just technology,
23:48 --> 23:50but in terms of actually getting
23:50 --> 23:52treatments and screening and
23:52 --> 23:55diagnostics to low and middle income
23:55 --> 23:57countries.
23:57 --> 24:01A majority of the deaths due to the
24:01 --> 24:0310 million cancer deaths were in
24:03 --> 24:05low and middle income countries in
24:05 --> 24:072020 and the trend has remained.
24:07 --> 24:09And in fact there will be a higher
24:09 --> 24:11proportion in low and middle income
24:11 --> 24:13countries because the population
24:13 --> 24:15there is increasing and there was
24:15 --> 24:17a bigger disruption in prevention
24:17 --> 24:18and treatment services.
24:18 --> 24:21And so I think there should be and
24:21 --> 24:24there has to be a call for action
24:24 --> 24:26to say that, you know, communities
24:26 --> 24:30impacted by mortality due to
24:30 --> 24:31preventable,
24:31 --> 24:33increasingly preventable mortality
24:33 --> 24:35due to cancer.
24:35 --> 24:38And so I think we need to have that kind
24:38 --> 24:41of an approach that we can and must end.
24:42 --> 24:44We must address all of these
24:44 --> 24:46issues that are major causes of
24:46 --> 24:48death and disease.
24:49 --> 24:51Yeah. One of the issues that I think is
24:51 --> 24:54really difficult when it comes to
24:54 --> 24:57cancer as opposed to HIV or malaria
24:57 --> 25:00or TB is is the fact that
25:00 --> 25:02cancer is so complex, right.
25:02 --> 25:06And in terms of screening,
25:06 --> 25:08we have good screening for some things,
25:08 --> 25:10not so good screening for other things,
25:10 --> 25:13but even if you were to screen and
25:13 --> 25:16then you know the treatments algorithms
25:16 --> 25:18do require you know, surgery
25:18 --> 25:22and radiation and chemotherapy and
25:22 --> 25:25immunotherapy and various biologics and
25:25 --> 25:28all of the diagnostics that go with it
25:28 --> 25:31and it's not as easy.
25:31 --> 25:34And that requires a lot of
25:34 --> 25:38infrastructure and a lot of resources.
25:38 --> 25:41So where do you start?
25:41 --> 25:43Because this is a very complex
25:43 --> 25:47onion to peel with so many layers of
25:47 --> 25:50issues from poverty to education to,
25:50 --> 25:52you know, other factors,
25:52 --> 25:55that makes it very difficult for
25:55 --> 25:58people really to make an impact
25:58 --> 25:59in terms of cancer care globally.
26:01 --> 26:03Absolutely correct. But global health
26:03 --> 26:08is the art of the possible is to look
26:08 --> 26:12at a problem and say that this is
26:12 --> 26:16unacceptable and to have that
26:16 --> 26:18somewhat Pollyannaish way of
26:18 --> 26:21thinking that all lives are created equal,
26:21 --> 26:24that inequity in access to care and
26:24 --> 26:27treatment and screening is not acceptable.
26:27 --> 26:29And that view is not Pollyannaish.
26:29 --> 26:30It's a way of looking at
26:30 --> 26:33the world. And saying that, you know,
26:33 --> 26:35there are certain things
26:35 --> 26:37not everyone has to have the latest
26:37 --> 26:39Tesla or the latest iPhone,
26:39 --> 26:42but health is a basic human right and this
26:42 --> 26:45cannot continue to happen on our watch,
26:45 --> 26:46at least without an effort.
26:46 --> 26:50And so when we start with that position,
26:50 --> 26:54we look for examples of similar
26:54 --> 26:56seemingly unsurmountable problems and
26:56 --> 26:59one of the seemingly unsurmountable
26:59 --> 27:02problem is and was HIV.
27:02 --> 27:05I remember starting work in the late 90s
27:05 --> 27:09and HIV in early 2000s and going
27:09 --> 27:12to countries like Uganda and Ethiopia
27:12 --> 27:15and parts of India as well.
27:15 --> 27:19And seeing that especially in
27:19 --> 27:22Uganda and Ethiopia that treatment
27:22 --> 27:25was nowhere to be found.
27:25 --> 27:28By the mid 90s some very good
27:28 --> 27:29treatment options were available in
27:29 --> 27:32the US and high income countries.
27:32 --> 27:34And even when we were doing studies
27:34 --> 27:37for a lot of these patients,
27:37 --> 27:39we were able to provide some treatment
27:39 --> 27:43to them in the context of studies with
27:43 --> 27:46the hope and the aim to bring those
27:46 --> 27:46treatments
27:46 --> 27:49through collective action to the
27:49 --> 27:52communities we were working with,
27:52 --> 27:54to the people we were working
27:54 --> 27:57with and now
27:57 --> 28:00started a recent phenomenon starting in
28:02 --> 28:032005, 2004, 2005.
28:03 --> 28:07The world has made major progress not
28:07 --> 28:11only in providing treatment but also
28:11 --> 28:14managing a complex disease like HIV
28:14 --> 28:18and so therefore I think
28:18 --> 28:20this is a model that can be a
28:20 --> 28:22template for cancer prevention,
28:22 --> 28:24screening, treatment, control, etc.
28:24 --> 28:26Doctor Saad Omer is the Harvey
28:26 --> 28:28and Kate Cushing professor of
28:28 --> 28:30medicine in infectious diseases
28:30 --> 28:32and professor of Epidemiology of
28:32 --> 28:34microbial diseases at the Yale
28:34 --> 28:36School of Medicine and director of
28:36 --> 28:38the Yale Institute for Global Health.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu,
28:42 --> 28:44and past editions of the program
28:44 --> 28:46are available in audio and written
28:46 --> 28:48form at Yale Cancer Center.
28:48 --> 28:50Dot org we hope you'll join us next week
28:50 --> 28:52to learn more about the fight against
28:52 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

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October 16, 2022

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