How can we sustain progress in cancer care in the COVID-19 era?

COVID-19 has taken a huge toll on health systems and economies, forcing governments to make tough decisions on the allocation of increasingly constrained resources. Cancer patients have experienced major disruptions to their care – from the suspension of screening services to delays in treatment and palliation. We are just beginning to understand what COVID-19 means for cancer patients. It has been estimated that disruptions to cancer services will cause hundreds of thousands of unnecessary deaths in high-income countries. Worse outcomes are likely in lower-income settings. This threatens to reverse the remarkable progress that has been made against cancer in recent years.

Through this pandemic, we have experienced the fragility of health systems firsthand. Overcoming the challenge that COVID-19 presents to cancer requires strong political will, cross-sectoral collaboration, and targeted, concrete actions to develop more resilient health services.

COVID-19 has unmasked failings in health systems around the world, exposing many uncomfortable truths about our ability to provide sustainable care under periods of social, economic or political instability. We seem to be approaching the pandemic as if it presents a 'Sophie’s choice' between providing care to either cancer or COVID-19 patients. This overlooks the fact that cancer and other non-communicable diseases (NCDs) make patients much more vulnerable to the ravages of coronavirus.

We have a rare opportunity to address diseases comprehensively rather than targeting our efforts in siloes. Providing cancer treatment should never be positioned as a difficult choice or a luxury. Even before COVID-19, we were losing nearly 10 million people annually to cancer, a disease that will continue to touch nearly every family around the world, during and after the pandemic.

We need to re-examine our investments in health, address inefficiencies in health delivery, and explore innovative ways to deliver care. We can make changes that ensure no one is left behind – not the elderly or the most vulnerable – without pitting one disease against another.

At the end of the second world war, the United Kingdom and Japan made the bold decision to embrace universal health coverage (UHC), a course of action that created a strong foundation for decades of improved health outcomes. Countries face a similar choice today to ensure all patients receive affordable, quality health care. The journey can take decades but the destination is entirely justifiable, yielding improve health, countless deaths averted and greater productivity and prosperity.

There is no short cut to building health systems that are accessible, equitable and resilient. We must go back to basics and reinvigorate investment in fundamental health system needs. This includes taking a comprehensive look at current systems with a view to transforming them, rather than band-aiding gaps. For example, we must address shortages in our health workforce. We still have health systems operating with less than one oncologist per 5,000 patients. By improving basic health infrastructure and investing in training healthcare workers, we can improve cancer care while contributing to the broader ambition of UHC. We must also bring attention to the prevention and detection of cancers, to address disease burdens before they overwhelm our health systems.

Let’s remember the “best buys” in global health and the opportunity to find efficiencies by investing wisely. As the World Health Organization has estimated, every $1 invested in NCD prevention and control in low- and middle-income countries delivers an estimated $7 return to society as a result of increased employment, productivity, and longer life. If governments prioritize feasible and affordable cancer interventions – from health system strengthening to effective screening and treatment – at least 7 million lives could be saved from cancer over the next decade.

In assessing countries’ responses to COVID-19, we have observed how collaborative action between the private sector, civil society and global health agencies can deliver better outcomes. Reflecting on the progress made in cancer, we have also learned it takes a village to make cancer care accessible to patients and we can all benefit from our shared experiences.

Organizations like the City Cancer Challenge (CCAN) are pioneering new ways to deliver effective cancer control. CCAN has inspired cities around the world to develop inclusive and empowering approaches to cancer planning, bringing all stakeholders from the public and private sector together for concrete action. This has been key to CCAN’s leadership on issues like budget allocation, treatment prioritization, and health infrastructure improvement, critical work that continues in spite of COVID-19.

The pandemic also underscores the need for the private sector to continue investing in research that can help solve the greatest health threats – whether for cancer or for infectious diseases. As a result of the scientific progress we’ve made in recent decades, we are increasingly able to deliver the right treatment for the right patient at the right time, improving patient outcomes.

There is no doubt that multilateral organizations and advocacy groups are also critical to knowledge sharing and mobilization across the world. To complement these efforts, governments and payers must fast-track policy developments that support the introduction of innovation and enhance timely access to screening and treatment for all. Time determines outcomes in cancer.

The way we address the challenges and opportunities faced now, amid the COVID-19 pandemic, has the potential to transform health care for the future. If we commit to 'health for all', we can focus attention on solving the underlying challenges that have plagued our health systems for years.

Social distancing will help stop the spread of COVID-19, but social cohesion is what we urgently need to tackle barriers to universal health. If we declare we are 'all for health' as a united global health community, we can ensure the progress we have made against cancer is not lost.

The authors participated in a recent Chatham House Virtual Policy Dialogue on Sustaining Progress in Cancer Care, which is available here.