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*Richard A Powell, Faith N Mwangi-Powell, Lukas Radbruch, Gavin Yamey, Eric L Krakauer, Dingle Spence, Zipporah Ali, Sharon Baxter, Liliana De Lima, Ali Xhixha, M R Rajagopal, Felicia Knaul

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PO Box 459-00621, Village Market, Nairobi, Kenya (RAP); University Research Company, Nairobi, Kenya (FNM-P); Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany (LR); Evidence to Policy Initiative, Global Health Group, University of California, San Francisco, CA, USA (GY); Harvard Medical School, Boston, MA, USA (ELK); Massachusetts General Hospital, Boston, MA, USA (ELK); Partners In Health, Boston, MA, USA (ELK); Hope Institute Hospital, Kingston, Jamaica (DS); Kenya Hospices and Palliative Care Association, Nairobi, Kenya (ZA); Canadian Hospice Palliative Care Association, Ottawa, Canada (SB); International Association for Hospice and Palliative Care, Houston, TX, USA (LDL); Ryder Albania Association, Tirana, Albania (AX); WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Trivandrum, Kerala, India (MRR); and Harvard Global Equity Initiative, Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA (FK) [email protected]

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We declare no competing interests. 1 2

WHO. WHO definition of palliative care. http://www.who.int/cancer/ palliative/definition/en/ (accessed Sept 26, 2014). Sustainable Development Knowledge Platform. Outcome document— Open Working Group on Sustainable Development Goals. http://sustainabledevelopment.un.org/focussdgs.html (accessed September 28, 2014).

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Worldwide Palliative Care Alliance. Mapping levels of palliative care development: a global update. London: Worldwide Palliative Care Alliance, 2011. Powell RA, Mwangi-Powell FN, Kiyange F, Radbruch L, Harding R. Palliative care development in Africa: how we can provide enough quality care? BMJ Support Palliat Care 2011; 1: 113–14. United Nations Committee on Economic, Social and Cultural Rights, Twentysecond session. Geneva, April 25–May 12, 2000. E/C 12/2000/4, General Comment No.14. World Health Assembly. Strengthening of palliative care as a component of comprehensive care within the continuum of care. http://apps.who.int/gb/ ebwha/pdf_files/WHA67/A67_R19-en.pdf (accessed June 8, 2014). The International Agency for Research on Cancer. Latest world cancer statistics: global cancer burden rises to 14·1 million new cases in 2012: marked increase in breast cancers must be addressed. Press release number 223. Lyon/Geneva: International Agency for Research on Cancer, Dec 12, 2013. Ferlay J, Shin H, Bray F, et al. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10. Lyon, France: International Agency for Research on Cancer, 2008. http://globocan.iarc.fr (accesssed Jan 9, 2014). Human Rights Watch. Letter to the UN General Assembly Open Working Group 12 on Sustainable Development Goals ahead of the 12th Session. http://www.hrw.org/news/2014/06/20/letter-un-general-assembly-openworking-group-12-sustainable-development-goals-ahead (accessed Oct 11, 2014). Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. WHO. WHO action plan for the global strategy for the prevention and control of non-communicable diseases. Geneva: World Health Organization, 2008. Montreal Declaration on Hospice and Palliative Care, September 2014. http:// www.palliativecare.ca/en/home/montreal_declaration.html (accessed Sept 28, 2014). Harvard Global Equity Initiative. Closing the pain divide. http://hgei.harvard. edu/icb/icb.do?keyword=k62597&pageid=icb.page662285 (accessed Sept 26, 2014).

The annual death toll from cancer has risen by almost 40% since 1990,1 and this increase is set to continue. Deaths from cancer are projected to increase from the present level of around 8 million a year to more than 13 million by 2030, with most of the burden being in poorer countries.2 Once a problem almost exclusive to rich countries, cancer is rapidly becoming a leading cause of death and disability in poor countries, where cancer survival is much lower than in the affluent parts of the world—eg, breast cancer survival in the Gambia is below 15%.3 Yet, low-income countries have just 5% of the resources to deal with 80% of the global cancer burden.4 The unacceptable asymmetry between the cancer burden and financial resources in low-income countries prompted the European School of Oncology to convene the World Oncology Forum (WOF) in 2012, bringing together 100 cancer researchers, clinicians, policy makers, industry representatives, patient advocates, and scientific journalists to debate the question “Are www.thelancet.com/oncology Vol 16 February 2015

we winning the war against cancer?”5 Having concluded that current global strategies to control cancer are largely insufficient, the participants issued an ten-point call to action—“stop cancer now!”6—formulated within the framework of the international commitment to reduce preventable deaths from non-communicable diseases by 25% by 2025 (“25 by 25”).7 The call to action not only asks for a major improvement in prevention, early diagnosis, and treatment, but also requests new models of research focused on patients’ benefit. To reach the 25 by 25 target, at least 1·5 million deaths from cancer will need to be prevented per year. In 2014, leading international experts met at the WOF to promote sustainable new models of public– private partnership to find new cancer therapies that could make a real difference in patients worldwide. This was followed by the 2014 World Cancer Leaders’ Summit, organised by the Union for International Cancer Control, when the economic case for cancer control was discussed. The loss of output from

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Towards a global cancer fund

This online publication has been corrected. The corrected version first appeared at thelancet.com/ oncology on January 29, 2015

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patients with cancer, and the costs of their care, comes to an estimated US$2 trillion globally. The critical imperative for coordinated effort to tackle cancer is rapidly becoming evident for policy makers. Several scientific taskforces are exploring avenues for better coordination of global efforts against cancer4,8,9 and generating options for a global cancer fund. Such a fund should draw on the experience of the three innovative financing mechanisms that have reached a global scale, namely the Global Fund to Fight AIDS, Tuberculosis, and Malaria, GAVI, and UNITAID.10 These organisations have introduced novel approaches in each step of the innovative finance value chain—ie, resource mobilisation, pooling, channelling, resource allocation, and implementation—and integrated these steps to successfully mobilise more than $30 billion in 10 years from diverse sources, which they have channeled rapidly to low-income and middle-income countries to address HIV/AIDS, malaria, tuberculosis, and vaccinepreventable diseases in children.10 These organisations do not finance cancer, but have strengthened health systems to establish service delivery platforms and supply chain management systems that can create synergies to benefit cancer prevention, treatment, and care.10 The HIV response, characterised by strong global leadership, civil society involvement, activism by the affected communities, and clear communication of investment imperative for HIV/AIDS, offers further lessons for the proposed global cancer fund. The first priorities of such a fund could be the development of cancer registries, cervical and breast cancer, and paediatric oncology. Tabaré Vazquez, a radiooncologist who was recently re-elected as the president of Uruguay and will in 2015 lead pro tempore the Union of South American Nations (UNASUR), is likely to convene an international conference of heads of state and leading cancer experts to discuss the proposal for a

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global cancer fund. In the meantime one of the authors (FC), representing the WOF, has been invited to share these ideas and proposals for a new fund at the World Economic Forum in Davos (Jan 21–24, 2015) during two sessions that will deal with the rapidly escalating burden of cancer. The World Economic Forum will provide the opportunity, as it has done for AIDS, tuberculosis, and malaria, as well as for maternal and child health, to communicate to world leaders the critical imperative to invest in cancer prevention, treatment, and care to alleviate needless suffering and realise significant health and economic benefits in low-income countries. *Franco Cavalli, Rifat Atun Oncology Institute of Southern Switzerland, Bellinzona, Switzerland (FC); School of Public Health, Department of Global Health and Population, Harvard University, Boston, MA, USA (RA) [email protected] FC is Chairman of the World Oncology Forum. We declare no competing interests. 1

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Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095–128. Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol 2012; 13: 790–801. Sankaranarayanan R, Swaminathan R, Brenner H, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 2010; 11: 165–73. Farmer P, Frenk J, Knaul FM, et al. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 2010; 376: 1186–93. Horton R. Offline: At least two reasons to be grateful for Europe. Lancet 2012; 380: 1542. Cavalli F. An appeal to world leaders: stop cancer now. Lancet 2013; 381: 425–26. WHO. 65th World Health Assembly. WHA65(8) Prevention and control of noncommunicable diseases: follow-up to the high-level meeting of the United Nations General Assembly on the prevention and control of non-communicable diseases. http://apps.who.int/gb/ebwha/pdf_fi les/ WHA65/A65_DIV3-en.pdf (accessed Jan 15, 2012). Goss PE, Brittany LL, Badovinac-Crnjevic T, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14: 391–436. Varmus H, Kumar H. Addressing the growing international challenge of cancer: a multi-national perspective. Sci Transl Med 2013; 5: 1–5. Atun R, Knaul FM, Akachi Y, Frenk J. Innovative financing for health: what is truly innovative? Lancet 2012; 380: 2044–49.

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Towards a global cancer fund.

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