KAWAHARA Norie, coordinator for the lecture series noted that this lecture had been pre-recorded and would be available to auditing students in an on-demand format. The lecture was recorded at the headquarters of Allm, Inc. in Tokyo.

  The central theme for today, “Elucidating the outlook for UHC from the potential of ICT networks,” is both timely and critical. In the wake of the global pandemic, our world has undergone tumultuous changes, plunging into what is now referred to as the era of “Polycrises,” characterized by the entanglement of multiple global crises, each magnifying the impact of the other, transcending the mere sum of individual events.

At the recent UICC Leaders’ Summit, the world's forerunners in the fight against cancer in these challenging times engaged in serious dialogue. In the lecture Dr. Adams will unpack how the UICC confronts the challenges of our time, what demands are placed on us to realize UICC’s vision, and how we, the international community, can respond. In addition, Mr. Sakano, who is contributing to the activities of the Asia Cancer Forum as a committee member, will discuss shared wisdom in overcoming the adversity of cancer in a chaotic world.

Cary ADAMS began with an introduction to the Union for International Cancer Control (UICC), the oldest and largest cancer-fighting organizations globally, established in 1933. UICC is an NGO, based in Geneva, with a team of about 50, working with a membership base of 1,160 members in over 170 countries, including major cancer societies, many cancer institutes, and also patient groups. UICC works with the WHO, the World Health Organization, also also other UN agencies, to ensure that they have cancer as a priority in their agenda. UICC also reaches out to member states, countries around the world, governments, and works through our members to effect change at the national level.

  UICC’s ambition is to lead action on global cancer control, covering the full range of cancer control challenges, from prevention through to early detection. treatment, care, and palliative care too. UICC is unique as an organization in that it is very broad in its interests on working with others to improve cancer control. UICC works with different partners around the world to address each component of the challenges of cancer control.

Importantly, UICC brings the world’s leading experts and leaders together—the politicians, the leaders of private sector, and the NGOs, civil society communities—to ensure that we work collectively on a common ambition to reduce cancer control over time.  

UICC’S mission statement is: UICC unites and supports the cancer community to reduce the global cancer burden, to promote greater equity, and to ensure that cancer control continues to be a priority in the world health and development agenda. 

UICC’S Board of Directors is currently led by Jeff Dunn as President. There is a very broad based board, which is drawn from patient group leaders, oncologists, specialists in the field of childhood cancer or breast cancer. All of them are leaders in cancer control. UICC has been recognized for excellence over many years, winning awards for our congress, our summit, our use of social media, and also our website for our leadership. UICC has also been shortlisted for the International Association of the Year Award. 

In terms of the membership base, there are about 440 patient groups representing the various diseases, and UICC also deals with major cancer societies, cancer leagues, cancer institutes, and academic organizations as well. We have great reach around the world, particularly reaching out to the politicians in all the capitals around the world, because many of our organizations work with those in government, and we also have great reach into the general public.

One of the public outreach activities is World Cancer Day every year on February 4, when our membership mobilizes action at a national level and a regional level. UICC membership is very satisfied with the way in which we operate and members are encouraged to help each other. We recently launched a new online community, which allows our members to talk to each other in a safe and secure manner, sharing best practice so that we can learn from one country to another country how we can do things differently.

The challenge we face with cancer is so complex it is impossible for a single organization, let alone a single sector, to solve the problem alone. So over the last 14 years, UICC has worked hard to bring together all different partners from different sectors to address different components of cancer control. And as difficult and as challenging as it is, it is the only way that we can fundamentally address the growth in cancer we anticipate over the next few years, and bring in the technology advances and the innovation we have to solve what is a generational challenge.

Bringing this community together is very important, and face-to-face interaction is fundamental to exchange of knowledge and understanding, including the recent World Cancer Leaders’ Summit in 2023 and the World Cancer Congress in Geneva in 2024. These events help to kick start initiatives, including the current Childhood Cancer Initiative at the WHO, which started from a conversation at the World Cancer Leaders’ Summit a few years ago. 

The World Cancer Congress, which is our flagship initiative bringing the cancer community together, brings together about 3,500 people from around the world who are interested in cancer control, and that will be meeting in Geneva next year in September 2024. It will be run with the WHO, the International Atomic Energy Agency (IAEA), and the International Agency of Research on Cancer (IARC). 

World Cancer Day on February 4 each year is an opportunity to bring the community together reach out to the general public and engage journalists around the world to talk about cancer in a very positive manner. There is a lot of negativity about cancer globally, but what the UICC tries to do on World Cancer Day is show what we can achieve together. The current World Cancer Day campaign is the “Close the Care Gap” initiative, through which we have been raising the issue of inequity in cancer care around the world.

  In terms of early detection, lung screening has started in some parts of the world, including Europe but it is not yet a WHO Best Buy. On the negative side of things there has been insufficient progress on breast, cervical, and colorectal screening globally, which could be due to the impact of the pandemic.

  In terms of treatment and care, positive developments are that there is now more radiotherapy available globally and there have been advances in treatment options. On the negative side, there is a lack of basic medicines and treatment options in many countries around the world, and there are concerns about the high costs involved. 

In terms of government engagement, there are now more National Cancer Control Plans in place. However, there are questions about whether they are being funded and implemented fully. Also, there is no additional funding for additional money for ODA to help low income countries (LICs). There has also been a tendency recently to focus on pandemic preparedness and the challenges of climate change.

In terms of the achievements of the UICC in the past decade, progress has been seen in getting cancer onto the global health and global development agendas, starting in 2011 with the first UN High-level Summit on Non-communicable Diseases (NCDs), and moving through to 2017 and the first cancer resolution at the World Health Assembly. The UICC has also driven improvements in the essential medicines list for cancer, as well as an essential technologies list at the WHO. Other initiatives with the WHO include on cervical cancer, childhood cancer and breast cancer.

The Global Action Plan for NCDs has a famous appendix called Appendix 3, which is continually updated with the best buy recommendations for countries around the world and what they should deploy within their National Cancer Control Plans. Appendix 3 now now includes multiple screening recommendations, as well as many recommendations on the risk factors that cause cancer. In the SDGs cancer and the NCDs are included in SDG 3, and although negatively impacted by the pandemic, some progress is being made.

UICC’s current areas of focus cover antimicrobial resistance (AMR), women's cancers, tobacco control, air pollution as well as lung cancer, universal health coverage (UHC), investing in cancer control, leadership development across the cancer community, and the issue of essential medicines, diagnostics and technologies, particularly in low and lower middle income countries. 

As part of our role in sharing knowledge, most people know UICC through the TNM manual that we produce for oncologists around the world, but we also publish the International Journal of Cancer. Our publication on AMR has been very popular, because it sets out why the cancer community needs to be involved in AMR going forward. 

UICC has created several new organizations and initiatives to address long-term public health challenges and unmet needs since 2009. These include the City Cancer Challenge, the NCD Alliance, the McCabe Center for Law and Cancer, and the International Cancer Control Partnership.

  Another organization is the ATOM Coalition, which is still a part of UICC. It was established two years ago at the World Health Assembly to address the issue of how we can improve cancer treatment and care in low and low middle countries. The opportunity to help to improve cancer treatment and care in those countries is immense. The ATOM Coalition brings together 42 organizations to improve access to essential cancer medicines in low and lower-middle income countries. The partners have made a commitment to bring their own knowledge and understanding of what they've been doing in those countries to get medicines into those countries. It is imperative to get better at improving the way in which we get medicines, radiotherapy, surgery, and treatment into low and low middle income countries. So the ATOM Coalition was established to address the issue of medicines in the first instance, but in time that will lead to improvements in treatment for people in low and low middle income countries. 

The ATOM Coalition deploys is a unique multisectoral approach. We have diagnostic companies, pharmaceutical companies, international organizations, and organizations that have already worked with the cancer community, all of whom are trying to work out how to deliver medicines into low and low middle income countries. 

Telemedicine is an important part of how we can deliver expertise or knowledge into resource challenged environments over time. We have an opportunity here with technology and AI to leapfrog the models which currently exist in other countries. The ATOM Coalition approach is therefore innovative in every aspect. The ATOM Operational Plan 23-24 is a detailed plan that is available on the UICC website. 

The ATOM Coalition approach is innovative in that it builds on the undoubted long-term experience of individual organizations. It is also an innovative approach because at the moment in low and low middle income countries, the predominant way to get cancer medicine is through donation schemes, which are unsustainable, particularly given the projections that cancer will continue to rapidly increase in low and low middle income countries. The ATOM Coalition is therefore looking at giving pharma companies three ways to make their medicines available (donation, costed, or through voluntary licenses). The diagnostic sector is also being included because pathology and diagnostics are fundamentally weak in such countries. We are looking into the potential for establishing a fund which can fund the development, delivery, implementation and running of pathology labs. The supply chain is also a sector that needs support in order to ensure that medicines can be supplied from warehouse to patient in the most cost effective way using current infrastructure.

The models that we have to introduce to solve the problem of cancer treatment and care in lower middle income countries undoubtedly require innovation, telemedicine, and AI, because there is no way to build up the competency, the volume of oncologists or pathologists required in those countries to address the problems that we face. The importance of telemedicine and the use of AI cannot be overemphasized. It is vitally important to leapfrog current thinking in order to reach patients who need our support today, tomorrow, and in the coming years.

In this lecture I have highlighted the work of the ATOM Coalition because the next lecture is featuring telemedicine and the power that brings to the pathologists and oncologists in countries where there are resource constraints. UICC remains committed to cancer control globally and interested in improving the way in which cancer is dealt with around the world.

Allm operates the operation center on behalf of the NCCJ. Any doctor nationwide who wants to receive a consultation from NCCJ can reach out and a consultation is then arranged, including pathology or imaging data. This project was launched in October 2023. Similar consultations are available in other areas of medicine. 

Allm is collaborating with each local government in Japan to provide this service to the greatest extent possible, looking where the greatest needs exist, collaborating with both the public and private sectors, including pharmaceutical and medical device companies.

The Asia Cancer Forum is also looking to start to take advantage of this platform infrastructure to provide support to Asian doctors facing similar conditions in terms of difficult and rare cases. The hope is to start a project initially in Malaysia, and provide consultation with NCCJ, with the Asia Cancer Forum working as the international operation center.

Another major innovative approach is international collaboration to bring new technologies such as AI, sensors and IoT and other medical services to the global market. One example of this initiative is to introduce a Brazilian technology, a retina imaging device that can be attached to a smartphone, and use it in AI and telemedicine. This is an initiative being implemented in Brazil that is low cost and effective, meaning that you do not need to be a medical doctor to take images of the retina. Once the image is taken using a smartphone, AI implements a diagnosis, which can then be passed on to experts if necessary. This means that much of the screening can be conducted automatically.

A technology from Israel checks vital signs, including body temperature, respiratory sounds, and skin images, etc. It is just one small device, but the AI does the basic screening, which is then forwarded to an expert. Another example is a portable ultrasound device developed in Taiwan, and a Korean tech start-up has developed a portable x-ray device capable of taking lung images.

Allm works to provide networked specialized doctors to low medical resource areas, using smartphones. Low medical resource areas are particularly vulnerable to disaster, either manmade or natural disaster.

In the case of Ukraine, the war with Russia has resulted in the destruction of more than 1,500 medical facilities and several hundred doctors have been killed. Allm and the Asia Cancer Forum are aiming to provide telemedicine to damaged and recovering areas of Ukraine with round-the-clock telemedicine, using portable IoT devices, such as those introduced above. 

The portable IoT device for deployment in Ukraine is contained in one box and can be distributed to anywhere it is needed in Ukraine. There are more than 60,000 medical doctors worldwide who have indicated their willingness to support the telemedicine project in Ukraine. 

Allm has been talking with the Ministry of Health of Ukraine, and has been formally requested to provide support to a region that covers approximately nine million people. The project is due to start in November and there will be a round-the-clock telemedicine/tele-surgical center operating in Kyiv that will link to medical centers around Ukraine. Allm has already presented the project to President Zelenskyy and the project will be implemented as a joint project between the Japanese and Ukrainian governments. 

In addition to emergency cases, the Asia Cancer Forum is going to be involved in a project in which medical doctors will come to Japan from Ukraine to study advanced treatment for cancer. The training is scheduled to be provided by the Cancer Institute Hospital of JFCR in Japan. 

This kind of innovative approach to cancer treatment has unlimited potential and the final structure will continue to develop throughout the course of its deployment and operation. More study will also be required about how to make the system self-sustaining. 

Dr. Kawahara noted that telemedicine is very important globally, particularly in low and middle income countries. Dr. Adams noted that UICC has been working with Ukrainian organizations since the war started to help them and he expressed interest in Allm’s contract with the Ukrainian government and how that came about. 

  Mr. Sakano noted that the war in Ukraine was resulted in 10 million displaced persons and needs are changing from day to day. It was necessary to come up with a nationwide structure, which was something that needed government support and cooperation, which is why Allm reached out to the Ukrainian and Japanese governments. 

Dr. Adams agreed that the problems being faced in Ukraine and other countries cannot be solved by a single organization, and it is important to get the right people around the table with governments and international organizations and work together on solving problems. He noted that the Asia Cancer Forum is working with individual companies, such as Astellas Pharma, and asked how such interactions work. 

Mr. Sakano responded that Allm approaches each institution, private company, or public sector entity individually. Just like the UICC, it is imperative for actors to come together and devise the best approach possible to a given situation.

Dr. Adams agreed that innovation is certainly the way that problems will be solved in the future. Where innovation is required is getting what we know works today into countries that don’t currently have it, and it is in such situations where telemedicine and AI are the technologies that could ensure that the right set of services or medicines gets to the right person. Similarly to the smartphone retinal imaging device introduced by Mr. Sakano, if the same sort of thing could be achieved for cancer screening it would be transformational. He asked whether technology could be a solution for cancer care in low income countries. 

Mr. Sakano replied that it is possible for technology to provide solutions but it is not possible for a single private telemedicine company to solve all the issues alone, which is why collaboration with the public sector and clinicians is so important. The technology for the retinal imaging device on a smartphone came from Brazil and the AI for the images taken is being developed by other clinical partners. 

Dr. Adams noted that Allm is engaged in similar actions to UICC, in that it is bringing in different organizations or companies with innovative products and providing the online support to make sure they are used properly. In the case of UICC, it is bringing together companies, NGOs, and governments to collectively solve the same problem, which is how to diagnose cancer earlier and how to treat it more successfully. Although the actions are slightly different, basically Allm and UICC are operating on the same principles.

Dr. Adams noted that emergencies such as Ukraine generate energy and enthusiasm for action, but the challenge is to create the same sort of energy and enthusiasm for cancer, which is a long-term, slow process. 

Mr. Sakano noted that the major difference between emergency treatment and oncology is that when we implement a new technology, the result is apparent the very next day. However, in the case of oncology it’s very difficult to show a clear end result immediately and the investment needed for oncology is a lot bigger than for emergency treatment.

Dr. Adams noted that while it is challenging it is possible to generate energy and commitment on cancer, as seen for the WHO long-term commitment to eliminate cervical cancer through HPV vaccinations. Five years ago, there was no commitment globally to eliminate cervical cancer, but now we have a commitment and people are beginning to take it forward. That is an inspirational example and hopefully the same sort of thing could be achieved for lung cancer, for example. 

Mr. Sakano noted that the pandemic has had negative and positive impacts, the negative impact being the many people who died. In terms of the positive impact, COVID pushed government to accelerate DX efforts in medicine and medical delivery systems. In the case of Japan, prior to the pandemic the government was very reluctant to bring any type of telemedicine to the market, but the pandemic has speeded up the process of implementing DX. People have now become used to accessing medical services online. Now is a very good time to think about the feasible ways of implementing DX in the market. Oncology is implemented over a long-term timeframe, but COVID has helped to speed up certain aspects. 

Dr. Adams agreed that sometimes actors, whether they be governments or doctors, may be resistant to AI and telemedicine, but it is important to make all people understand the supportive role that AI and telemedicine have to play. He asked if Allm had experienced any pushback from the medical community about its platforms, technologies and devices.

Mr. Sakano noted that there was reticence about applying new AI and telemedicine technologies among the medical community in Japan. However, he expressed his belief that AI can enable experts to truly concentrate on their own specialties and improve efficiency from a patient perspective. 

Dr. Adams noted that the use of technology could dramatically change the way that we can deal with cancer in low and middle income countries because there are very few oncologists and very few pathologists, so efficiency is everything. 

Mr. Sakano noted that it is actually the case that innovation is happening faster in developing countries where there is a lack of oncologists, or lack of equipment, etc. Dr. Adams agreed that the speed of innovation is a silver lining and the hope is that developing countries can leapfrog current technology and approaches, particularly given that it is in developing countries where cancer cases are going to increase most rapidly in the next 20 to 30 years. 

Dr. Kawahara noted that cancer is a human tragedy, but we have gathered wisdom to overcome it. We are proud that the UICC has supported Ukraine and Ukraine’s issue is our own challenge. She also noted the importance of human touch points, referring to the BEAUTY Project that is being implemented in Malaysia.

Mr. Sakano noted that the BEAUTY Project is being promoted in Malaysia by the Asia Cancer Forum and the National Cancer Society of Malaysia (NCSM). He added that the major focus in Malaysia is to incentivize people to get health checkups, and while digital approaches are useful, they are just one approach and it is important to reach out to people in their own communities and motivate them to think about cancer. 

Dr. Adams noted that the same goes for Europe, where there are screening services available for breast cancer and colorectal cancer, etc., but the uptake in some countries is really low. While technology is one solution, at the end of the day, it is important to reach out to people, and encourage them to want to care about their own health, which is a very difficult thing to do in most countries. Reaching out to the community and dispelling fear of cancer is part of what we've all got to do. 

Mr. Sakano noted that there is a chicken or egg situation in Malaysia in that although efforts are being made to promote health checkups, the healthcare infrastructure itself is not well developed. 

Dr. Adams noted that in such cases it is important for all players to work together to put the technology, infrastructure, outreach and services in place, without seeking to make excuses for inaction. He noted the case of Jordan, where outreach activities and efforts to promote health checkups have successfully increased the early detection of breast cancer, which in turn has changed perceptions about breast cancer being a “death sentence.” It takes time to get a community comfortable with the fact that being diagnosed with cancer early is actually a good thing. 

Mr. Sakano noted that there are also opportunities for the private sector to expand their business to the global market. Dr. Adams noted that until now the way that cancer has been dealt with in low and middle income countries has been the donation of medicines, which is no longer sustainable long term. A commercial solution which allows for a reasonable margin for all the players in the supply chain in order to guarantee longer term support for that country and a funding solution in that country which allows the government to fund those medicines or that technology is what is now needed, without relying on overseas development systems. 

Mr. Sakano noted that the efforts being made on the BEAUTY Project are really very promising for Malaysia. Dr. Adams also congratulated the Asia Cancer Forum and NCSM on their joint efforts to make a difference in Malaysia.