Cancer Care in Pandemic Times 1st Edition by Geoffrey Banda, Maureen Mackintosh, Mercy Karimi Njeru, Fortunata Songora Makene, Smita Srinivas ISBN 9783031441257 3031441257

This open access edited volume focuses on the scope and benefits of strengthening local industrial-health linkages. The Covid-19 pandemic collapsed international supply chains for health. That experience brought home to African policy makers the critical nature of local manufacturing capabilities for sustaining and strengthening health care, and highlighted the pandemic benefits of India’s much stronger industrial base. At that time, a network of researchers in East Africa, India and the UK were investigating how to address the crisis of cancer care in low-resource health systems. Their project, uniquely, focused on the scope and benefits of strengthening local industrial-health linkages. The project researchers were also drawn into the pressing demands of Covid19 response. The result is this very timely book. The authors link their research on cancer to pandemic experience, and they draw sharp lessons for how countries can enhance their populations’ health security. The authors argue that improving cancer care is crucial for human wellbeing and more inclusive health care. They challenge policy makers to bring together health needs, health innovations and improved industrial capabilities to embed better cancer care and broader health system improvement in local industrial innovation and development.

Part I Cancer in Pandemic Times
1 The Cancer Care Challenge in the Light of Pandemic Experience
Cancer Care Through a Pandemic Lens: African and Indian Perspectives
The Cancer Research Focus
The Cancer Care Challenge in Low-resource Health Systems
Cancer and the Health Industries
The State of Health-related Manufacturing Across Africa
Researching Cancer Care: Methods and Contexts
Perspectives on Cancer Care
Health Sector Research Methods
Industrial Research Methods
Health System Organisation: Key Aspects
Book Structure: Evidencing and Reframing the Challenges
Notes
2 Broken Supply Chains and Local Manufacturing Innovation: Responses to Covid-19 and Their Implications for Policy
Introduction: Warnings Become Reality
Covid-19: An Immediate Crisis that Triggered a Wakeup Call for Africa
Similar but Unequal Response to Crisis: Proximity and Positionality
Sources of Supply Chain Crisis: Cascading Import Dependencies
Pandemic Impacts in India
Sociotechnical Imaginaries: Imaging and Designing the Future
India’s Pharmaceutical Industry: Technological and Political Projects
African Pandemic Innovation
Covid-19-induced Policy Shifts and Need for Long-term Policy Sustainability
Regulation
Industry Policy
Conclusion
Notes
Part II The Cancer Care Experience in East Africa
3 The Social Pain of Cancer in East Africa: Understanding Need
A Carer’s Story
Understanding Social Pain
Despair, Fear and Helplessness
Failures of Information and Advice
Loss of Social Roles and Relationships
Stigma and Rejection
Social Isolation
The Cost of Cancer as a Source of Social Pain
Families’ Economic Losses
Financial Burden and Social Stigma
The Social Pain of Surviving Cancer
Recognition of Social Pain in the Health System
Conclusion
4 Access to Cancer Care: Navigating the Maze
Introduction: Accessing Cancer Care
The Access Maze
Mapping the Maze
Availability and Accessibility in the Cancer Care Maze
Unavailable Diagnostic Services Close to Home
Travel Challenges
Navigation Constraints Within Facilities
Unaffordable Care
Unaffordability and Delays Within the Maze
Insurance and Private Care: Facilitation but High Costs
Payment Burdens and Impoverishment
Tackling the Maze?
Information, Maps and Guides
Financial Support and Lower Costs
Accessible Capacity for Cancer Care
Political and Government Support
Notes
5 Beyond “Late Presentation”: Explaining Delayed Cancer Diagnosis in East Africa
Introduction
Delayed Diagnosis in Kenya and Tanzania
Screening and Early Detection
Weak Referral Processes
Pathology and Laboratory Capability
Cost of Diagnosis
Conclusion
Part III Local Industry and Cancer Care in India and East Africa
6 Cupboard Full, Cupboard Empty: The Industrial Building Blocks of Covid-19 and Cancer Systems
Introduction: Generalities About ‘Broken Health Systems’ Despite Covid-19 Successes
Cupboard Full, Cupboard Empty: A Thought Experiment
The Building Blocks and Methods Behind a Health-Industry Interface
Policy Frames
Uncertainty and Demand in the Pandemic
Cupboard Full, Cupboard Empty
Choosing Wisely for Stocking the Cancer Cupboard
Conclusion: a Cancer System’s Industrial Building Blocks
Notes
7 Manufacturing for Cancer Care in East Africa: Raising the Ambition
Building Local Health Industries: Pandemic Lessons
The Paradox of Need and Demand
Procurement and Market-Consolidation
Tackling Market Fragmentation: Involving the Users
Consolidating and Refocusing Procurement
Innovation and Technological Capability-Building
Manufacturing Innovative Capabilities in the Pandemic
Systemic Capability-Building for Innovation
Technology Transfer and Sources of Finance
The Challenge of Sterile Manufacturing
Finance, Technology Transfer and Skills
Technology, Skills and Learning
Strengthening Local Health Industries: Building Collaboration
Collaborative Priorities
Concluding Reflections: Building Innovation Capability and Ambition
Notes
8 Oncology Drug Production in Sub-Saharan Africa: The Challenge and Opportunity, with Evidence from India
Introduction
Unaffordability of Oncology Drugs
Import Reliance and Supply Chain Risk
India as Oncology Supplier and Benchmark
Competition Failures in Generic Oncology Markets
Competition Failures Within India
Effective Procurement as Competition Policy
The Scope for Local Oncology Manufacturing
Local Oncology Manufacturing: Market and Technical Challenges
The Role of the Health System in Building Local Oncology Supply Chains
Conclusion
Notes
Part IV Industrial Innovation and Industrial Policy
9 Emerging Business Models in Cancer Diagnostic Startups in India and Lessons for African Countries
Introduction
MedTech Startups in Developing Countries and Systemic Scarcities
The Business Model in Context
Case Studies
Sascan
AiNDRA
Panacea Medical Technologies
Analysis and Discussion
Catalysts and Gridlocks in Indian MedTech Startups
Business Models: Evaluating Value Proposition, Creation and Capture
Implications for Startups in LMICs
Conclusions
10 Realistic Ambitions: Technology Transfer for Biologics Platform Technologies
Introduction
Why are Biologics, Especially MAbs, Important for African Countries?
Incremental Versus Disruptive Innovation and Impact on Business Models
African Vaccine Manufacturing Footprint—Where are We Starting from?
Planned and New Vaccine Plants Triggered by Covid19 Vaccine Nationalism
Biologics as an Incremental Innovation on Vaccines and Molecular Biology Techniques
The Market Challenges to Successful Technology Transfer
Technology Transfer can be Difficult—The Cipla Biologics Case Study
Cipla in South Africa: A Lesson for Policy
Conclusion
Notes
11 Palliation Economics: The Industrial Organisation of Morphine in India
Introduction: From Health Policy to Industrial Policy
Provision of Palliative Morphine
An Industrial Organsation Approach: Moving Beyond Price and Availability
Differentiating Countries by Industrial Capabilities
Insufficient Health Policy Reform
Industrial Policy Gaps and Opportunities
Capacity Utilization and Technology Used
Policy Priorities for India
Discussion and Conclusion
Notes
Part V Tackling Institutional Gaps: Using Scenarios
12 Innovation and Policy in Cancer Pain Management: Systemic Interactions in Tanzania
Introduction
Framing the Undertreatment of Pain in Cancer Care
Undertreatment of Cancer Pain in Tanzania
Experiences of Pain
Palliative Care Provision
Access to Pain Medication
The Need-Demand Gap for Severe Pain Relief
Morphine Ordering and Distribution
Is Fiscal Constraint the Problem?
Measuring the Need-Demand Gap for Morphine: A Comparison with Uganda
Addressing the Cancer Pain Management Deficit: Mutually Supportive Innovations
The Scope for Local Manufacturing
Skills, Training and Management of Medication by Health Workers
Conclusion: A Focus on Policies, Regulations, and Licensing
Notes
13 Using Scenarios to Support Innovation and Mutual Linkages
Introduction
Tools to Support Innovation and Health-Industry Linkages
A Practical Tool: Scenarios
Scenarios in Health Policy
Developing Scenarios
Three-Stage Process for Health System Scenarios
Two Scenario Case Studies for Cancer Care Innovation
Exploring Innovation Pathways Using Scenarios: A Tanzania Cancer Care Case Study
Reflections on Practice
Collective Visioning with Scenarios: A Kenya Cancer Care Innovation Case Study
Reflections on Practice
The Strengths of Scenarios for Cross-Sectoral Innovation Support
A Whole System View
Synthesis Across Sectors and Professions
Usefulness in Research and Evidence
Uncertainty and the Absence of Empirical Data
Inclusive and Accessible Tools
Using Scenarios to Build Cross-Sector Innovation Capability
Notes
14 Conclusion: Better Cancer Care and Greater Local Health Security: Lessons, Opportunities and Ways Forward
Core Themes
Local Health Security: Pandemic Lessons
Need, Demand, Supply, Access: Tackling Institutional Gaps in Cancer Care
Scope for Investment in Local Manufacture of Drugs, Vaccines, Biologics and Medical Technologies
Interlinking Health Care and Industrial Development: Reframing Policy
Concluding Reflection
References
Index