Some 50% of countries surveyed by WHO have had cancer services partially or completely disruptive because of the pandemic, according to new WHO data released just ahead of World Cancer Day on Thursday. There have also been significant reductions in cancer-related research and clinical trials, said Andre Ilbawi, speaking at a press briefing in Geneva on Tuesday. 

“To state it simply, the consequences of the pandemic on cancer control efforts have been profound,” said WHO’s Dr Ilbawi at the Tuesday briefing in Geneva. 

Meanwhile, in an open letter to national heads of state, WHO, UNICEF, Norway’s Minister of International Development and the NCD Alliance, called for massive investments in prevention and treatment of non-communicable disease and mental health – in order to “build back better” post pandemic. 

The letter, Building Back Better: Investing in healthy populations and resilient health systems for NCDs  and Mental Health published in Foresight Global Health, was co-signed by WHO’s Director General Dr Tedros Adhanom Ghebreyesus, Director-General; UNICEF’s Executive Director Henrietta Fore, Dag-Inge Ulstein, Minister of International Development, Norway and Todd Harper, President, NCD Alliance. 

The letter cites data that shows people living with these NCDs are at a higher risk of severe complications from COVID-19, are more likely to be hospitalized, and are at a higher risk of death.

WHO – Cancer Cases Rising Globally Unabated

In terms of cancer, one of the big NCD killers, recent trends demonstrate how quickly the burden is rising, WHO said in its briefing. In 2000, there were an estimated 10.1 mil compared to nearly 20 million in 2020. Based on demographic projections alone, by 2040, we anticipate there will be 30 million cases per year.

Cancer is now the second leading cause of death globally, now responsible for more than one in six total deaths. Breast cancer is now the most commonly occurring cancer worldwide (12% of new cases), followed by lung and colorectal cancers. Currently, one in five people develop cancer during their lifetime. 

The burden of cancer can be lessened with global efforts. The theme of this year’s World Cancer Day – “I can and I will” – serves as a reminder that each of us can and must play a role in reducing the impact of cancer, said Ilbawi. 

While the COVID-19 pandemic has disrupted cancer services around the world, governments have begun to return to the fundamentals of cancer care – promoting early diagnosis, focusing on essential services, developing innovative models to increase care through telemedicine, and providing care as close to home as possible.

The WHO is prioritizing several initiatives calling for collective action and collaboration in combating the rise of cancer for World Cancer Day:

1. Focusing on breast cancer – The WHO is hosting the first global consultation of breast cancer with the anticipation of launching on International Women’s Day 2021. 
2. Eliminating cancer as a life threatening disease – WHO Europe is calling for a pan-European movement, United Action Against Cancer, that will build on a set of signature solutions. 
3. Highlighting risk factors to cancer – One environmental risk factor, radon, an odorless gas found in residential buildings, is estimated to have caused 84000 deaths by lung cancers. In some countries, it is among the leading causes of lung cancers. 
4. Emphasizing current WHO initiatives on cancers – In November 2020, governments endorsed the global strategy to accelerate the elimination of cervical cancer as a public health problem. This would be the first opportunity to eliminate cancer and save 4.5 million lives. Additionally, the WHO is releasing a technical package for the Global Initiative for Childhood Cancer, on International Childhood Cancer Day, 15 February. This initiative is active in more than 30 countries, working to improve survival and quality of life for children with cancer. 

 Foresight Report – COVID & NCDs  

In terms of the specific links of COVID with the broader array of NCDs, the Foresight letter also notes that health services disruptions will result in a longer-term upsurge in deaths from NCDs which overstretched health systems will struggle to manage.  

In addition, data has shown that people living with NCDs are at a higher risk of severe complications from COVID-19, are more likely to be hospitalized, and are at a higher risk of death. Emerging studies of critically ill COVID-19 patients tell the same story around the world –  

• Of those dying of COVID-19 in Italian hospitals, 67% were people living with hypertension and 31% with diabetes. 
• In Spain, 43% of people who developed COVID-19 disease were living with cardiovascular diseases.
• In Indonesia, 16% of reported COVID-19 deaths were people living with diabetes.  In Mexico, of deaths from COVID-19 in the Indigenous population, diabetes was the most frequent co-morbidity (30%).
• Mortality has been high in long-term care facilities for people with dementia and other mental health conditions. Those who are lucky enough to recover from COVID-19 may well face additional long-term health challenges.
• In the Netherlands, the number of people newly diagnosed with cancer dropped by 25%. In India, 30% fewer cardiac emergencies reached health facilities.  

“NCDs are the largest, and yet most underfunded, public health issue globally, where the most lives could be saved. For too long they have been overlooked by leaders and policymakers,” said the co-signers of the letter. 

The result of underfunding is that more than one in five people now live with one or more NCDs. But the pandemic has exposed even more uncomfortable truths – for these people living with NCDs, people living in poverty, people in institutions, and minority groups who are paying the price for government underspending on health around the world. 

People are facing the virus at uneven starting points. Exposure to COVID-19 and its level of severity is strongly linked to the growth and development of children, where you live and the social, political, economic and environmental inequalities that have been allowed to fester in our societies, says the authors. 

Strategies & Solutions – Invest In Prevention – Early In Life 

The Foresight letter calls on leaders and policymakers to not “shy away from the hard lessons of COVID-19”, and to include NCDs in national COVID-19 response plans:.

“It is clear that the world cannot return to the way it was pre-COVID-19. The pandemic must be a wake-up call for governments and leaders to step up in their investments and ensure that there is prevention, screening, early diagnosis, and appropriate treatment of NCDs, especially for those disproportionately affected.

“It’s high time governments invest in health and prevention, starting from early in life. COVID-19 has exposed the damage done by neglecting NCDs and reducing public spending over the years on health, prevention, and essential public health services in many countries.

“We need to invest in resilience – for health services and healthy societies – and to dismantle long-standing disparities in our societies. And we need strong social protection systems and policies in place to protect vulnerable communities and reduce inequalities.”

Investing in prevention early in life can also reduce the NCD burden, the authors state. Child and adolescent exposure to air pollutants, tobacco, alcohol, drugs, and poor diets that leaves them predisposed to NCDs.

Strategies include laws and economic measures to reduce salt, sugar, and trans fats in foods that growing children consume; promoting physical activity; urban planning that allows for safe physical activity; enabling clean public transportation and other policies to reduce air pollution; and price and marketing measures on tobacco and alcohol. 

Finally, there must also be investments in mental health and well-being. The COVID-19 pandemic has resulted in increases in unemployment, missed education, social isolation, and risk of family violence. “The associated distress coupled with the uncertainty as to when normal life can be resumed, has greatly impacted people’s short-term and long-term mental health. This is an opportunity to build mental health services for all people in need,” the letter states, concluding that –

“Investing in NCDs and mental health is an investment in a better future – the future of people, health security and economic stability.” 

Image Credits: Rhoda Baer/National Cancer Institute, WHO – C de Bode, World Health Organization, Global Health Estimates , WHO, City of Fortaleza, World Health Organization .