Programme of Action for Cancer Therapy (PACT)

1. Building SustainableCancer Control Capacity and Infrastructurein Developing CountriesPresentation to IAEA Seminar for Diplomats6-7 Feb 2007Massoud SamieiHead, PACT Programme Office Programme of Action for Cancer Therapy (PACT) Contact: pact@iaea.org and Web: http://www-naweb.iaea.org/pact/

2. Access to Radiotherapy

3. A “PACT” with Developing Countries • PACT’s primary goal is to enable low and middle income countries to: • introduce or expand existing infrastructure and capacity in radiotherapy, in a sustainable manner • improve or accelerate widespread access to effective radiotherapy services as an essential part of multidisciplinary cancer care

4. Expanding Global Radiotherapy Access Expanding radiotherapy access will not achieve maximum clinical or public health value without paying attention to the following facts: • 70-80% of all patients treated with radiotherapy in low and middle income nations today are palliated because of late detection • Radiotherapy is being employed to palliate potentially curable patients if they had been detected earlier • Without simultaneous expansion of prevention efforts, any radiotherapy investment will be overwhelmed by demand as the cancer burden expands

5. Maximize the Impact of Interventions including Radiotherapy through Balanced Investments across the System 5 11

6. Cancer Control Objectives • Preventcurrently preventable cancer – one third of all cancers • Curecurrently curable cancers – another third of all cancers • Reduceunnecessary pain and suffering in all • This iscurrent state-of-the-art cancer controlthatdoes not exist in most developing countries

7. PACT’s Basic Strategy • To move the Agency’s cancer-related programmes to a public health model where our radiotherapy intervention is integrated into a broad cancer capacity building effort that exploits prevention and early detection synergies to maximise the public health impact of treatment investments

8. Resource Mobilization Data Collection and Needs Assessment Joint Programme Design Joint Proposal Development Partnership Building Fundraising

9. Tata Memorial Centre Private Sector Implementation Strategy • Joint Global Efforts for “New Money” • To formulate a framework for PACT within a multidisciplinary programme strategy to secure critically needed alliances in order to drive forward programme development and fundraisingthrough the implementation of specific pilot projects • Implementation in several stages

10. Stages of PACT Implementation • Comprehensive cancer control needs assessment with partners (imPACT reviews) • Establish Pilot Projects through PACT Model Demonstration Sites and use them for incremental fundraising • Regional cancer training networks for capacity building • Move towards a global alliance and fund

11. Stage 1:imPACT Review • imPACT (integrated missions of PACT) is a multi-disciplinary national needs assessment of all aspects of cancer • imPACT is multi-stakeholder, involving national authorities and public-private partners working with PACT (WHO and others) • Outcome: • National Cancer Strategy • Action Plans • PACT Model Demonstration Sites

12. Stage 2:PACT Model Demonstration Sites (PMDS) • Establish PMDS projects in each of the six WHO regions: • Albania, Nicaragua, Sri Lanka, Tanzania, Vietnam, Yemen • Areas of Activity: • Cancer Control Planning • Knowledge Transfer and Multidisciplinary Education and Training • Programme Evaluation • Society Building • Cancer Registration • Prevention • Early Detection and Diagnosis • Treatment • Palliative Care • Fundraising

13. Stage 2:Objectives of PMDS • Develop multidisciplinary cancer capacity building projects • Illustrate feasibility and value of an interagency cancer control alliance • Complement RT expansion with investments in cancer registration, prevention, early detection, palliation, and civil society • Demonstrate to donors the value of multi-disciplinary cancer capacity building • Use PMDS projects as a basis for fundraising • Create policy, and raise donor and public awareness until regional/global initiatives can be funded • Leverage successful PMDS execution with major donors for regional fundraising for larger scale efforts • Cooperate with Member States to establishcentres of competence and excellence

14. Stage 3: Regional Capacity Building • Lack of adequate human resources is a critical bottleneck which: • Leads to suboptimal utilization of existing radiotherapy facilities and delivery of cancer public health services • Constrains ability to expand services locally and nationally • Puts new investments at risk due to retirement or migration • Limits establishment of other regional treatment centres • Need to create and accelerate multidisciplinary regional cancer training networks • Use South-South and North-South mentoring

15. Stage 3:Regional Capacity Building • Deploy modern IT tools and rely on existing recognised centres • Create national and regional self-sufficiency (centres of competence/excellence) • Train multidisciplinary personnel for replacement personnel as well as creation/expansion of facilities • Develop new facilities and tools for RT and other cancer training as needed • Serve as regional hubs or centres of excellence for multidisciplinary cancer training among neighbours • Use as a basis for regional/global fundraising initiatives

16. PACT By Region Africa (AFRO & EMRO) Potential Centres of Excellence or Mentors: Morocco, Egypt, Ghana, South Africa, Algeria, Tunisia, Tanzania imPACT and First Executions: Tanzania, Ghana Assistance Requests Received: Cameroon, Niger, Senegal, Kenya, Eritrea Asia (WPRO, SEARO & EMRO) Potential Centres of Excellence or Mentors: India, Thailand, Jordan, Iran, Syria, Philippines, Singapore, Australia, Japan, Israel, New Zealand, Rep Korea imPACTand First Executions: Sri Lanka, Vietnam Preliminary imPACT: Yemen Assistance Requests Received: Afghanistan, Syria

17. PACT By Region Latin America (PAHO) Potential Centres of Excellence or Mentors: Brazil, Colombia, Mexico, Argentina, Cuba, Peru, Uruguay, Chile, Canada, United States imPACTand First Executions: Nicaragua Preliminary imPACT: Peru Assistance Requests Received: Bolivia, El Salvador, Colombia, Costa Rica, Panama, Dominican Republic, Haiti, Venezuela Europe Potential Centres of Excellence or Mentors: Czech Republic, Greece, Poland, Hungary, Monaco, Germany, Russia, Spain, Sweden, France, UK imPACTand First Executions: Albania Preliminary imPACT: Georgia, Montenegro Assistance Requests Received: Moldova, Uzbekistan, Kyrgyzstan, Romania

18. Nobel Peace Prize Institutes • Special 5-day events in three regions to: • Draw the attention of society to why comprehensive cancer control is so essential for enhancing the effectiveness of cancer treatment by radiotherapy • Encourage the planning for and investments in Regional Cancer Training Institutes • Participation of policy makers and professionals • Multidisciplinary cancer lecturers Next Event: 23-27 April in Buenos Aires

19. PACT 2007-2009 Plans • Consolidate partnerships • Execution of 3 PMDS (Albania, Nicaragua, Tanzania) • Initiate another 3 PMDS (Sri Lanka, Vietnam and Yemen) • Solicit equipment, products and services donations • Fundraising campaign for PMDS • Proposals on cervical and breast cancer • Sub-Saharan regional capacity building proposal UK • Cancer Therapy for Africa EU • Individual country and donor matching

20. Summary of Resources 2005-07 • Over $2.4 million by IAEA Member States • US NCI $200,000 in-kind • OPEC Fund $500,000 Grant approved • Up to 3 new Theratron cobalt machines MDS Nordion • One new Bhabhatron cobalt from India • Pledge for 13Mev cyclotron from KIRAMS Korea • Offer of Cost-Free staff/experts for PACT

21. PACT: PACT Expected Outcomes • Placing cancer on global health agenda • Building strategic public-private partnerships • Encouraging integrated national cancer control plans and programmes • Raising new funding for cancer care programmes including radiotherapy services • Promoting affordable cancer therapy for everyone • Developing regional cancer training networks • Moving towards a global alliance and fund to fight cancer PACT: pact@iaea.org

22. More Information: pact@iaea.org and http://www.iaea.org/PACT/