COMMENTARY

Procuring Anticancer Drugs: Lessons From Uganda

David J. Kerr, CBE, MD, DSc

Disclosures

August 24, 2021

This transcript has been edited for clarity.

I'm David Kerr, professor of cancer medicine at University of Oxford. I'd like to talk today about an important study that's been published in Future Oncology by a pal of mine from the old days, Professor Jackson Orem, and his colleagues from the Uganda Cancer Institute in Kampala.

In a very highly focused way, they have set about improving the procurement of anticancer drugs — those which are on the World Health Organization (WHO) essential medicines list — for their patients. They've done a remarkable job.

We know that expenditures on cancer drugs globally are rising exponentially. In 2013, it was estimated that we were spending around $90 billion a year on anticancer medicine. By 2022, it's estimated that this will have risen globally to around $200 billion a year.

Now, we've talked many times before that, increasingly, the burden of cancer in the future will start to fall in those low- and middle-income countries, which in some aspects are the least well prepared to deal with this advancing burden of cancer, this tsunami of disease, which we'll be facing over the next couple of decades. Access to cancer medicine is one of the elements of any national cancer control plan.

Jackson and his colleagues have put together a really important map as to how other colleagues in low- and middle-income countries might take this approach to procuring cancer medicines.

There were four strands as to how they went about it.

Legally defining cancer medicines. One strand was redefining cancer medicines as highly specialized drugs. This was important in terms of the legalities in Uganda as to how drugs were compared by the central government. This responsibility was given legally to the professionals at the Uganda Cancer Institute on behalf of the whole country.

Streamlining the supply chain. There's a really complex ecosystem in terms of getting drugs from the manufacturers to the clinical front line, with many opportunities for drug costs to be marked up along the way. Therefore, they went directly, as a group, to the manufacturers of these essential cancer medicines. By cutting out a whole series of middlemen, managing their own drug supply, and storing it appropriately, they managed to hugely simplify the drug supply chain and also reduce the possibility of counterfeit drugs.

You have no idea how common that is in low- and middle-income countries — something that we rarely think about in the North and in the West. It's a huge problem in low- and middle-income countries. They went directly to the manufacturers and made a good deal with them.

Collaborating with stakeholders. This is a beautiful example of the government — the Ministry of Health and the Ministry of Finance — working together with citizens to come up with and legalize this plan. That also ties in with the first point about creating a legal structure so that the Uganda Cancer Institute could procure these highly specialized drugs as a carved-out area for them to be able to deliver on their own.

Demonstrating success. Finally, through access initiatives and working with overseas partners, such as the Clinton Foundation, other NGOs, and access programs from the pharma companies, within a couple of years, they were able to demonstrate, remarkably, that their essential cancer drug access went up from around 30% to 85%. That's fantastic. Not only that, the drug access improved with the same budget. They estimated that there had been budgetary savings of around $2 million. It's a remarkable win-win story.

This is a great group. They're highly organized and hugely trusted by government. They are the Uganda National Cancer Institute; therefore, they're upstanding and have great status within their own country. Nevertheless, it is a fantastic story that one would hope we can amplify and repeat elsewhere.

What lessons might we take from this concerted action joined up with the government? Perhaps the idea that each of the sub-Saharan African nations should create a national cancer center with the sorts of legal procurement powers that were granted to my friends and colleagues in Kampala. And also, not only making sure that the drugs can be procured, but that they can be delivered and that there will be socioeconomic benefit to those countries.

It's a great story, and it's a hopeful one. Here is a piece of work that we can use and learn from and see how we can apply it elsewhere to increase access to essential cancer medicines, which are the bread-and-butter drugs that we need to do the best that we can for the communities that we serve. Have a look at it. It's quite an inspiring piece of work.

Thanks for listening. For the time being, Medscapers, ahoy.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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