More than a decade after their Peace Corps-like initiative changed the landscape for pediatric AIDS care in Africa, Baylor College of Medicine and Texas Children’s Hospital are readying to take the fight to cancers afflicting the continent’s children.
At a news conference in Botswana on Tuesday, the two Houston institutions unveiled a plan to create a network of pediatric cancer care facilities in southern and east Africa, where the disease is little treated and fatal the vast majority of the time.
The initiative represents a $100 million commitment, $50 million of which is being donated by Bristol-Myers Squibb’s philanthropic foundation.
“This may be the silver lining to come out of the AIDS pandemic,” said Dr. Mark Kline, Texas Children’s physician-in-chief and the architect of the Baylor International Pediatric AIDS Initiative.
“We learned a tremendous amount about how to deliver care to people in Africa because of the HIV-AIDS epidemic. The great thing is, it all can be applied for cancer and other life-threatening conditions that up until now have largely been ignored.”
Cancer kills as many as 90 percent of the roughly 100,000 sub-Saharan children who develop the disease annually. In the U.S., by contrast, roughly 80 percent of the 15,000 children diagnosed annually are cured.
The difference in death rates is commonly attributed to an inadequate health care infrastructure and a significant lack of expert physicians and support staff trained to treat children with cancer. Most of the African pediatric patients are only diagnosed when the disease is in the late stages, when it is too late.
The initiative’s model, BIPAI, is considered one of the great U.S. health outreaches to the developing world. It began as a pilot program in Romania in 1995 and has since become the world’s largest university-based program dedicated to pediatric HIV-AIDS care globally, providing care in seven African countries, Colombia and Papua New Guinea.
It has treated 300,000 pediatric AIDS patients in sub-Saharan Africa and trained 52,000 health care professionals and is credited as the leading force behind reducing the number of pediatric AIDS cases in Africa from 650,000 in 2003 to less than 150,000 today.
Overlooked and sick
The new initiative was announced at the site of the program’s first planned center by Baylor and Texas Children’s doctors, Botswana President Seretse Khama Ian Khama and Bristol-Myers Squibb leaders. The Botswana government and the two Houston institutions last summer said they’d sign an agreement to build the center, located near the BIPAI clinic.
“Now that communicable diseases are being better treated here, it’s time to focus on non-communicable diseases,” Dr. Alan Anderson, a Baylor/Texas Children’s pediatric oncologist, said Monday from Botswana. “These are the overlooked sick children, the ones who are often never diagnosed and typically only are diagnosed when their parents think they have some other disease.”
BIPAI’s Botswana clinic, launched in Gaborone in 2003, was the initiative’s first such facility in Africa. Pediatric oncologists from Baylor and Texas Children’s have provided limited cancer care there for about 10 years, the first such program on the continent. Their new lodgings, like all of those planned for the program, will be a stand-alone center.
‘We have big ambitions’
The initiative, known as Global HOPE (Hematology-Oncology Pediatric Excellence), will also treat serious noncancerous blood disorders. Most pediatric cancers are leukemia or lymphoma, liquid tumors in the blood.
“This is absolutely a transformational opportunity for us to dramatically improve pediatric cancer care in Africa and change the landscape,” said Dr. David Poplack, director of Texas Children’s Cancer and Hematology Centers and professor of pediatrics at Baylor. “We have big ambitions.”
In all, in the program’s first five years, Baylor/Texas Children’s doctors hope to train an estimated 4,700 health care providers in Botswana, Malawi, Uganda and other African countries and treat more than 5,000 children. Most of the BIPAI sites currently have no more than a few pediatric oncologists, typically one.
In east Africa, an oncology fellowship program will be developed in Uganda, where all sub-specialists in the continent’s region will go to train. It will be the only such program in sub-Saharan Africa outside South Africa. A second fellowship program is planned for Malawi.
Early signs point to success
BIPAI benefited in the early part of the century from Bristol-Myers Squibb and other leading pharmaceutical companies making cutting-edge HIV-AIDS treatment available to African countries at highly discounted prices.
There are such plans for Global HOPE, but Poplack said the drugs that will be used are cheaper chemotherapies that the local governments can get for good prices from Asia and India. He said there may be need for more and better drugs as the initiative grows.
The two Houston institutions are hoping to raise $50 million in the U.S. through BIPAI.
The plan is for Global HOPE to partner as well with the governments of Malawi and Uganda and have centers at all BIPAI sites, which also include Angola, Liberia, Swaziland and Tanzania. Ultimately, the program will expand to other locations, said Poplack.
Poplack acknowledged that it will take time to build the program to desired levels. But he said the first returns, based mostly on some moderate ramping up that Baylor and Texas Children’s staffers have undertaken since the summer, are highly encouraging.
“I got a phone call recently relaying that the number of deaths in the hospital’s pediatric cancer unit is already less,” said Poplack. “Doctors and nurses there are asking, ‘What’s happening? We’re not seeing the number of deaths we usually do.’ “