It took Eve Namisango four years to find funding for a project close to her heart: researching ways to deliver dignified and more personalized care to patients with complex non-communicable diseases, such as cancer, in settings where resources are scarce. Uganda, where Namisango is based as a clinical epidemiologist and palliative care expert, has just one specialized cancer-care centre. “We need evidence to shape our care,” says Namisango, yet finding grants to produce that evidence is extremely difficult.
With colleagues in Uganda, the United Kingdom and Zimbabwe, Namisango won a £180,000 (US$235,000) grant from the Medical Research Council, one of the United Kingdom’s national science funders, which enabled them to interview patients, caregivers and health-care professionals as part of a study into what patient-centred care might look like in Africa, and how it can be implemented. “We were grateful to get that grant,” says Namisango, who leads research at the African Palliative Care Association, a non-profit organization based in Kampala that supports the integration of palliative care into health systems across Africa.
Although cancer is a rapidly growing health concern in Africa, it is significantly under-studied. But as funders and scientists have become more aware of the need for equity and representation in medical research, African researchers are hopeful that change will come. “I wouldn’t say we are where we want to be, but people are becoming more aware of these things,” says Fidel Rubagumya, an oncologist at Rwanda Military Hospital in Kigali.Nature Index 2023 Cancer
Africa’s cancer trajectory differs greatly from trends seen in high-income countries. The cancer death rate in the United States, for example, has fallen by one-third over the past three decades, according to a report published in January1, which cited advances in treatment and diagnosis and a decline in smoking as contributing factors. Sub-Saharan Africa, by comparison, expects to see cancer deaths double to reach 1 million per year by 20302.
Research has not kept up with Africa’s cancer crisis. A 2022 study3 led by Miriam Mutebi, a breast surgical oncologist at Aga Khan University in Nairobi, found that African countries produced five times more research on infectious diseases such as malaria, tuberculosis and HIV/AIDS between 2009 and 2020 than they did on cancer. The number of African cancer papers did increase rapidly over this time, by about 15% annually, but authorship was concentrated in the richest African countries: Egypt published nearly half (48%) of Africa’s cancer papers and South Africa and Nigeria produced 14% and 6%, respectively.
The study also found that Africans, on average, do not lead the research coming out of the continent. Among the more than 5,000 international cancer papers with at least one author from sub-Saharan Africa published during the study period, only 42% had African first authors, and 30% had African last authors.
Several factors contribute to this imbalance. Cancer research lacks domestic support across most of sub-Saharan Africa, says Violet Kayamba, a gastroenterologist who studies stomach cancers at the University of Zambia in Lusaka. This translates into a lack of funding and infrastructure for locally relevant priorities, as well as a lack of mentors for young Africans wanting to move into cancer research. “We need our local governments to take ownership and to take the lead in supporting African scientists,” says Kayamba.
Yaw Bediako, an immunologist and founder of Yemaachi Biotech, a company based in Accra, Ghana, believes government support is a small part of the solution. To tackle cancer, he says, Africa’s private sector must join the endeavour. At Yemaachi, Bediako is developing cancer diagnostics and treatments tailored to Africans, and he describes the limited official data on patients with cancer across Africa as a major challenge. “We don’t know how many people have cancer,” says Bediako. This prompted Yemaachi to build its own data set — something that similar companies in high-income settings with more robust cancer data do not have to do. “Because we have certain structural challenges on this end, it is difficult for us to move at the pace that scientists in the United Kingdom or United States can move,” says Bediako.
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