The need for preventive drugs and vaccines in global cancer

In developing countries up to 23 of malignan cies are

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In developing countries, up to 23% of malignan- cies are caused by infectious agents, including hepatitis B and C virus (liver cancer), human papillomaviruses (cervical and anorectal cancers), and Helicobacter pylori (stomach cancer). Vaccina- tions and drugs are essential tools in preventing and treating these cancers. The disparities between affluent and poor countries are made worse because of a lack of access to drugs and vaccines, as well as the difference in nutrition and sanitation. Effective drug treatment exists for most of the leading infectious diseases, including HIV/AIDS, malaria, tuberculosis and diarrhoeal diseases. The WHO estimates that currently one-third of the world’s population lacks access to essential drugs, with this figure rising to over 50% in the poorest parts of Africa and Asia (WHO, 2000). Historically, drugs and vaccines have become available through an informal division of responsibilities between public entities and private companies, and undertaking activities in accordance with their mandates or motivations. This division of labour constitutes a poorly defined partnership in which outcomes derived by different priorities have never been explicitly negotiated. In the more economically advanced countries, it is generally regarded success- ful, having led to the availability of a broad range of effective anticancer drugs, and vaccines for certain infectious agents have been developed. However, this kind of system is not particularly responsive to the specific needs of chemoprevention, nor to the needs of world’s poorest populations. Despite the great discoveries and medical ad- vances during the last 50 years, there are still substantial differences between rich and poor countries and even between the rich and the poor within wealthy countries. As documented by the WHO in `The global burden of disease’, grouping nations by geographic areas or by economic status reveals huge differences, not only in years of life lost to disease, but also in years of life impaired by disabilities (WHO, 2000). One reason why progress has not been more rapid is that investigation of diseases that mainly affect poor people, especially from poor countries, tends to be neglected in research efforts, which are largely done in rich countries. Even when science has found solutions to diseases, it often fails to deliver, especially to the poor. One important reason for this is the cost of healthcare; poor transportation and communication systems and the size and distribution of the population in less affluent countries; and illiteracy and inadequate instruction about healthy habits, especially to women; all of these factors make it difficult to deliver adequate healthcare . The example of HIV/AIDS in sub-Saharan Africa is illustrative. Because HIV/AIDS also affects advanced economies, albeit on a smaller scale, a major investment in research has produced an astounding set of discoveries: isolation of the viral cause of AIDS; definition of the viral compo- nents required for growth of HIV; and development of drugs that inhibit those components, suppress the virus and restore health to most patients. But
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