Back in 2009, when we at the Union for International Cancer Control (UICC) joined the International Diabetes Federation and the World Heart Federation in forming the NCD Alliance, the motivation for us was the fact that the 2005 cancer resolution had disappeared from the global discourse. “What - there is already a cancer resolution?” I hear you ask.
Yes, WHA58.22 Cancer prevention and control said all the right things and was approved at the World Health Assembly in 2005. UICC shaped the World Cancer Declaration around the building blocks of this document, but attention faded rapidly. In fact, WHA58.22 only gets a cursory mention in the World Health Organization’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2020 (GAP), which puts forward the target of a 25% reduction in non-communicable disease (NCD) mortality by 2025.
So needless to say, UICC’s spirits have been buoyed by the adoption of an updated cancer resolution at the recent World Health Assembly. Furthermore, we are confident, and working hard to ensure that it will not be another ‘paper tiger’, disappeared from the global discourse. Rather, it will grow teeth through national action for impact in the lead up to 2025 and beyond.
Firstly, incidence and mortality projections from the International Agency for Research on Cancer (IARC) are no longer theoretical. Total cancer deaths have grown from 8.2 million in 2012 to 8.8 million in 2015, with a rise in incidence from 14.1 million to 15.2 million in the same short time span. Already 70% of these cancer deaths are occurring in low- and middle-income countries, and the number of new cases is expected to rise by about 70% over the next two decades. All governments are therefore aware they have a cancer problem but are struggling to choose the right path toward sustainable impact against the mix of over one hundred disease types and sub-types that we call ‘cancer’.
Secondly, Member States have been calling for global action alongside UICC. Health systems strengthening was seen as key for NCDs in the 2011 United Nations Political Declaration, but we have not seen this get full attention in either the GAP or the Global Monitoring Framework. In particular, the economic impact of inaction was very much in the minds of countries representing all regions of the globe, setting out the path to a resolution in May 2017 (Malaysia, Zambia, Kuwait, Jordan, Honduras and Spain).
Our side event in 2016 focused on the health systems response for cancer, recognizing that prevention policy would only have impact if populations could first see that cancer can be treated and cared for. At the end of this session, Member States called for the cancer resolution and UICC followed with a call to action at our 2016 World Cancer Leaders’ Summit in Paris in November.
It was with the support of these Member States that the resolution was formally added as an agenda item at the WHO Executive Board Meeting in January 2017, following a WHO progress report. The discussion of the resolution in January was a major milestone.
Twenty-five Member States made supporting statements and emphasized how a resolution would help drive their own national plans and 12 NGOs in official relations made statements.
Under the excellent chairmanship provided by Malta and the leadership taken by Canada to take forward to drafting activities, we ended the January Executive Board with a largely finalized text, the challenging discussion of how to address the rising cost of cancer medicines being one area where there was still need for debate.
Taking discussions back to Geneva, the missions of the Netherlands, Colombia, Jordan, Luxembourg, Morocco, Pakistan and Zambia, among others, were instrumental in navigating dialogues and drafting to ensure timely consensus and approval in May. We applaud incorporation of text on populations that need special attention, such as children and adolescents, text on evidence-based cancer management, a focus on multidisciplinary collaboration and training at all levels of healthcare as well as the emphasis on scale up highlighting quality of care, cost-effective treatments, with an update to the Appendix 3 of the GAP, and equity to leave no one behind.
Thirdly, and finally, we have seen the collective effort behind the successful adoption of the cancer resolution at this year’s World Health Assembly. WHO, Member States and civil society leadership was central to its quick adoption. UICC’s 1,000-strong and growing membership organisations are ready partners to governments. We made a collective commitment at the 2016 World Cancer Leaders’ Summit so this paper tiger has already drawn its claws, ready for action.
Now, it is time to drive national policies and implementation to reduce cancer incidence and drive the levers for improved patient outcomes in terms of equity of access to and quality of early detection and diagnosis, optimal treatment and care for impact on 2025 and 2030 targets.