Title: Economic crises and cancer care in Pakistan—timely action saves lives
Abstract: Cancer treatment is often ignored during economic crises; Sri Lankans are still striving to stabilise their health-care system.1Das M Economic crisis in Sri Lanka causing cancer drug shortage.Lancet Oncol. 2022; 23: 710Summary Full Text Full Text PDF Google Scholar Currently, the health systems in low-income and middle-income countries are least prepared to operate independently in emergencies and combat global cancer inequities. Alarmingly, in Pakistan, political turmoil has contributed to a catastrophic decline in the economy and looming bankruptcy.2Shakil FM Pakistan awaits an economic collapse. Al Mayadeen.https://english.almayadeen.net/articles/analysis/pakistan-awaits-an-economic-collapseDate: Dec 9, 2022Date accessed: January 2, 2023Google Scholar Being the world's fifth most populous country (with a population of >232 million people), due to depleting reserves, rising inflation, and calamitous recent floods, the value of currency in Pakistan has declined by 21·72% this fiscal year.2Shakil FM Pakistan awaits an economic collapse. Al Mayadeen.https://english.almayadeen.net/articles/analysis/pakistan-awaits-an-economic-collapseDate: Dec 9, 2022Date accessed: January 2, 2023Google Scholar With a gross domestic product of US$340·64 billion (per capita $1471·1),3StatistaPakistan—statistics & facts.https://www.statista.com/topics/2666/pakistan/#topicOverviewDate accessed: February 7, 2024Google Scholar Pakistan's Human Development Index has increased from 154 in 2020–21 to 161 (score 0·544) in 2021–22.4United Nations Development ProgrammeHuman development report 2021/2022. Uncertain times, unsettled lives: shaping our future in a transforming world.https://hdr.undp.org/system/files/documents/global-report-document/hdr2021-22pdf_1.pdfDate: 2022Date accessed: July 26, 2023Google Scholar According to WHO estimates, every year in Pakistan, 118 442 individuals lose their lives to cancer and 173 937 new cancer cases are identified.5World Health OrganisationCancer Pakistan 2020 country profile.https://cdn.who.int/media/docs/default-source/country-profiles/cancer/pak-2020.pdf?sfvrsn=ad5509e4_2&download=trueDate accessed: February 7, 2024Google Scholar By contrast, the Pakistani Government has not planned for any substantial measures to combat cancer incidence, merely spending $38 per capita in 2020 on health care.6World BankCurrent health expenditure per capita (current US$)—Pakistan.https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locations=PKDate accessed: February 7, 2024Google Scholar Only 40 institutions (government and private) across the country declare themselves cancer treatment centres, yet the demand from patients considerably outweighs the supply. The state-of-the-art Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), founded by former Prime Minister Imran Khan, is supported by national and international fundraising efforts, and treats patients from Pakistan, Afghanistan, and Tajikistan, irrespective of their capacity to pay for treatment.7Yusuf MA Pursuing excellence in cancer care in Pakistan.Lancet Oncol. 2022; 23: 1365-1366Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Cancer treatment challenges, besides financial strain on people with cancer, are far worse than we had anticipated. Most anti-cancer drugs are imported; following Government import restrictions, a severe shortage of medicines is anticipated. Due to the depletion of foreign exchange and low investment returns, pharmaceutical companies have withdrawn their business from Pakistan, while domestic companies operate illegally in the black market.8Business StandardPakistan faces shortage of life-saving medicines including insulin: report.https://www.business-standard.com/article/international/pakistan-faces-shortage-of-life-saving-medicines-including-insulin-report-122122100108_1.htmlDate: Dec 21, 2022Date accessed: January 7, 2023Google Scholar Recruiting and continuing to employ well trained doctors, nurses, and other medical workers is a perennial struggle in Pakistan. Worryingly, fewer than 250 expert medical or radiation oncologists are now practising nationwide.7Yusuf MA Pursuing excellence in cancer care in Pakistan.Lancet Oncol. 2022; 23: 1365-1366Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar According to the Ministry of Health, Pakistan needs 2 million more nurses.7Yusuf MA Pursuing excellence in cancer care in Pakistan.Lancet Oncol. 2022; 23: 1365-1366Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Paramedics in Pakistan are emigrating to high-income nations.7Yusuf MA Pursuing excellence in cancer care in Pakistan.Lancet Oncol. 2022; 23: 1365-1366Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 9Nazir Z Pakistan's brain drain crisis escalates as thousands leave.https://www.dw.com/en/pakistans-brain-drain-crisis-escalates-as-thousands-leave/a-65733569Date accessed: February 7, 2024Google Scholar The current Pakistan Government's actions towards SKMCH&RC Chairman Imran Khan and probes into foreign funding10AljazeeraImran Khan's party received illegal funds: Pakistan poll panel.https://www.aljazeera.com/news/2022/8/2/imran-khans-party-received-illegal-funds-pakistan-poll-panelDate: Aug 2, 2022Date accessed: January 9, 2023Google Scholar might undermine the cooperation of overseas donors. The question is, what can be done right now? First, it is necessary to take concrete steps, such as reaching out to international health-care organisations and cancer care agencies to solicit monetary donations, pharmaceuticals, consumables, and equipment. Second, austerity measures should be adopted to ensure the judicious use of resources and more reliance on empirical treatment rather than laboratory investigations. Third, the Government should uplift import restrictions on medical supplies and establish price regulation of pharmaceuticals in Pakistan. In conclusion, we would like to reaffirm the famous adage—to save one life is like saving all mankind—and recommend the collaborative efforts of international cancer organisations and funding agencies for a worldwide cancer care framework to deal with such emergencies. We declare no competing interests.