SPONSORED FEATURE: JOHNS HOPKINS MEDICINE
creation of agencies or groups that provide formal and informal since its foundation in 2000. In cancer care, GAVI has been able
health technology assessment, one dimension of which is cost- to lead negotiations in decreasing the cost of cancer preventing
effectiveness. While the main reasons for establishing these vaccines in low-income countries, bringing the price per dose of
agencies or groups are similar around the world, namely the hepatitis B and HPV vaccines down to US$0.18 and US$5,
creation of an objective and transparent way of assessing respectively.
alternative interventions in the setting of limited resources, Most importantly, the Alliance provides a model that those of
aiming to improve health care quality, low- and middle-income us interested in increasing access to cancer medications in low-
countries struggle even more with lack of resources, human and middle-income countries can draw inspiration from and
capital and knowledge of the subject. build upon. Through engagement and goal setting, recipient
At the same time, low- and middle-income countries may countries have incentives to create and develop their health and
leverage from health systems that promote value in oncology. human capital infrastructure with adequate technical support
Value-based insurance design and pricing may eventually follow from the Alliance’s technical partners; second, through the
in the wake of health technology assessment and cost- provision of funding, the Alliance creates a functioning market in
effectiveness evaluations. Many new drugs in oncology improve vaccines for low-income countries, generating interest and
median overall survival by just a few months at a cost of solutions from private players. Finally, GAVI has been the test
thousands or tens of thousands of US dollars. Value-based case for a new approach in innovative funding models, through
insurance design and pricing, with a basic premise that an the creation in 2006 of the International Finance Facility for
intervention’s cost should be linked to the benefit it provides, Immunization, which issues bonds in capital markets, leveraged
could potentially bring the cost of new medications closer to by guarantees of future donations. The Facility, which is funded
thresholds in which these would be considered cost-effective. by many donor countries such as Australia, France, Italy, the
This would also avoid the rationing of more effective and life- Netherlands, Norway, South Africa, Spain, Sweden, and the
saving medications due to high costs. These can also help United Kingdom and has the World Bank as its treasurer, has
industry and payers establish price discrimination policies as raised in excess of US$3.5 billion in capital markets, effectively
cost-effectiveness thresholds vary according to national per more than doubling the amount of funds available to GAVI.
capita income.
Looking forward
Public-private partnerships and philanthropy: The It will take the whole world to control cancer in low- and middle-
GAVI Alliance and the international financing facility income countries. Only through multiple stakeholder
for immunization involvement, including governments, industry and civil society,
The challenge of access to cancer medications in low- and and through the creation of a global entity to fight cancer,
middle income countries can only be effectively addressed supported by a global fund in the mould of the GAVI Alliance and
through a combination of public and private efforts. Throughout the International Finance Facility for Immunization will we truly
the world there are a growing number of such entities aiming to be able to win the fight against the disease. Finally, it is of
improve health care financing and delivery in low- and middle- paramount importance to note that, while in this perspective the
income countries. The most relevant example to this author has focused on access to medications, effective cancer
commentary is that of the GAVI Alliance and the International control plans have to be culturally appropriate, comprehensive
Financing Facility for Immunization. and holistic, involving data gathering, health education,
The GAVI Alliance, formerly the Global Alliance for Vaccines prevention, screening, early detection, surgical and
and Immunization, is a public-private partnership that has made radiotherapeutic treatments in addition to access to anti-cancer
significant strides in increasing access to vaccines, including drugs. l
those that prevent cancer, such as human papillomavirus [HPV]
and Hepatitis B, in low-income countries. Bringing together all (The author welcomes comments and would like to invite readers
significant stakeholders, including industry, donor and recipient to contribute with stories and their experience by emailing
governments, UNICEF, WHO, The World Bank, The Bill and us or posting them at “Access to Cancer Care in Low and
Melinda Gates Foundation and other philanthropists, research Middle Income Countries”, a webpage which is available at
and technical agencies and representatives from civil society http://www.facebook.com/CancerControlInLowAndMiddleIncomeC
groups, the Alliance has helped immunize an additional 325 ountries?ref=hl)
million children and likely helped avert 5.5 million future deaths
26 CANCER CONTROL 2013