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In turn, such clarity on size and regulation of markets can aid

firms in areas such as materials, scanners, lasers, dosage forms,

optics, plastic molding and 3-D printing. This departure from

cancer's US or European industrial histories, more accurately

reflects domestic cancer data as well as domestic technological



Major changes in the economics of technological change

have emerged in the last half century which can move us

beyond unrealistic war metaphors. COVID-19 has also

revealed fundamental industrial gaps in global distributed

manufacturing, fair pricing for imports or adjudication rules

for technology transfer. Global policies in cancer should

therefore support, not drive, national dialogues on priorities

and evaluation. Health policy and industrial policies are

rarely analysed as essentially intertwined. We hope that the

Innovation for Cancer Care in Africa (ICCA) project can provide

a preliminary body of research to analyse these linkages and

improve cancer care in the coming years. n


The support of the Economic and Social Research Council (ESRC)

(UK) is gratefully acknowledged in the Innovation for Cancer Care in

Africa (ICCA) project (Grant reference ES/S000658/1). The content

of this article is the sole responsibility of the author and does not

necessarily reflect the views of the UK ESRC. I thank the Editors

of Cancer Control, Mark Lodge for the invitation, Prof. Maureen

Mackintosh of the Open University UK, and the National Centre for

Biological Sciences-Tata Institute of Fundamental Research (NCBSTIFR), Bengaluru, India.

Smita Srinivas (TC-Lab) is India project lead of the Open University

UK-led Innovation for Cancer Care in Africa (ICCA) at NCBS-TIFR.

She recently served the Think 20 (G20); UN TAP's Diagnostics

Review group, and UNIDO's 2022 Industrial Development Report.

Professor Srinivas is the 2021 Clarence E Ayres Scholar (AFEE). Her

book Market Menagerie won the 2015 EAEPE Joan Robinson Prize.

management goals to context-driven industrial response for

health enhancements and universal healthcare commitments.

At the same time, cancer-generating and multi-industry

challenges such as environmental toxicity can be framed

within industrial and systemic drivers of health (16).

A technologically contingent approach emphasized that

societies need continuous problem-solving capabilities to

resolve production, demand and delivery challenges and to

clarify what knowledge systems serve them best. Industrial

churn in cancer technologies can originate outside cancer.

During COVID-19, countries under strict lockdowns or import

curbs have behaved in unexpected ways in highly compressed

timelines to produce PPE or COVID-19 diagnostic kits and

which now shape how their cancer treatment is addressed


How institutions and organizations come together

illustrates the dynamic problem of morphine production for

cancer palliation (19). India has in principle a complete supply

chain but in practice one with several production, demand

and delivery gaps, from opium cultivation to final opioids

availability. Dramatic improvements are certainly possible:

industrial gaps between agricultural production, procurement

quotas and licenses to align with technology upgrading for

opium processing; and alignment of national programmes,

state bureaucracies, or leading hospital procurement systems

to track and anticipate the demand of palliative care morphine.

This requires procurement systems to match decentralized

district-level networks of regional hospital and clinics which

can see the urgency of morphine availability hiding in plain

sight (20,21). Patients are also often unaware that doctors

and medical bureaucrats may unwittingly undermine pain

management with misplaced worries about addiction or

trafficking. Medical and science education, and the training

of bureaucrats need updates in dynamic industry models of

global and national opioids supply chains, and exposure to

mixed teams for policy design with economics, engineering,

law and ethics.

A second example, Choosing Wisely India, demonstrates

why and how traditional US, UK, or Canadian technology

priorities for scanning or chemotherapy may need to be reassessed in Indian or African contexts

(22,23). Choosing

Wisely India fits within the ambitious National Cancer Grid

of India (NCG) with tumour boards and expert panels and

Vishwam Connect which combines Indian cancer standards

with growing overseas requests (24). If extended to the

industrial side, these initiatives can usher in sensible minimum

thresholds for standardized imports, identify priority

innovations, specify local content requirements that dovetail

with economic plans, establish quality or safety standards, and

iteratively develop agile procurement or malpractice systems.


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