Every year, an estimated 400,000 children worldwide face the battle against cancer. In high-income nations, five-year survival rates often exceed 80%, with some cancers like retinoblastoma having a near 100% cure rate. However, in low- and middle-income countries, the situation is far more dire, with an average five-year survival rate of less than 20%. This issue was raised at the Union for International Cancer Control congress in Geneva this fall.

Uncovering the Hidden Dangers of Generic Cancer Drugs for Children

Survival Rates: A Tale of Two Worlds

In high-income nations, the success stories in cancer treatment are remarkable. Take retinoblastoma, for example, which affects about 8,000 children annually. With advanced medical care, the cure rate is nearly 100%. But in low- and middle-income countries, the average five-year survival rate is a disheartening less than 20%. This stark contrast highlights the global disparity in cancer treatment.Cancer is a global health crisis, and the survival rates for children in different parts of the world vary significantly. In high-income nations, the advancements in medical research and access to quality treatments have led to higher survival rates. On the other hand, in low- and middle-income countries, the lack of resources and infrastructure makes it difficult to provide the same level of care. This disparity not only affects the lives of children but also raises questions about equity in healthcare.

The Impact of Generic Drugs

While generic drugs play a crucial role in making life-saving medications more accessible, they also pose significant risks. Take folinic acid, commonly prescribed for childhood leukemia. A month's supply of the original drug costs nearly $2,500, but generic versions are available for as little as $139. In many countries, there is no proper evaluation of these generic drugs, leaving doctors and patients in the dark about their quality.In some cases, the generic drugs are of dubious quality, contaminated, or even outright fake. For instance, in Colombia, approximately 100 children with leukemia developed high fevers after receiving a generic form of methotrexate. Tests revealed that the drug was contaminated with pseudomonas aeruginosa, leading to the deaths of four children. Such incidents highlight the need for stricter quality control measures for generic drugs.

African Challenges

Across the Global South, including Africa, the problem of contaminated and suboptimal quality generic drugs is widespread. In Ethiopia, researchers found that samples of generic cisplatin imported from India contained only 40-70% of the key ingredient, rendering it useless. Without foreign aid for testing, doctors are often left wondering whether a patient's deterioration is due to the disease or the medication.In Ghana, Professor Lorna Renner expressed concerns about the quality of medicines coming from India. "Many of our medicines come from India where there's a vast spectrum when it comes to the quality," she said. "When a child doesn't respond to treatment or relapses, you don't know what really happened. Was it the cancer itself or was the medication at fault?"

International Collaborations

In an effort to address this global issue, international collaborations are emerging. The Franco-African Group for Pediatric Oncology (GFAOP) has been supplying cancer drugs manufactured in France to French-speaking African countries like Senegal. However, with a limited budget of around $150,000 per year, the organization's impact is relatively limited.St. Jude Children's Research Hospital is also taking a lead. Through a new partnership with the World Health Organization, St. Jude has launched a pilot program to identify suitable manufacturers and deliver effective generic forms of vital childhood cancer medicines to six countries. Over the next few years, this program aims to expand to between 40 and 50 countries.

The Way Forward

Oncologists like Renner hope that the WHO/St. Jude initiative will lead to a certified list of WHO-vetted drugmakers. "When the first generics were produced of HIV antiretroviral medications, the companies all had WHO pre-qualification, so every country knew that they were getting the right drugs and they were made well," she said. "We need the same thing for childhood cancer medicines. A database which national pharmacies across Africa can access and see that if you buy from this particular manufacturer, they're certified as being WHO standard."However, not every country supports the idea of receiving donations through the WHO/St. Jude partnership. Some countries prefer to create their own vetting processes. Senegal, for example, is not on the initial list of nations set to receive drugs. Dr. Niang believes that the best approach would be for foreign donors to create pharmacovigilance laboratories to screen cancer medicines on behalf of each African region.In conclusion, the battle against contaminated and low-quality cancer drugs for children is a complex global issue that requires international cooperation and stricter quality control measures. While progress is being made through initiatives like the WHO/St. Jude partnership, there is still a long way to go in ensuring that all children have access to safe and effective cancer treatments.