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The parlous state of research in paediatric oncology
Editorial
Science Photo Library
The parlous state of research in paediatric oncology
For the report on the state of research into children with cancer across Europe see ecancer 2011; 5: 210; DOI:10.3332/ecancer.2010.210
Wide variations across Europe in research into cancer in children are identified in a report in ecancer on Feb 9. Published by the European Society for Paediatric Oncology and the Kings Health Partners Centre for Global OncoPolicy, the authors investigated the state of research in paediatric oncology, and compared research outputs from Europe with those from the USA and Canada. They found that only 5% of research papers on any form of cancer were published by the global paediatric oncology community. About a third of paediatric oncology papers were from Europe, compared with a third from USA and Canada, and a third from the rest of the world. Collaboration in research between Canada and the USA, or between some European countries, was greater than that between Europe and the rest of the world including North America. In most European countries, funding of paediatric oncology research was greater from privatenon-profit sources than from governments, but almost half of all papers reported no funding source. Information provided to parents and children varied greatly across Europe and was inadequate in some countries.
The report’s authors highlight the need for longterm commitment to a European clinical trials network to underpin internationally collaborative clinical and translational research. The authors also call for changes to the EU Clinical Trials Directive to remove barriers to recruiting children into trials, support for a panEuropean organisation to improve quality of information for patients and parents, an integrated European epidemiological registry to support outcomes research, and support for adoption of harmonised treatment guidelines across Europe. Urgent action to improve the state of paediatric oncology research across Europe is needed simply to maintain the improvements in diagnosis, treatment, and survival seen in the past 40 years. 80% of all children with cancer now survive, despite the parlous state of research. There is no room for complacency. Children with cancer deserve the highest quality of care and access to novel therapies, developed through the most rigorous and sustainably funded research, wherever they live. The Lancet
GAVI/11/Riccardo Gangale
A shot in the arm for MDG 4 in Africa
See Articles Lancet 2009; 374: 893 See Articles Lancet 2010; 375: 1969 For more on the financing concerns of Médecins Sans Frontières see http://www. msfaccess.org/fileadmin/user_ upload/medinnov_ accesspatents/MSF_Oxfam%20 Vaccine%20Summary%20 26%20Jan%20FINAL.pdf For more on the AMC funding see http://www.vaccineamc.org/ files/AMCannualReport10.pdf
612
On Feb 14, 2011, the introduction of a pneumococcal conjugate vaccine into Kenya’s national immunisation programme will mark a turning point for reducing child mortality in Africa. Through a novel finance mechanism pioneered by the GAVI Alliance and its partners—the Advance Market Commitment (AMC)—a vaccine specific to the serotypes most prevalent in developing countries will become rapidly available at affordable prices. Every year, over 1·5 million children younger than 5 years die from pneumococcal diseases, with the highest burden in Africa. In Kenya alone, about 30 500 children died in 2008 from pneumonia. Yet it can take 20 years before pneumococcal vaccines routinely available in developed countries become affordable for low-income countries; even then, these vaccines are not specific for developing countries. By contrast, the vaccine being rolled out in Africa covers the 1, 5, and 14 serotypes prevalent in the region. The AMC provides incentives to the manufacturers by guaranteeing a market and subsidising costs to ensure supply. GlaxoSmithKline (PCV10) and Pfizer (PCV13) have
agreed a set maximum price of US$3·50 per dose for 10 years, most of which will be paid for by GAVI and six donors. The same vaccine costs $70 per dose in the USA. However, Médecins Sans Frontières has expressed concern that this commitment might hamper competition, and thus impede lower vaccine costs. Some suppliers could provide the vaccine at lower costs, although manufacturers must be WHO qualified and be able to supply the high quantities needed now. Faster and more affordable access to pneumococcal vaccines for Africa and other developing countries will be crucial to meet Millennium Development Goal 4, to reduce child mortality. For the first time, children in low-income countries will have the same access to an effective pneumococcal vaccine as do children in Europe and the USA. Now that access to a suitable vaccine has become a reality for developing countries, governments must invest in integrated health-care infrastructures and plan for a future in which they no long rely on donors for sustainable vaccination programmes. The Lancet www.thelancet.com Vol 377 February 19, 2011
Science Photo Library
The parlous state of research in paediatric oncology
For the report on the state of research into children with cancer across Europe see ecancer 2011; 5: 210; DOI:10.3332/ecancer.2010.210
Wide variations across Europe in research into cancer in children are identified in a report in ecancer on Feb 9. Published by the European Society for Paediatric Oncology and the Kings Health Partners Centre for Global OncoPolicy, the authors investigated the state of research in paediatric oncology, and compared research outputs from Europe with those from the USA and Canada. They found that only 5% of research papers on any form of cancer were published by the global paediatric oncology community. About a third of paediatric oncology papers were from Europe, compared with a third from USA and Canada, and a third from the rest of the world. Collaboration in research between Canada and the USA, or between some European countries, was greater than that between Europe and the rest of the world including North America. In most European countries, funding of paediatric oncology research was greater from privatenon-profit sources than from governments, but almost half of all papers reported no funding source. Information provided to parents and children varied greatly across Europe and was inadequate in some countries.
The report’s authors highlight the need for longterm commitment to a European clinical trials network to underpin internationally collaborative clinical and translational research. The authors also call for changes to the EU Clinical Trials Directive to remove barriers to recruiting children into trials, support for a panEuropean organisation to improve quality of information for patients and parents, an integrated European epidemiological registry to support outcomes research, and support for adoption of harmonised treatment guidelines across Europe. Urgent action to improve the state of paediatric oncology research across Europe is needed simply to maintain the improvements in diagnosis, treatment, and survival seen in the past 40 years. 80% of all children with cancer now survive, despite the parlous state of research. There is no room for complacency. Children with cancer deserve the highest quality of care and access to novel therapies, developed through the most rigorous and sustainably funded research, wherever they live. The Lancet
GAVI/11/Riccardo Gangale
A shot in the arm for MDG 4 in Africa
See Articles Lancet 2009; 374: 893 See Articles Lancet 2010; 375: 1969 For more on the financing concerns of Médecins Sans Frontières see http://www. msfaccess.org/fileadmin/user_ upload/medinnov_ accesspatents/MSF_Oxfam%20 Vaccine%20Summary%20 26%20Jan%20FINAL.pdf For more on the AMC funding see http://www.vaccineamc.org/ files/AMCannualReport10.pdf
612
On Feb 14, 2011, the introduction of a pneumococcal conjugate vaccine into Kenya’s national immunisation programme will mark a turning point for reducing child mortality in Africa. Through a novel finance mechanism pioneered by the GAVI Alliance and its partners—the Advance Market Commitment (AMC)—a vaccine specific to the serotypes most prevalent in developing countries will become rapidly available at affordable prices. Every year, over 1·5 million children younger than 5 years die from pneumococcal diseases, with the highest burden in Africa. In Kenya alone, about 30 500 children died in 2008 from pneumonia. Yet it can take 20 years before pneumococcal vaccines routinely available in developed countries become affordable for low-income countries; even then, these vaccines are not specific for developing countries. By contrast, the vaccine being rolled out in Africa covers the 1, 5, and 14 serotypes prevalent in the region. The AMC provides incentives to the manufacturers by guaranteeing a market and subsidising costs to ensure supply. GlaxoSmithKline (PCV10) and Pfizer (PCV13) have
agreed a set maximum price of US$3·50 per dose for 10 years, most of which will be paid for by GAVI and six donors. The same vaccine costs $70 per dose in the USA. However, Médecins Sans Frontières has expressed concern that this commitment might hamper competition, and thus impede lower vaccine costs. Some suppliers could provide the vaccine at lower costs, although manufacturers must be WHO qualified and be able to supply the high quantities needed now. Faster and more affordable access to pneumococcal vaccines for Africa and other developing countries will be crucial to meet Millennium Development Goal 4, to reduce child mortality. For the first time, children in low-income countries will have the same access to an effective pneumococcal vaccine as do children in Europe and the USA. Now that access to a suitable vaccine has become a reality for developing countries, governments must invest in integrated health-care infrastructures and plan for a future in which they no long rely on donors for sustainable vaccination programmes. The Lancet www.thelancet.com Vol 377 February 19, 2011