Welcome to the June 2020 issue of the Global Washington newsletter.
IN THIS ISSUE
- Letter from our Executive Director
- Issue Brief: Navigating Global Health Priorities During a Pandemic
- Member Profile: Fred Hutchinson Cancer Research Center Expands World-Class Cancer Care in East Africa
- Member Profile: Building Bridges to Access: For The Max Foundation, Treatment is a Human Right
- Welcome New Members
- GlobalWA Member Events
- Career Center
Letter from our Executive Director
Over the last few weeks, the U.S. has been gripped by unrest resulting from centuries of smoldering systemic racism that caught fire in the midst of a global pandemic. Global Washington stands with the Black Lives Matter movement and recognizes that Black communities in the U.S. are disproportionately impacted by COVID-19. As the disease continues to spread throughout the developing world, we see how those who are most marginalized by society are exponentially more vulnerable to health threats.
Global Washington members have been responding to the COVID-19 health crisis in many ways. Our members are also providing life-saving services for non-COVID-19 health issues that are critical for so many people around the world.
During the 2013-2016 Ebola crisis, in addition to all those who died from that swift and frightening disease, disruptions in routine medical services caused an estimated 10,000 preventable deaths from HIV/AIDS, malaria, and tuberculosis alone. As we take on this novel coronavirus that is sweeping the globe, we remember that the choice is never either, or – it is yes, and.
Despite the fact that COVID-19 is challenging us in ways we never imagined, children still need their regular vaccines. Pregnant women still need a safe place to deliver their babies. And cancer patients still need their medications.
Someday, we will better understand this virus – the ways it spreads, the ways it attacks the body, and the ways in which we can keep it in check. And in the meantime, we are seeing extraordinary ingenuity, borne out of necessity, to keep all of our other global health priorities on track. Many Global Washington members are doing just that. You can read more in this month’s issue, with special features on Fred Hutchinson Cancer Research Center and The Max Foundation.
The Pacific Northwest is known for our innovative global health organizations and our commitment to tackling difficult challenges. I find hope in the work of Global Washington members who are dedicated to saving lives and making the world a better place. I hope you do, too.
Navigating Global Health Priorities During a Pandemic
By Amber Cortes
Just a few short months ago (but what already seems like a lifetime ago), COVID-19 began to wreak havoc on the world. There’s been no sector left untouched by this pandemic—from work and economic growth to food security and education, and of course, global health.
COVID-19 and its economic consequences threaten to upend so much of the work that’s been done in the global health development community—and to stall progress towards the Sustainable Development Goals for 2030.
First, there are the immediate effects: disrupted supply chains, a squeeze on health system capacity and resources, confusion about health safety protocols, and lockdowns that prevent access to treatments and life-saving medicines.
The United Nations Children’s Fund (UNICEF) reported a 70% to 80% drop in vaccine shipments since March due to pandemic-related shipping and logistics challenges. Because of this, many preventable diseases like measles, polio and cholera are expected to rise. According to the Measles and Rubella Initiative, up to 117 million children worldwide could miss out on measles vaccinations since immunization campaigns were suspended to deal with the novel coronavirus.
Many organizations have had to shift their strategic goals for the year toward providing emergency response services, in many cases halting or significantly adjusting their regular programs and reconfiguring their supply chains in order to keep serving their populations, all while trying to navigate new realities, both known and unknown, of COVID-19.
But there’s even more at stake than that. COVID-19 has the potential to roll back decades of progress made in addressing many non-communicable diseases (NCDs). According to the Global Malaria Program, COVID-19 impacts could double the number of malaria deaths in sub-Saharan Africa from just two years ago. Another report by Stop TB Partnership projects an additional 1.4 million TB deaths during that same period. And a six-month interruption in the supply of anti-retroviral drugs (ARVs) could double AIDS-related deaths, essentially ‘setting the clock back’ to 2008 levels.
Then there are all the interruptions to regular and ongoing critical health services: for cancer patients who need chemotherapy, for example, or for women who need protection from gender-based violence or access to contraception and neonatal care.
When it has all been said and done, the COVID-19 crisis will have profound consequences for the world. The Global Washington community has stepped up in extraordinary ways to meet the immediate needs of this health crisis—and is working to build more resilient healthcare systems that are adaptable, scalable, and universal.
We know it’s a long road ahead, and that the complexity of the COVID-19 crisis has yet to be fully understood. There’s important, valuable work being done in all sectors right now. The following highlights some of the work being done by GlobalWA members.
The Bill & Melinda Gates Foundation
The Bill & Melinda Gates Foundation is leveraging its twenty-years of experience in global health innovation to support vulnerable communities in African and South Asian countries. At home in the U.S., the foundation is focused on education-related needs, such as emergency aid to colleges to help mitigate closings, and developing online learning modules for K-12 students.
According the World Health Organization (WHO), Africa could become the next epicenter of the pandemic. There are severe shortages of both personnel and equipment, such as ventilators and personal protective equipment (PPE). A Reuters survey found that even in a best-case scenario, African countries would need at least 111,000 more intensive care beds and ventilators to meet the projected needs of patients. In response, the Bill & Melinda Gates Foundation is donating an additional $100 million to help prepare clinics to treat and isolate patients who may be infected with COVID-19, and to create protocols for contact tracing and infection control.
The Coalition for Epidemic Preparedness Innovations (CEPI), co-founded by the Gates Foundation in 2017, is helping scientists race for a vaccine with their COVID-19 Therapeutics Accelerator. In a bright spot of coronavirus news, the site reports that trials of potential treatments are already underway and the Gates Foundation says they will mass-produce any COVID-19 vaccine they develop to make it accessible and affordable.
Software company Tableau’s free, publicly-accessible COVID-19 Data Resource Hub includes real-time data on case reports from Johns Hopkins University, the WHO and the CDC, as well as a curated gallery of visualizations from national news and health organizations.
The foundation has also ramped up its Community Grants Program, expanding the number of grantees and streamlining the application guidelines. Tableau has created two other giving campaigns for employees: one to support frontline health workers, and another, the COVID-19 Response Fund, to meet the needs of community organizations and non-profits serving at-risk communities that are disproportionately impacted by the disease and its repercussions.
The Institute for Disease Modeling (IDM) is an institute within the Global Good Fund, a collaboration between Intellectual Ventures and Bill and Melinda Gates. IDM publishes models and studies disease transmission dynamics for malaria, polio, tuberculosis, HIV, pneumonia, typhoid, and more. Since COVID-19 struck, IDM has been instrumental in providing epidemiological models that predict transmission rates, collaborating with Fred Hutchinson Cancer Research Center, Microsoft AI for Health, and Washington State Department of Health officials to guide counties in Washington State towards an informed and safe re-opening.
Their comprehensive COVID-19 Infohub incorporates data on COVID-19 transmission rates along with economic impact projections in Washington State and around the world. It includes two powerful models: one for COVID-19 epidemic analysis, and a health systems model to help hospitals determine the number of ICU beds and waiting times needed for COVID-19 patients.
Fred Hutchinson Cancer Research Center
When COVID-19 first hit, the Hutch rallied its global teams of scientists and researchers who have experience tackling global health threats like AIDS and Zika. In addition to keeping those efforts on track, they are now working to track and assess the COVID-19 pandemic’s viral spread, developing diagnostic tests, and designing vaccines to prevent future outbreaks.
One way the Hutch is gaining insights into the virus is through a rapid genome sequencing tool called Nextstrain that builds viral “family trees” to track how and where the virus moves. It’s a “genetic jigsaw puzzle” that can provide clues to viral mutations in samples across the globe.
Keeping Non-Communicable Disease Targets on Track
People with underlying health conditions caused by non-communicable diseases (NCDs), whether cardiovascular disease, diabetes, respiratory diseases, or cancer are at higher risk for COVID-19 complications and death. Now, it’s even harder for these patients to get access to medications and diagnostic services—challenges that already existed before in many areas, but have been intensified by COVID-19.
During the Ebola outbreak in West Africa, health service disruptions caused 10,000 preventable deaths from HIV/AIDS, malaria, and tuberculosis. Citing the lessons from Ebola, PATH recognizes how crucial it is to protect the progress made on malaria prevention—which saves nearly 600,000 loves per year. As a result, they are adapting their delivery channels to continue bringing essential health services and important preventive measures like insecticide-treated bed nets to communities, while minimizing COVID-19 transmission.
In partnership with the WHO, Bill & Melinda Gates Foundation, Global Fund, PMI, and other organizations, PATH is also using data to detect new COVID-19 hotpots around the globe and modeling scenarios for how the virus may impact malaria transmission rates in high burden areas across Ghana, Kenya, and Malawi. PATH is also partnering with leaders in Senegal and the Democratic Republic of the Congo to integrate data visualization from information provided by national Emergency Operations Centers and National Malaria Control Programs.
By mapping out health priorities with real-time data and monitoring delays in drug manufacturing supply chains, PATH and its partners are able to build a sustainable tracking system that can respond to diseases long after COVID-19 is fully contained.
Malaria No More
“People all over the world now have an all-too personal experience with how a deadly, infectious disease can upend health systems and economies—and, more personally, how it can do the same to our families and communities,” says Martin Edlund, Chief Marketing Officer of Malaria No More.
Malaria deaths and cases were at their lowest levels ever recorded in 2018. Since then, progress has stalled, and now, COVID-19 could bring malaria back to 2000 levels—erasing the progress of the last twenty years. With the rainy season on its way in many parts of the world, Malaria No More has been intensifying its routine distributions of long-lasting insecticide-treated bed nets in the highest-burden villages.
“We have a critical window to support high-burden countries in taking actions that will save hundreds of thousands of lives and prevent health systems from being overwhelmed with tens of millions of additional malaria cases,” says Edlund.
Along with PATH, the Malaria Atlas Project, and the Bill & Melinda Gates Foundation, Malaria No More helped create a modeling analysis for the WHO with nine COVID-19 scenarios—and detailed what countries can do to save lives through early intervention efforts. The study found that India and many countries in Africa face a “dangerous double jeopardy” with peak transmission of both malaria and COVID-19 colliding in the next few months.
“The Ebola outbreak taught us that the best defense is a good offense,” says Edlund. Relying on data-driven decisions to stay ahead of both COVID-19 and malaria outbreaks will save lives. “By preventing, screening, diagnosing and treating malaria symptoms at the local level, countries can avert a devastating surge in severe-malaria cases at district and national hospitals.”
The Max Foundation
For The Max Foundation, COVID-19 has made it harder to fulfill their mission—getting crucial cancer medications across borders and into the hands of patients in low- to middle-income countries.
“In the case of The Max Foundation, our work in supply chains has been impacted in a number of ways directly as a result of COVID-19,” says Neal Parry, The Max Foundation’s senior supply chain manager.
There have been new restrictions on importing medicines, changes in cargo flight availability, and points of entry closures. But The Max Foundation is finding new solutions for home-delivery of medicines through local distribution partners, shifting from paper to digital prescriptions, and having physicians dispense a few months-worth of treatments ahead of time to last patients through the shutdowns.
“This pandemic has shown that there is no “one-size-fits-all” approach that will be successful in global supply chain operations,” Parry says. “However, it has shown that leveraging an organization’s network can create additional opportunities for collaboration.”
Burkitt’s Lymphoma Fund for Africa
Burkitt lymphoma (a form of non-Hodgkin’s lymphoma that’s highly curable with chemotherapy) is the leading cause of pediatric cancer deaths in equatorial Africa. Met with the sudden challenge of needing to procure personal protective equipment (PPE) for front-line healthcare workers, Burkitt’s Lymphoma Fund for Africa (BLFA) is now channeling immediate funds into procuring PPE in their grant network.
“In addition to sorely needing PPE, there are other situations that we are helping our grantees address (COVID-19) through this emergency fund,” says Karen Osofsky Michelson, a BLFA board member. They’ve helped one grantee in the network, a shelter in Tanzania where children and their families can stay during cancer treatment, to create an “isolation house” for quarantine purposes. They are also meeting transportation and meal costs for their patients and clinic employees.
“In essence, our fund provides a holistic, full life-cycle approach to keeping children safe and healthy. It goes way beyond the needs for PPE,” Osofsky Michelson says.
Meeting Healthcare Needs in a Crisis
A recent report released by the medical journal The Lancet modeled two COVID-19-related scenarios affecting some of the more vulnerable groups that Adara serves: pregnant women, and children. If maternal coverage and newborn interventions are reduced by 15% over the next 6 months due to COVID-19, there will be an almost ten percent increase in child deaths (under 5 years old) per month. If coverage reduces by 45%, the situation becomes even more dire: likely a 44.7% increase in mortality per month.
Adara is meeting the immediate needs of the COVID health crisis by delivering PPE, including thousands of N95 masks, to remote districts in Nepal, distributing soap to midwives in Uganda, and working on guidelines and protocols for staff in maternity and neonatal wards in both countries.
“Many of our programs are being adapted to respond to COVID-19 and its associated impacts. However, our goal is to maintain delivery of these critical health and education programs in order to help countries continue to drive toward the SDG targets,” says Brooke Magnusson, the global health partnerships manager (USA) for Adara.
Adara is shifting some of its educational programs, for example, by delivering curriculums through radio. And since the economic impacts of COVID-19 have affected food security, Adara has also been providing midday meals to children who can’t go to school right now.
Americares has a long history of disaster response, in particular to other outbreaks such as Ebola, Zika and measles. This experience makes the organization well-prepared to mobilize and distribute protective gear and infection control supplies that can help keep healthcare systems from becoming overwhelmed. Right now, Americares is mainly focused on maintaining capacity at under-resourced primary care clinics in Colombia and El Salvador. But Americares is also delivering masks (more than 2 million!), gowns, gloves and disinfectants to health facilities in 12 countries, and developing training modules on COVID-19 for healthcare workers.
For Amplio, mobilizing communities is what they do best. The Amplio Talking Book is an audio device designed for low-literate adults and youth around the world to learn about such topics as malaria prevention, hygiene and sanitation. In response to COVID-19, Amplio is using its technology to link community media with district health experts and helping governments and media organizations align their key health messages to keep information consistent and credible.
PRONTO International understands the language of urgency—the organization provides emergency training materials for health care providers in obstetrics and neonatal care. The organization was able to respond quickly to COVID-19 threats among its teams in Africa, India, and Central America.
For example, they’ve developed multiple COVID-related SIMPACs, or simulations—artificial scenarios where trained facilitators can use real-world events to educate others—to help teach providers to triage among COVID-19 obstetric patients and their babies. And for healthcare workers who are not trained as simulation facilitators, PRONTO International plans to release how-to videos and guidelines regarding COVID-19 management.
The Spreeha Foundation meets the challenge of poverty with a three-pronged, holistic approach—providing healthcare, education and skills training to underserved communities in Bangladesh. Now, COVID-19 has forced the foundation to temporarily close education and training services in order to ramp up its healthcare response.
“Overall, our SDG global health target has not changed,” says Ferdouse Oneza, CEO of Spreeha Foundation. “Although we are engaged in emergency responses, we’re keeping our long-term goals in focus. To that end, we are even pre-positioning ourselves with (a) more robust healthcare delivery system using telehealth.”
At the moment, Spreeha is working closely with the government of Bangladesh in providing health awareness messaging and door-to-door coronavirus screening services.
VillageReach solves health care delivery challenges in low-resource communities. When it comes to continuing its work amid COVID-19, “we need to be more creative than ever about how to do this,” says VillageReach President Emily Bancroft. This can mean using advanced technology—including deploying drones for delivery of medications or analyzing powerful datasets through OpenLMIS to forecast where medicines may be needed most during outbreaks.
The organization is also leaning into predictive analytics, such as in Mozambique, where VillageReach is collaborating with machine-learning firm Macro-Eyes to allow health workers to engage their communities. In Malawi, VillageReach has been collaborating with Global Good’s Institute for Disease Modeling (IDM) to predict COVID-19 transmission using datasets from sources like local health phones lines.
* * *
Besides the above highlights, check out our entire list of GlobalWA members who are working to improve health and healthcare in developing countries:
- Adara Development
- American Cancer Society
- Bill & Melinda Gates Foundation
- Bloodworks Northwest
- Burkitt’s Lymphoma Fund for Africa
- Days for Girls International
- Fred Hutchinson Cancer Research Center
- Friendly Water for the World
- Gambia Health Education Liaison Project
- Kati Collective
- Life Science Washington
- Malaria No More
- Medical Teams International
- Path from Poverty
- PeaceTrees Vietnam
- Planned Parenthood of the Great Northwest and the Hawaiian Islands
- PRONTO International
- Pygmy Survival Alliance
- Rotary District 5030
- SIGN Fracture Care International
- Spreeha Foundation
- The Max Foundation
- UNICEF USA
- Washington Global Health Alliance
- World Bicycle Relief
- Worldwide Fistula Fund
Fred Hutchinson Cancer Research Center Expands World-Class Cancer Care in East Africa
By Andie Long
When Fred Hutchinson Cancer Research Center (“the Hutch”) launched its partnership in 2008 with the Uganda Cancer Institute (UCI) in Kampala, Uganda, there was exactly one oncologist for the entire East African country of 43 million people. Today there are 14 clinical oncologists, and more are being trained every year.
While the oncologist is typically the individual in the white lab coat, the one everyone in the clinic looks to for definitive answers and direction, skilled oncology nurses are the people a cancer patient depends on most. They are the ones who know how to start and maintain an IV, administer the right drugs, check vital signs, alert the doctor to any significant changes, and in the case of UCI, arrange transportation for patients and their families to and from the clinic, a roundtrip journey that can be over 100 miles.
“The most important person on the care team is the nurse,” says Dr. Houston Warren, head of Global Oncology at the Hutch.
A researcher and practicing physician himself, Dr. Warren’s goal is to adapt the work that the Hutch is doing in Seattle for cancer patients all over the world. In order to do this, the Hutch Global Oncology team is finding ways to increase the number of people who can navigate the complicated world of cancer research, diagnosis, and care. Not just nurses and doctors, but also laboratory technicians, clinical coordinators, and more.
“Training providers at all levels is an important part of our mission,” he says.
Using Technology to Expand Human Capacity
Despite the urgency of training more Ugandan oncologists, nurses, clinical researchers and support staff, one human resource challenge that Warren believes can be transformed through technology is the role of the pathologist.
As it now stands, UCI staff can send digital microscope images of Ugandan patients’ tumors over the internet to a server in Seattle, where a Fred Hutch pathologist can review them the next morning and record her findings. Then every Wednesday at around 10pm Pacific Time, the Fred Hutch Global Oncology team in Seattle joins a virtual “tumor board” with their colleagues in Uganda to review the high-definition scans and the pathologist’s reports, look over patient histories, and discuss treatment options.
Pathologists, like other specialties, are in very short supply in Sub-Saharan Africa. At present there are fewer than 15 in all of Uganda, according to Warren. In addition to training more Ugandans pathologists, Warren sees potential in using artificial intelligence to amplify the work of each pathologist. Using high-throughput analysis, for example, could allow them to flag cases requiring priority review.
“Data science and AI have enormous potential for reducing global cancer disparities,” Warren says. Although the Hutch is not currently using artificial intelligence to help analyze pathology images from Uganda, this approach is part of Warren’s long-term vision for expanding the Global Oncology program.
In addition, new technologies may one day enable pathologists in Uganda to leapfrog current methods for tumor diagnosis and monitoring. One such approach is liquid biopsy, a technique that allows pathologists to identify molecular markers for cancer in a small sample of a patient’s blood. These highly sensitive tests would enable oncologists to identify and treat many more forms of cancer, especially those that can be difficult to biopsy and track over time.
Unique Needs of Cancer Patients in Uganda
Like many Sub-Saharan African countries, Uganda’s citizens are quite young. According to Warren, about 86% of Ugandans are under 40, and a third of the population is younger than 10 years old. Not surprisingly then, at UCI, many of the patients are kids.
There’s also a different mix of cancer types than the Hutch normally sees in Seattle. For instance, roughly a third of the cancers are infection-related – including Burkitt lymphoma, which is often associated with Epstein-Barr virus; Kaposi sarcomas that are associated with HIV; and cervical cancer, which can arise from certain types of persistent HPV infections. As far as non-infection related cancers, breast cancer is also on the rise in Uganda and across sub-Saharan Africa.
In addition, many of the cancer patients who visit the UCI frequently have underlying conditions that can make diagnosis and treatment a challenge. For example, in addition to the cancer, their bodies might also be grappling with malaria, tuberculosis, and various tropical infections, such as worms or other intestinal parasites.
Given these challenges, Warren says the Hutch is conducting clinical research to ensure that their interventions are “just as safe and effective as they are in Seattle.”
As a clinical researcher himself, Warren practices oncology at the Seattle Cancer Care Alliance once a week, and there is one question that drives him above all else.
“I have access to drugs that still aren’t available in Sub-Saharan Africa,” he says. “The drugs I use in my everyday practice are only available to at most 1 billion people or so, if that. And most of the cancer is obviously in the other 6.5 billion people. So how do we get those drugs, these unbelievably exciting and remarkable drugs that have been developed over the last 20 to 30 years, how do we get them to that majority of the population who could also benefit from them?”
The Impact of COVID-19 on Clinical Research and Treatment
The global COVID-19 pandemic has had a profound impact on the UCI since March, Warren said. Their research has been completely suspended in Kampala and only patients who are receiving direct treatment are able to visit the clinic.
“I’ve been surprised at the trajectory of the pandemic so far,” Warren said. “Most modelling of the disease for Sub-Saharan Africa suggests that cases will peak in July and August. Which makes it all the more reason to prepare as best we can and get more resources for testing.”
Even with the lockdown in Kampala, the Hutch and UCI have been building up their COVID-19 testing capabilities so that when cancer patients arrive for treatment they can be tested both to see if there is active infection from the novel coronavirus, and also to see whether they have been exposed to it at some point in the past.
“If we’re going to get our research program up and going again, we’ll need to have good COVID-19 testing going. It’s going to be a co-morbidity that will be important to be aware of long before this predicted peak.”
As far as how the pandemic will impact their global cancer work over the long-run, Warren says, “One possible scenario is that COVID-19 will become just one more potentially lethal infection that Uganda and the other countries in Sub-Saharan Africa have to deal with on a constant basis – added to malaria, TB, HIV, bacterial diseases, other viral diseases…” That said, he noted, “We don’t yet know what the impact [of COVID-19] will be on individuals living with HIV infection. That’s something we definitely need to study.”
High-impact, affordable diagnostic tools and therapies
Given many of the resource limitations in Uganda, the clinical researchers at the Hutch and UCI are studying ways to provide highly effective therapies to cancer patients at a lower cost. For instance, a breast cancer trial underway in Kampala is evaluating a combination of oral chemotherapy drugs for women who have locally advanced breast cancer. Since the COVID-19 pandemic got underway, patients in the clinical trial have been receiving a month’s worth of medications at a time – allowing them to bypass frequent clinic visits – a workaround that wouldn’t be possible with chemotherapy drugs that have to be delivered through infusions.
Another study is looking at a method of administering Rituximab, a targeted cancer therapy, under the skin (subcutaneously). If the approach is effective, it could replace the daylong infusions needed for that drug – a significant time-saver for patients and staff.
The Hutch currently has 30 clinical cancer trials underway in Uganda, investigating five different types of cancer and six associated viruses. In addition to its research center in Kampala, the Hutch also has a research center in Cape Town, South Africa, where the focus is primarily on developing a vaccine for HIV. While the Uganda lab focuses on cancer research and treatment, including a large focus on infection-related cancers, Warren hopes that one day the research activities of the two centers could be more deeply integrated. “There are lots of synergies possible,” he says.
Building Bridges to Access: For The Max Foundation, Treatment is a Human Right
By Amber Cortes
According to Pat Garcia-Gonzalez, Chief Executive Officer of The Max Foundation, being told you or someone you love has cancer is one of the worst things that can happen in a person’s life—and she knows, because she went through it. Her stepson Max was diagnosed with chronic myeloid leukemia (CML) in 1988.
“But the only thing that’s worse than hearing that,” she adds, “is to be told that there is a treatment, but because of the place where you are—you cannot have it.”
It’s a frustrating reality of oncology many people aren’t aware of—the majority of new “revolutionary” cancer drugs that are discovered and come to the market aren’t even registered in most countries around the world.
“These drugs are made for the Western world,” Pat says. “In developing countries, often they’re just not available.”
For Garcia-Gonzalez, bringing life-saving drugs to patients in these countries is a moral obligation, “and it’s the responsibility of drug manufacturers to develop global access strategies, and of governments to participate in bringing these drugs to the patients.”
“We believe that access to treatment is a human right,” she added, “and there is no reason in my mind why people should die because they don’t have access to these treatments.”
Tragically, Max passed away in 1991— “a very genuinely loving kid, whose life was robbed too young, you know, he was diagnosed when he was 14, just a teenager,” says Garcia Gonzalez.
“Some people, when they go through what we went through, I think you have two types of reactions. One is to never want to hear the word ‘cancer’ again. And then I think there are people that refuse to accept that is the end, that it’s over. And there was this feeling that there has to be something more—it cannot be that Max passed away, and then you just go back to your life.”
Seeking to create meaning from this tragic loss, she started The Max Foundation in 1997 as a grassroots effort—a group email list, created to help support other parents of children with leukemia. Originally from Argentina, Garcia-Gonzalez expected to get only requests from parents of children from Latin America with leukemia.
“But to our surprise, from day one, we started receiving desperate emails from people all over the world, in a very similar situation, where they or their loved one had been diagnosed with some cancer, not just leukemia. They were told they needed a treatment, but the treatment was not available in their country.”
The Max Foundation’s mission is different than other cancer organizations—instead of focusing on finding a cure, they partner with pharmaceutical companies, hospitals, and oncologists to get life-saving medications and treatments that already exist directly to patients. To do this, they’ve built a sophisticated supply chain that moves medicine from just three warehouses to over 90 hospitals and clinics around the world.
The Max Foundation’s model—possibly the only of its kind in the world—works differently than typical humanitarian medicine donation models. They don’t just donate medicine for relief efforts; they seek to fill in the gaps of cancer care by operating as a bridge between resources and patients while improving supply chains and working with governments and distributors to get medicines approved and into the hands of patients.
And, as Garcia-Gonzalez learned, the challenges of building these bridges—securing donated medicine, or understanding shipping logistics, for example—are complex.
“Distributing medicines internationally is not for the faint of heart!” she exclaims.
In May 2001, Swiss pharmaceutical company Novartis released a groundbreaking, targeted medication called Glivec® (Gleevec) that transformed chronic myeloid leukemia treatment—turning a previously fatal disease into a manageable one.
And their new partnership forged with the company became a game-changer for The Max Foundation, as well—allowing them to serve more patients on a scale that they never thought possible.
“So here we were, you know, a small grassroots volunteer organization that now had the opportunity to help thousands of people—to fulfill our mission 100 times more,” explains Garcia-Gonzalez.
Together with Novartis, The Max Foundation co-developed a direct-to-patient international medicine donation model. The program proved successful—reaching more than 70,000 patients in almost 80 countries for 15 years.
Eventually, The Max Foundation leveraged what it learned from this partnership and developed its own program, called Max Access Solutions. Max Access Solutions is a unique treatment access model that prioritizes individual patients’ needs with the sophistication and flexibility to fit local regulations. Just last month, Max Access Solutions passed an important milestone—distributing over 10 million daily doses to patients in over 70 countries since the program’s inception in 2017.
But The Max Foundation’s role doesn’t just end once the patient gets their medication. Many patients need supportive care, as well, and The Max Foundation’s global on-the-ground team supports these patients by providing local patient services.
“So, for us,” Garcia-Gonzalez explains, “we literally put the patient at the center and then we think what is the best, most holistic approach to everything the patient needs? And let’s provide all those pieces, you know, from the access to treatment and diagnostics, to the emotional support that cancer patients and their families need.”
One huge piece of the puzzle of making patient-centered care more accessible in underserved countries is meeting the cost of diagnostics. CML patients have to be diagnosed and tested every three to four months to find out which drugs are most appropriate to their treatment and monitor their response to the treatment. Often the high cost of these tests remains a roadblock. On a 2009 trip to Africa, Garcia-Gonzalez discovered that cancer patients in Ethiopia were selling their homes just to cover the $600 for their blood tests, which had to be shipped to Europe for analysis.
“Those who could were selling everything they had to send their blood to Europe to get a diagnostic test,” Garcia-Gonzalez explains.
“And this is one of those things where I thought, ‘this is not possible. It just cannot be.’ So, when I came back, everybody I met, I told them this story.”
One of the people she told the story to was Dr. Jerry Radich, an oncologist at Fred Hutchinson Cancer Research Center, who specializes in the molecular genetics of leukemia. Radich connected her to Cepheid, a molecular diagnostics company that was developing a cheaper point-of-care technology with a CML specific kit. The Max Foundation entered into a preferential pricing partnership with Cepheid which reduced diagnostic testing costs from $600 down to $50.
Further, Dr. Radich later develop a cheap, affordable way to ship blood samples called “Spot On CML.” The patient puts a dried blood sample on a card that can be mailed to the Hutch for testing.
This award-winning solution, Spot On CML, is a stopgap—eventually The Max Foundation and the Hutch hope to provide high-end equipment to handle diagnostics onsite around the world. And since $50 is still a lot of money for many people, they’ve formed a Solidarity Fund so that more stakeholders can commit to making diagnostics affordable in the long run. Working with the world we have now is a big part of The Max Foundation’s philosophy.
And of course, the world we have now has been changed forever by COVID-19. The effects of the pandemic have been felt in every development sector, including and especially global health.
“I think I would be lying if I told you that COVID-19 is not impacting cancer organizations,” Garcia-Gonzalez says. “It is kind of bringing us back a little bit. So, we have to really reverse courses in a little bit of an unexpected way.”
For The Max Foundation, this has meant navigating around disrupted supply chains and cancelled appointments, as public hospitals become converted into COVID-19 clinics and medical supplies get re-routed. Still, Garcia-Gonzalez sees these problems as opportunities to make healthcare more responsive, adaptive, and resilient.
“I think that we’re finding some opportunities of things we could do better,” she says. This includes arranging home delivery of medications through drones, and using electronic prescriptions instead of paper, so the patient does not need to leave their home.
“And, you know, I’m hoping once we go back to normal, the new normal will include some of the lessons learned from COVID-19.”
Like others in the global development community, The Max Foundation is racing to meet the UN’s Sustainable Development Goals by 2030. It’s a daunting path ahead—while SDG 3 seeks to reduce non-communicable diseases (NCDs), like cancer, diabetes, and cardiovascular disease by one-third, the World Health Organization predicts that by 2030 the number of new cancer patients diagnosed each year will double worldwide, with the vast majority of those people—7 out of 10—living in underserved countries.
Despite the disruptions from COVID-19, Garcia-Gonzalez remains optimistic about meeting this goal. In part because she knows that one day there will be a cure, but for now—there are lives to be saved.
“I feel sometimes people assume that, ‘Oh, well, we cannot provide access to treatment because first we have to spend 20 years strengthening healthcare systems.’ And I want to challenge that assumption,” says Garcia-Gonzalez.
“What we have shown through the years is that by bringing these medicines, we strengthen the healthcare system, because we provide physicians with a way to safely and successfully treat cancer.”
Welcome New Members
Please welcome our newest Global Washington members. Take a moment to familiarize yourself with their work and consider opportunities for support and collaboration!
ChildFund International promotes children’s development at each stage of life to ensure infants and young children are healthy and secure, children are educated and confident and youth are skilled and involved in their communities. ChildFund reaches over 10.5 million people across 24 countries – including the United States – through work with local partner organizations, governments, corporations and individuals. The organization works to strengthen child protection-focused institutions and policies by combining its programs with efforts to influence local and national leaders to prioritize the protection and well-being of children and youth. Approximately 200,000 Americans support ChildFund’s work through sponsoring individual children and investing in its programs. https://www.childfund.org/
Covenant House International
Covenant House International is the largest charity in the Americas serving and advocating for youth facing homelessness and trafficking. It offers a continuum of care to help young people move from poverty to opportunity and from homelessness to hope through shelter, education, job training, medical care, substance-use treatment, parenting support, and legal aid in 31 cities and 6 countries: Guatemala, Honduras, Mexico, Nicaragua, Canada, and the U.S. https://www.covenanthouse.org/
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