Death in the shade of world’s attention
From the December 15, 2006 Business Day
December 15, 2006
by Jeremiah Norris
PUBLIC concern about AIDS often drowns out all talk of the myriad other diseases faced by South Africans. AIDS is obviously a serious problem but its monopoly of the health debate has led to the neglect of simple things which could save millions of cancer and heart disease patients. Consider the facts. Worldwide, cancer kills more people than AIDS, TB and malaria combined — three times as many as AIDS alone. And it is not true that these “chronic diseases” affect only developed countries. According to the World Health Organisation (WHO), 80% of deaths from such diseases occur in low-and middle-income countries such as SA. Somehow, policy makers seem to labour under the misapprehension that cancer and heart attacks are not emergencies or that they are more expensive to treat than HIV/AIDS. Nothing could be further from the truth. The WHO states unequivocally that 40% of cancers can be prevented “and that many solutions are also inexpensive to implement”.
HIV/ AIDS, of course, remains incurable and palliative treatment is expensive, complicated and long-term.
SA’s Medical Research Council and the WHO Collaborating Centre published a report in 2001 on chronic diseases in SA. Heart disease was found to account for 38% of all deaths from chronic disease, followed by cancer at 20,4%. Of those cancers, cervical and breast were the two biggest killers: “Death due to cancer of the cervix is the commonest cause of cancer deaths among poor women,” frequently heads of households. This means that women suffer disproportionately from cancer during their most productive years and when they are most essential to their families.
South African men have a high rate of death from liver cancer but a cheap preventive intervention has been put in place by the government. The hepatitis B vaccination is now part of the Expanded Programme of Immunisation and all children should receive it.
Over the past 30 years, the only United Nations (UN) agency that has addressed this problem is the International Atomic Energy Agency (IAEA) in Vienna. In 2004, its director-general, Mohamed ElBaradei, initiated a more comprehensive global initiative: the Programme of Action for Cancer Therapy (Pact). The WHO passed a unanimous resolution of support in May 2005. In the first year of operation, Pact undertook to build cancer treatment capacity in seven member states, using the IAEA’s share of the 2005 Nobel Peace Prize award (split between the IAEA and ElBaradei).
Compared to AIDS, this seems like a cost-effective use of resources that will save many lives. On AIDS, the International Monetary Fund states that $8bn was spent in 2004; WHO says it rose to $8,3bn in 2005. This year, it is likely to be at least $9bn. That comes to $25,3bn over the past three years. But on World AIDS Day on December 1, UNAIDS announced that the disease had yet to stop rising in Africa, that infection rates continued to increase and that the epicentre had moved to Asian nations.
What is more, there is no cure for AIDS. Once treatment is initiated, experience points toward two certainties: first, drug resistance will inevitably set in among a certain percentage each year — even in the best of medical environments — and, second, medical-care costs increase over time. Many cancers, however, can be treated cheaply if caught in time: that kind of investment could have provided full cures for millions. For instance, Pact estimates that cervical cancer can be cured with 30 radiotherapy treatments at an average price of $5 per treatment.
In Cape Town this week, many of the world’s leading cancer experts are gathering under an IAEA/Pact initiative to propose strategies. Pact’s goals are backed by African Nobel Prize laureates Nelson Mandela, Desmond Tutu and FW de Klerk.
Neither AIDS nor cancers will go away soon. Aid donors and national health leaders have to understand the full range of threats they face, not just AIDS, and to allocate money effectively: millions of lives depend on it.
Jeremiah Norris is a Senior Fellow and Director of Hudson Institute's Center for Science in Public Policy. He specializes in public-private partnerships in development assistance, trade and development, and global AIDS, tuberculosis, and malaria policies.
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