The Role of Nuclear Technology and the IAEA Contribution to Expanding Access to Quality Health Care in Developing Countries

Berlin Germany
World Health Summit

IAEA Director General Yukiya Amano at the World Health Summit 2016. (Photo: S. Kugler)

(As prepared for delivery)

Good afternoon, Ladies and Gentlemen.

You may be wondering why the Director General of the International Atomic Energy Agency is addressing a session on technological innovation for health.

We are more commonly associated in the public mind with monitoring Iran’s nuclear programme, or nuclear power, or helping Japan deal with the aftermath of the Fukushima Daiichi accident.

These are very important areas of our work. But, in fact, the IAEA has also been working for decades to help developing countries use nuclear science and technology in meeting their development goals.

This includes helping them to deploy medical procedures using radiation to improve the health of their people.

Our motto today is Atoms for Peace and Development.

The work of the IAEA encompasses many areas in which nuclear technology can contribute to human health.

For example, we responded quickly to the Ebola crisis in West Africa two years ago, providing nuclear-derived diagnostic kits and laboratory supplies for use in the field. We are now helping countries in Latin America and the Caribbean respond to the Zika virus.

I would be happy to talk about these and other aspects of our work afterwards if you are interested. However, now I would like to concentrate on cancer.

Ladies and Gentlemen,

When I became Director General in 2009, my first official visit was to Nigeria. I was shocked to learn that cancer treatment facilities for this nation of 173 million people were completely inadequate.

Many people died of conditions that could be treated effectively if they lived in countries where services such as radiotherapy are taken for granted. I found similar situations in many other developing countries in the years that followed.

This left me with a passion for improving access to cancer treatment in developing countries. Cancer control remains a high priority for the IAEA and for me personally.  

Ladies and Gentlemen,

When world leaders agreed the Sustainable Development Goals last year, they acknowledged for the first time that non-communicable diseases such as cancer are a major challenge for development.

They set a target of reducing premature deaths from such diseases by one third by 2030.

Cancer is one of the most significant non-communicable diseases, so I was pleased that the cancer epidemic in developing countries had finally received international recognition at the highest political level.

In the past, cancer was often seen – wrongly – as a disease of wealthier nations.

Unlike in developed countries, where great progress has been made in understanding and treating cancer, a cancer diagnosis is often still a death sentence in developing countries.

The statistics are troubling. Seventy percent of cancer cases in low- and middle-income countries are diagnosed too late for curative treatment. A doctor in Tanzania told me that many patients don’t appear at the hospital until their tumours are visible.

Breast cancer is the top cancer in women worldwide and its numbers are increasing everywhere. But a woman in North America, Sweden or Japan has an over 80 per cent chance of surviving it whereas in Africa, a woman is more than twice as likely to die from the disease.

The difference is due to the huge discrepancy in the availability of prevention, screening, early diagnosis and treatment services.

Around 80 percent of Africa’s one billion people have no access to radiotherapy and related cancer services at all. I repeat – 80 percent of Africans have no access to radiotherapy.

The IAEA is working to narrow that discrepancy.

Ladies and Gentlemen,

Our work related to cancer covers three main areas: nuclear medicine, radiation oncology, and dosimetry.

Our Division of Human Health helps countries to ensure optimized delivery of radiotherapy and to use advanced cancer treatment technologies effectively.

Our Programme of Action for Cancer Therapy – PACT – helps them to use limited resources efficiently and to raise global awareness of the challenge of cancer in the developing world.

We also help countries that are planning new cancer treatment centres to produce bankable documents that will enable them to secure funding from lending institutions.

The IAEA’s work covers diagnosis and treatment, as well as ensuring the safety of patients and medical staff.

As far as diagnosis is concerned, we help countries to use nuclear medicine. This involves procedures such as PET/CT and SPECT scans that use radioactive sources to help doctors to diagnose and manage heart disease, cancer and many other conditions.

When it comes to treatment, we help developing countries to plan and establish radiotherapy facilities. We advise on the choice of the most appropriate equipment and provide education and training for oncologists, radiologists, medical physicists and other specialists.

We arrange for experts to receive training in hospitals and research centres in more developed countries.

We also support e-learning through initiatives such as our Human Health Campus and Virtual University for Cancer Control.

These platforms offer high-quality online training, free of charge, in areas such as radiotherapy and medical physics. Our Human Health Campus platform alone has an average of 4,500 visitors per month.

One important IAEA initiative is the African Radiation Oncology Network, known as Afro-NET. This enables doctors in different countries to provide real-time online training in how to conduct a tumour board.

Physicians from Canada, the United States and African countries, for example, can review X-rays, scans and pathology images together, as if they were in the same room, instead of on different continents.

Ladies and Gentlemen,

Let me give you a few examples of our work in different countries.

In 2010, the IAEA conducted what we call an imPACT review mission in Burkina Faso, requested by the government, to study what cancer services were available.

We then advised on the development of a comprehensive national cancer plan. We helped Burkina Faso to establish its first nuclear medicine centre and we are now working with the country on developing its radiotherapy services.

Lesotho has the capability to diagnose cancer but has to send patients to South Africa for treatment. The IAEA helped the country to plan its first radiotherapy centre. We arranged training in radiation oncology for doctors from Lesotho so they can provide radiotherapy treatment when the new centre opens in a few years’ time.   

We provided diagnostic equipment for child cancers in Ghana. In Mongolia, we arranged training in palliative care for doctors, nurses and radiation medicine professionals. Nicaragua received diagnostic equipment and training related to breast and cervical cancer.

Ladies and Gentlemen,

Let me stress that safety is crucially important when nuclear and radioactive materials are being used.

Cancer patients treated with radiation must receive the correct doses – high enough to destroy tumours, but not too high so as to risk avoidable damage to healthy tissue.

The IAEA dosimetry laboratory near Vienna helps to ensure that radiotherapy equipment throughout the world is correctly calibrated.   

We also help countries to put proper procedures in place to ensure that patients and staff are protected from unnecessary exposure to radiation.

Ladies and Gentlemen,

Partnerships with key international organizations and NGOs are an essential part of the IAEA’s work.

The IAEA works with partners such as the World Health Organization to help countries to devise comprehensive cancer control programmes.

We are playing an active part in the Joint Programme on Cervical Cancer Prevention and Control, which brings together seven international organizations in a sustained and targeted approach to the disease in specific countries.

This cruel disease affects young women in their most productive years. It involves great personal tragedies for patients and their families and also has very negative effects on economic development.

Under the Joint Programme, each organization brings its particular expertise to bear. The IAEA supports the radiology, nuclear medicine and radiotherapy aspects.

This is a good example of the sort of coordinated global response that is needed to achieve results.

Ladies and Gentlemen,

The IAEA is a specialist organisation with expertise in nuclear technology. Our mission is to transfer technologies to help save lives.

We do not have a broad mandate in health, nor do we have sufficient funding to do everything we would like to do. But when it comes to technology transfer and capacity-building, we deliver.

Our work has made a difference to countless individual lives. But, to be frank, we are only scratching the surface. There is an estimated shortage of 5,000 radiotherapy machines throughout the world.

To meet the cancer needs of developing countries, we need around 10,000 additional radiation oncologists, 6,000 medical physicists, 3,000 dosimetrists and 20,000 radiation therapists.

This is a daunting challenge. But the global response to the HIV/AIDS crisis demonstrated that coordinated international action, backed by serious funding, does achieve results. And let us remember that cancer kills five times more people every year than HIV/AIDS.

I believe it is time to put cancer in developing countries at the top of the international agenda.

Many of the organisations and companies represented at this World Health Summit can help to make that happen.

A comprehensive approach is needed which must include cancer prevention, surveillance, screening, early detection, treatment and palliative care. Please join us.

By working together, we can save millions of lives.

Thank you.