University of North Carolina at Chapel Hill

Cancer Control at National Scale in Malawi


We will achieve unprecedented ’50-50-50-50’ targets in Malawi to durably address global cancer disparities in LMICs and save tens of thousands of Malawian lives.

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Project Summary

Cancer is the leading cause of death in low and middle-income countries (LMICs), and the disease for which global disparities are greatest. While high-cost, high-intensity treatments have led to unprecedented survival in resource-rich settings, even low-cost, low-intensity interventions are unavailable in most LMICs. We are committed to eliminating these disparities in one of the poorest countries in the world, Malawi. Building on our preeminent LMIC cancer program and Malawi’s region-leading progress toward UNAIDS ‘90-90-90’ targets for HIV, we will develop a national platform to achieve ambitious, unprecedented ’50-50- 50-50’ targets for cancer prevention: (1) 50% reduction in preventable cancers; (2) 50% of cancers diagnosed at early stages; (3) 50% of patients with curable cancers in remission at two years; (4) 50% of patients with incurable cancers receiving effective palliation. These efforts will create large-scale operational evidence, catalytic energy, and a stable coalition to achieve durable progress for cancer in LMICs.

Problem Statement

The global economic toll of cancer is >$1 trillion annually, greater than for any other disease. Worldwide, 70% of cancer deaths occur in LMICs, where cancer causes more deaths than HIV, tuberculosis, and malaria combined. Additionally, >2 million lives could be saved each year in LMICs with appropriate investments in cancer control. However, there is no large-scale international effort to address cancer in LMICs that is remotely comparable to what has been accomplished for HIV through the Global Fund, PEPFAR, and other initiatives, with respect to funding levels, prioritization, coordination, or implementation. Additionally, cancer is the disease for which global disparities are greatest, and in Malawi, basic cancer control elements remain either absent or severely limited. The country suffers from only four pathologists, three oncologists, no radiotherapy, limited early detection, and erratic supply of essential medicines for treatment and palliation. Moreover, given competing priorities and funding sources for various cancer types, and diverse opportunities for intervention (prevention, early detection, treatment, palliation), there is no implementation framework to guide the optimal, evidence-based translation of what is known, with defined deliverables and metrics for evaluation, toward an effective and comprehensive cancer control strategy that best serves the Malawian people. Our proposal will leverage the national cancer research program we have built in Malawi, to develop a parallel implementation framework. This will inform and catalyze future development initiatives to address global cancer burden, in a manner that is coordinated, comprehensive, and intensely focused on evidence-based application of finite resources to maximize population-level impact.

Solution Overview

Annual health expenditure per capita is $9,000 in the US). By adding ~$1 per capita per year ($100 million over 5 years for 18 million Malawians), we will achieve unprecedented ’50-50-50-50’ targets for cancer control: (1) 50% reduction in preventable cancers; (2) 50% of cancers diagnosed at early stages; (3) 50% of patients with curable cancers in remission at two years; (4) 50% of patients with incurable cancers receiving effective palliation. The ’50-50-50-50’ metrics will be principally assessed and applied across the five most common cancers in Malawi: Kaposi sarcoma, cervical cancer, esophageal cancer, breast cancer, lymphoma. Together, these account for 63% of all cancers in Malawi. Relative to alternative, previously proposed solutions, our approach addresses the lack of coordination, inefficiencies, and skewed prioritization resulting from piecemeal cancer control efforts that are driven by diverse funders, focused on various cancers, and subject to diverse political pressures. We will develop and implement a coordinated national package of cancer control interventions, informed by scientific, technical, and programmatic assistance from within and outside Malawi, focused on achievability and translating proven strategies to a population level. Effects will be sustained for decades by creating a stable, multilateral, coordinated research translation framework for cancer with high-level Malawian ownership, training and capacity building and handover to Malawi partners, sustained benefits from focused interventions on specific cancer types, operational insights provided to other LMIC cancer control programs, and economic impact data provided to donors making future commitments for cancer control in LMICs.

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Project Funders

  • United States National Institutes of Health 1991 - Ongoing
  • University of North Carolina at Chapel Hill

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