Cancer Care in Pandemic Times: Building Inclusive Local Health Security in Africa and India: Cancer Care in Africa and India (International Political Economy Series)

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. Preface and Acknowledgements Contents Editors and Contributors About the Editors Contributors Acronyms List of Figures List of Tables 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