In 2018, the World Health Organization (WHO) launched a bold new initiative with St Jude Children’s Research Hospital in the United States, aiming to save one million more children with cancer by 2030.

The Global Initiative for Childhood Cancer (GICC) aims to increase the capacity of countries to provide quality services for children with cancer and to increase the prioritisation of childhood cancer at global and national levels.

The intent is to improve the treatment for these children and achieve at least a 60% survival rate for childhood cancers globally by 2030, while reducing suffering for all.

The catchphrase “60 by 30” was created both as a target, as well as a call to action.

At present, there is a significant discrepancy between the survival of children in high-income countries (HIC, or developed nations) compared to low- and middle-income countries (LMIC).

For example, in acute lymphoblastic leukaemia, which is the commonest cancer in those aged less than 18 years, the survival rate for children in developed countries is close to 95%, but can be as low as 20% to 30% in resource-challenged LMICs.

This global initiative harnesses the collective efforts of the WHO, which is the initiative’s founding technical, funding and implementation partner, St Jude Children’s Research Hospital (the WHO Collaborating Centre for Childhood Cancer), as well as global organisations like SIOP (International Society of Paediatric Oncology) and Childhood Cancer International, working with local partners throughout the world.

Together, more than 70 countries have committed to identify and address the issues that cause current health inequalities and to help scale up national health system capacities to overcome the obstacles faced in reaching “60 by 30”.

Six childhood cancers

The GICC has selected six index cancers as starting points of focus.

These are all highly curable cancers, found in all countries and represent 50% to 60% of all childhood cancers.

They are:

• Acute lymphoblastic leukaemia
• Burkitt lymphoma
• Hodgkin lymphoma
• Retinoblastoma
• Wilms’ tumour, and
• Low-grade glioma – a form of brain tumour.

The GICC is guided by the CureAll framework, a strategic and practical approach to implementing the initiative, with each letter capturing a distinct dimension or set of interventions to integrate improvements across existing health systems.

These include the development of centres of excellence with quality assurance, efforts to protect families from financial catastrophe, access to evidence- based diagnostics and treatment, and data for decision-making.

The first in-person regional meeting in the WHO Western Pacific region (which includes Malaysia) to discuss the GICC since the start of the Covid-19 pandemic was held in September (2023) in Kuala Lumpur.

The paediatric oncology team from Universiti Malaya served as the local hosts.

Alongside the team from St Jude and representatives from the Health Ministry and WHO, were 48 paediatric oncology clinician leaders from 15 countries around the Asia Pacific region.

Over the three days of the meeting, challenges faced in the region were identified and strategies needed to amplify this work in the region were discussed.

The key themes that emerged from the discussed strategies were solution-sharing networks, training and medicine access.

Working groups were established to identify medical care networks of neighbouring countries that could provide training or support to oncology teams as they try to improve their skills and knowledge in the clinical management of these complex patients.

There were also discussions to address ongoing issues surrounding the availability of medicines that would directly improve the survival and outcome of childhood cancer patients.

In the middle

Malaysia is in a unique position where there are several paediatric oncology treatment centres across the country and a health system that provides effective care to patients (both from a medical care perspective, as well as financial and social support).The catchphrase '60 by 30' was created both as a target to achieve at least a 60% survival rate for childhood cancers globally by 2030, as well as a call to action. — Freepik

Despite having a paediatric oncologist to patient ratio of approximately 1:35 (ideal ratio is 1:7 new cases), the quality of cancer care for children in this country is generally good.

This is reflected in the survival rates, e.g. survival of children with acute lymphoblastic leukaemia in Malaysia is between 75% to 80% despite not having a standardised national treatment protocol.

However, issues relevant to the Malaysian childhood cancer health system remain.

It is in a position where high-level support in diagnostics and expertise in the form of advice from international colleagues and networks are still needed.

Given the relatively small number of children with a particular cancer in any single facility, childhood cancer also continues to present challenges where teams in Malaysia, as elsewhere, continue to benefit from being part of a global community with opportunities to collaborate in studies, and explore tools and solutions at scale.

This includes the St Jude Global Alliance, which connects more than 200 institutional and foundation partners around the world.

Nevertheless, there is local capability to help train and support some of the health professionals from neighbouring countries to play our role in this global village.

Ensuring best performance

As a national health system, Malaysia requires a robust process to evaluate and monitor performance, be it for therapeutic protocols, efficacy of medications or others.

This would help ensure that information systems and data recording is continued at a high level, and processes are in place for quality assurance and can be easily exchanged with other centres of care to ensure best practices.

Access to quality medication has become a particular issue.

A specific example is the medication L-asparaginase, which is an essential component in the chemotherapy regimen for acute lymphoblastic leukaemia.

The supply of this drug has recently been threatened due to the cessation of production by its main supplier and alternative biosimilars (almost identical biological products to the original biologic drug) entering the market.

Unfortunately, some alternative products have not demonstrated the expected level of effectiveness, leading to negative impact on patient outcomes.

Unsurprisingly, the inadequate supply of this important anti-leukaemia agent, and worse still, the potential emergence of substandard substitutes, has caused grave concern in the paediatric oncology fraternity around the world.

Currently, concerted efforts have been made in identifying affected zones, gathering evidence, carrying out quality assurance processes and verifying drug efficacy.

To its end, collective efforts in sharing and verifying information, creating platforms for open discussion and teaching, improving drug access and provenance, as well as working as a single team on a global scale, will enable any child anywhere in the world who is undergoing cancer therapy to achieve the best outcome he or she deserves.

Hope for all

Every year about 400,000 children around the world are diagnosed with cancer.

Every hour, 400 children die from cancer.

The recent Kuala Lumpur meeting opens new doors for many more to play their role in this global challenge.

Through the efforts of WHO, St Jude Global and many international partners, it is hoped that children with cancer, wherever they may be, may have a chance of a cure.

The journey ahead may be arduous, but the clarion call has been made: “Dream Big, Cure All”.

Professor Dr Hany Ariffin is a senior consultant paediatric oncologist and Universiti Malaya Medical Centre Paediatric Haematology-Oncology and Blood & Marrow Transplantation head. Dr Catherine G. Lam is a paediatric haematologist/oncologist and WHO Collaborating Centre for Childhood Cancer director. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.