The World Health Organisation (WHO) estimates that global cancer incidence is likely to touch 35 million by 2050, a sharp 77% rise from 20 million cases in 2022. A large proportion of this cancer burden will come from lower and middle-income countries, where improvements in overall health and sanitation, control of malnutrition and infectious diseases, has led to an improvement in overall life expectancy. The burden of cancer rises exponentially with an increase in average life expectancy, and hence India will have to bear a potentially heavy cost to keep its population healthy in coming years. But are we ready for the challenge?

The last few decades have seen the emergence of technologies and tools such as smart biologicals, immune modulation, targeted therapy, smart delivery of conventional chemotherapy as antibody-drug conjugates and parallel developments in radiology, critical care, anaesthesia, transfusion medicine and transplants that have constantly pushed the boundaries of what is possible in managing cancer. These are the result of decades of painstaking prior research by unknown scientists far away from the clinic. While these are laudable, India needs its own solutions because of the unique challenges it faces as a middle-income country. A vast majority of our patients cannot afford the ever-increasing cost of novel drugs and treatment modalities.

The answer may possibly lie in allocating resources smartly and rethinking the way we deal with diseases. Most domain experts work in silos, whether it is doctors, engineers, basic scientists in biology, mathematics or other fields in science, technology, engineering and medicine (STEM) field. This leads to a vast gulf between what is needed in the clinic and what is being researched at the bench-side. This is akin to making a car with its various component makers never having met each other. There is a need to create elite organisations that bring all the relevant domain experts under one roof, provide them with a mandate and necessary resources within the existing constraints, and challenge them to provide solutions that are robust, accurate, translatable and scalable for India and the world.

For Kerala, this would mean setting up five or six centres spread across the state, from Kasaragod to Trivandrum, which are attached to major cancer centres and house oncologists, biomedical and materials science engineers, bioinformaticians, molecular biologists, data scientists, pathologists with an interest in molecular and digital pathology, biochemists, microbiologists, geneticists, biotechnologists and patient care advocates under one roof in an autonomous, compact, yet self-sufficient centre. They should be given seed funds, and allowed to participate in competitive grants. The mechanisms to set up such systems already exist. What is needed is a renewed focus, and streamlining of approaches so that resources are optimized, and solutions that touch the lives of our patients are given priority, instead of reliance on solutions that are out of reach for the majority. The government can be the facilitator and catalyst, but the private sector has to be the main stakeholder for this effort.

Hence, the model created must be able to balance the needs of the professionals involved and the state. This could, in time, produce the sustainable and scalable solutions India needs to tackle its oncoming cancer epidemic.

Our Problems; Our Solutions!