Cancer

As Cancer Tears Through Africa, Drug Makers Draw Up a Battle Plan

Paul Mugumya, 7, lying in the Kawempe Home Care facility for children in Kampala, Uganda, had three hernia operations before surgeons realized he had a blistering football-shaped tumor. Cancers — many of them treatable — kill about 450,000 Africans a year.

NAIROBI, Kenya — In a remarkable initiative modeled on the campaign against AIDS in Africa, two major pharmaceutical companies, working with the American Cancer Society, will steeply discount the prices of cancer medicines in Africa.

Under the new agreement, the companies — Pfizer, based in New York, and Cipla, based in Mumbai — have promised to charge rock-bottom prices for 16 common chemotherapy drugs. The deal, initially offered to a half-dozen countries, is expected to bring lifesaving treatment to tens of thousands who would otherwise die.

Pfizer said its prices would be just above its own manufacturing costs. Cipla said it would sell some pills for 50 cents and some infusions for $10, a fraction of what they cost in wealthy countries.

The price-cut agreement comes with a bonus: Top American oncologists will simplify complex cancer-treatment guidelines for underequipped African hospitals, and a corps of IBM programmers will build those guidelines into an online tool available to any oncologist with an internet connection.

“Reading this gave me goose bumps,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said after seeing an outline of the deal. “I think this is a phenomenal idea, and I think it has a good chance of working,”

It reminded him, he said, of his work in 2002 helping design the President’s Emergency Plan for AIDS Relief. Pepfar, as it is known, has been a success: over 14 million Africans are now on H.I.V. drugs, many of them thanks to American aid.

“It’s exactly what we went through then,” Dr. Fauci said. “Finding the countries with the highest burden, figuring out how to approach treatment differently in each one, and getting the prices down.”

Cancer now kills about 450,000 Africans a year. By 2030, it will kill almost 1 million annually, the World Health Organization predicts. The most common African cancers are the most treatable, including breast, cervical and prostate tumors.

But here they are often lethal. In the United States, 90 percent of women with breast cancer survive five years. In Uganda, only 46 percent do; in Gambia, a mere 12 percent do.

Cancer wards at Mulago Hospital in Kampala, Uganda. Cancers in most of Africa are more lethal than in the West. In the United States, 90 percent of women with breast cancer survive five years; here, only 46 percent do.
Patients receiving chemotherapy at Mulago Hospital. In a breakthrough, two major pharmaceutical companies will work with the American Cancer Society to drastically reduce the price of cancer medicines in six African countries, including Uganda.

The complicated deal was struck by the cancer society, along with the Clinton Health Access Initiative, founded in 2002 by former President Bill Clinton; IBM; the National Comprehensive Cancer Network, an alliance of top American cancer hospitals; and the African Cancer Coalition, a network of 32 oncologists in 11 African countries.

“I have a friend back home whose daughter has cancer, and I can’t believe the outpouring of support she got, like special lacrosse games and T-shirts,” said Megan O’Brien, the cancer society’s director of global cancer treatment and the chief organizer of the deal.

“There’s nothing like that in Africa — but I can save a child with leukemia for $300. That’s a disease that has a 90 percent cure rate in America, and a 90 percent death rate in Africa.”

As more Africans survive into middle or old age, cancer rates are climbing rapidly. But most countries here are ill-equipped for the fight.

There are few oncologists, radiotherapy machines or advanced surgical suites. Tumors are often misdiagnosed or even blamed on witchcraft, and 80 percent go undetected until they have spread to lymph nodes or distant organs.

Doctors often see cases far worse than Western doctors ever do: babies with growths half as big as their heads, women with breast tumors the size of softballs that have broken the skin, putrid and weeping blood.

On a recent day in July, Brenda Nakisuyi, 17, sat silent and despondent in a darkened room at Kawempe Home Care, a cancer hostel for children in Kampala, Uganda.

Burkitt lymphoma had torn open her left cheek, leaving a crater that looked as if a cherry bomb had exploded in her mouth.

“In our village, they know malaria, they know HIV, they know typhoid — but they don’t know cancer,” said her mother, Florence Namwase, 48. “People said Brenda was bewitched, and they began to shun her.”

Brenda Nakisuyi, who has Burkitt lymphoma, at Kawempe Home Care in Kampala.

Many Africans who get cancer assume they are doomed.

“I came here to see if I was condemned to death,” said a wry George Odongo Ogola, 73, a retired high school principal being treated for prostate cancer at the M.P. Shah Hospital in Nairobi.

“But the doctor says they got it in a nascent stage and gave me a 99.9 percent chance that it will be contained,” he added. “I brought all my children and their wives so they could hear this. Here, once you are diagnosed with cancer, they treat you like a dead person.”

Even doctors — especially rural ones — may be slow to recognize the disease.

Paul Mugumya, a lively 7-year-old in the Kawempe hostel, had three hernia operations before surgeons realized that something else was swelling his abdomen, which now has a football-shaped tumor with tangerine-sized blisters on it.

And Flavia Anyesi, 4, who stood in her crib at the Uganda Cancer Institute in pink and white hair beads matching her pink nightgown, was first sent to a dentist to have a tooth pulled, said her mother, Teopista Nafuna.

Only when Flavia’s jaw kept swelling did doctors realize something else was amiss. She, too, has Burkitt lymphoma.

Even when in agony, victims may be too poor to travel for treatment. Patients who find the money to reach urban hospitals often sleep on mats on the verandas or in parks between their daily infusions, or while waiting for biopsy results, which can take weeks.

Flavia Anyesi, 4, at Mulago Hospital in Kampala, Uganda, has Burkitt lymphoma. She was first sent to a dentist to have a tooth pulled, but continued swelling in her jaw indicated to doctors that something else was wrong.

“When you are not well and you are sleeping under trees, can you really rest in peace?” asked Proscovia Mutesi, 50, a former school secretary who has lost an eye and part of her jaw to cancer.

Sitting on the bed she recently found at the Cancer Charity Foundation, a Kampala adult hostel, she recounted a seven-year battle to slow down the tumor gnawing away her face.

“I have struggled,” she said. In some years, she was able to raise $110 for a course of chemo or $85 for radiation.

“But in some, I did not have a coin. And then the radiation machine collapsed.”

If there is little treatment, it is partly because there are so few cancer specialists.

Ethiopia, one of the six countries covered by the new agreement, has only four oncologists for its 100 million citizens. Nigeria has about 40 for its population of 186 million.

Uganda’s national hospital campus boasts a cancer institute that was founded in 1967, and it has a spotless new clinical trial building erected by the…