Could Rwanda become Africa's healthcare leader?

More Africans are now dying from cancer than from malaria. Like most other nations in the world, many African countries are contending with rising rates of non-communicable diseases (NCDs). The World Health Organization reports that NCDs are responsible for 71% of deaths globally, rising in number as infectious disease deaths fall, people live longer and adopt poor lifestyle habits. Among NCDs, cancer is the second leading killer globally, with 70% of cancer deaths occurring in low and middle income countries. Across these countries, including many in Africa, services to diagnose and treat cancer patients are limited. Modern medical approaches may rapidly change this situation.

Precision medicine, driven by our understanding of a person’s genetic and biological makeup, presents an opportunity to empower clinicians and policy-makers to deliver enhanced, personalized care to cancer patients in Africa. In emerging economies, laying the foundation for a precision-medicine-ready healthcare system presents an opportunity to revise treatment approaches, inform resource allocation, implement innovative policies and skip over legacy approaches and equipment, thus leapfrogging some healthcare approaches of more developed economies.

Why Precision Medicine for Cancer?

Precision medicine’s impact fighting disease may be most noticeable in cancer diagnosis and treatment, where doctors are moving to more individualized treatment approaches by looking at the genetic make-up of patients and their tumors, and matching people to treatment options that may include targeted therapies, immunotherapies or gene therapies. Developing a precision-medicine-ready system using cancer as a starting point can inform health policies, data systems, laboratory networks, and diagnostic capacity growth while stemming rising mortality rates. Furthermore, these developments will also support diagnosing and treating other diseases.

One might argue that on the continent of Africa, the focus of healthcare innovation should be on infectious diseases. Afterall, the majority of deaths in Africa are still caused by HIV/AIDS, malaria and tuberculosis. While alleviating the burden of infectious diseases is still critical, emerging economies also need to lay the foundation to tackle the growing cancer pandemic.

A focus on Rwanda

The east African nation of Rwanda has come a long way. Only 24 years after the genocide that ripped apart the country’s socio-economic fabric, it now has a fast-growing economy, with an average GDP growth of around 8% per year between 2001 and 2015. The nation has made significant strides to enhance healthcare delivery to its population of 12 million people as it keeps demonstrating its appetite to undertake ambitious new approaches to addressing its challenges.

For example, as part of an ambitious goal to eradicate cervical cancer by 2020, Rwanda provides free Human Papilloma Virus (HPV) immunizations to all girls between 11 and 15 years old, and has now immunized over 97% of girls. Cervical cancer is the most common cause of cancer in Africa, and it is largely preventable, so this preemptive move by Rwanda’s leadership is a significant step towards protecting its population, and demonstrates how countries can quickly expand capacity to address critical health issues.

Responding to growing cancer rates, Rwanda is currently developing a National Cancer Control Plan and instating a national cancer registry to collect data on cancer occurrences in the country. The country also provides a national health insurance plan, making healthcare services, including cancer diagnosis, more affordable for lower-income citizens.

Then there’s the Nucleic Acid Lab, part of the Rwanda Biomedical Centre in Kigali, which was inaugurated in February 2018 to improve testing and detection of markers for diseases such as cancer. A radiotherapy treatment centre will be operational at the Rwanda Military Hospital by the end of 2018, and the Butaro Cancer Center of Excellence in rural northern Rwanda is leading the way in cancer intervention in the country.

Opportunities for Leapfrogging

Rwanda is taking a long-term view of its healthcare system and building the foundations for a precision medicine approach to patient care. Other emerging economies may be doing the same. For those that are, the following four areas are opportunities to set the stage, and possibly avoid some of the complexities that high-resource countries are now facing in implementing precision medicine:

● Proactively design an agile regulatory system that can adapt to advanced approaches to research and development, clinical trials and treatment evaluation

● Articulate requirements for data platforms and system interoperability, including standards for genomic data privacy and protections, which will pave the way for data sharing to drive precision medicine

● Experiment with new reimbursement models that incentivize precision diagnostic innovation and value-based healthcare

● Conduct retrospective trials to understand if medications work differently in subpopulations, especially when medications developed on Western populations are used on non-Western populations

It is important to recognize that precision medicine approaches are neither simple to implement nor effective as stand-alone initiatives. They must be built on a basic healthcare infrastructure that can support increased healthcare capacity. If built this way, precision medicine approaches can provide patients with better health outcomes at reduced personal cost and provide emerging economies with increased information on disease trends and treatments that can drive better allocation of health resources.

Dr Francois Uwinkindi, Director if Cancer Diseases Unit, Rwanda Biomedical Center, and Lynsey Chediak; Community Specialist, World Economic Forum contributed to this article