GLOBAL CANCER INITIATIVES
30 CANCER CONTROL 2021
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
capabilities.
Conclusion
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
Acknowledgements
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
(17,18).
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.