Editorials of The Times: A Promising Step in Tackling Childhood Cancer

Posted September 29, 2018 2:57 p.m. EDT

Like most of the boys in his San Salvador neighborhood, Gabriel Alessandro Mayorga Hernandez — Gabo, to his family and friends — loves soccer. But in 2014, just before he turned 12, he found himself exhausted by even a short game. Eventually he became too tired to play at all and started having headaches so severe they made him vomit. When he developed chest pains and difficulty breathing, his grandmother took him to the doctor, where X-rays and blood work indicated that he had acute lymphoblastic leukemia, or ALL, a blood cancer that develops most often in young children.

A decade ago, that might have been the end of Gabo’s story. While high-income countries like the United States have made tremendous strides against ALL and a string of similar childhood cancers, those gains have not trickled down to low- and middle-income countries, many of which simply don’t have the resources to treat complex diseases. In such places, the blood and fever of leukemia are often mistaken for malaria. And even when doctors do diagnose the disease properly, chemotherapy and radiation are in short supply, and bone marrow transplants nearly nonexistent.

The result of those deficits is not surprising, but it is striking. In rich countries, 80 percent of children with diseases like ALL survive. In many poor countries, 80 percent die.

That inversion marks one of the greatest health disparities in the world, according to the World Health Organization, which convened a meeting at the U.N. General Assembly to discuss the issue Friday. “With childhood leukemia, the single biggest predictor of whether you recover or not is where you happen to have been born,” said Dr. Carlos Rodriguez-Galindo, executive vice president of St. Jude Children’s Research Hospital and chairman of its global pediatric medicine department. “We’re talking about many thousands of young children dying every single year of diseases that we have known how to cure for decades.”

In El Salvador, Rodriguez-Galindo and his colleagues have managed to upend that calculus by forging a partnership with the nation’s government and its nonprofit sector that has enabled them to pass on the tools of their trade. As a result, El Salvador has had unusual success for a low-income nation: The survival rate for childhood cancers there has increased dramatically, from 5 percent in 1993 to 48 percent today.

By the time Gabo got sick in 2014, doctors in San Salvador knew how to diagnose ALL, and pediatric oncologists were available to treat it. He received specialized care similar to what he’d get in any high-income country. And he went into remission a month after his diagnosis.

This week, St. Jude announced a five-year, $15 million partnership with the World Health Organization, aimed at expanding on that success. The hospital’s goal is to cure at least 60 percent of children around the world with the six most common types of cancer, including ALL, by 2030, using tools that have long been commonplace in wealthier countries: training and basic equipment for doctors, access to chemotherapy drugs and other technology, and support and follow-up care for patients.

The collaboration marks a welcome opening of institutional borders. The WHO rarely teams up with outside nonprofit groups, despite the obvious benefits of doing so: St. Jude has extensive specialized knowledge that is clearly lifesaving when shared; the WHO has decades of experience working in countries marred by sweeping poverty and enduring violence. Together, they are well equipped to finally close this inexcusable survival gap.

But their success will hinge on several other entities. Individual governments need to prioritize noncommunicable diseases like cancer, and work harder to provide universal health coverage; the drug and device industries need to come to the table on pricing — the technology of cancer care is expensive, but it can be made affordable. And wealthier countries need to contribute resources of their own to the effort. Such investments can only strengthen the global economy in the long run: The WHO estimates that every dollar invested in tackling these noncommunicable diseases will generate a $7 return by 2030.

If world leaders can recognize that benefit, hundreds of thousands of children around the world may finally have the same chance as Gabo, who received a standing ovation when he addressed the United Nations on Friday. He has long since returned to playing soccer. This fall, he started high school. And he has his whole life ahead of him.

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