Diagnosing Global Health Systems: Reflecting on COVID-19’s impact on cancer care around the world

What are the lessons to learn from many weaknesses in our health systems revealed by the pandemic? Banner image: Shutterstock/ DC Studio

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This article is part of a series in which OECD experts and thought leaders  from around the world and all parts of society  address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.

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As the world marks the grim milestone of 5 million COVID-19 deaths, health systems and patients are living under the threat of a second COVID-19 related health disaster—an acceleration of illness and mortality born of health care delayed or abandoned over the course of the pandemic.

This is particularly acute among those living with cancer. Patients already diagnosed may have seen lifesaving treatment deferred. Others have missed the opportunity for early diagnosis and intervention.

Profound consequences

This disruption is a global concern. During the first wave of the pandemic, the World Health Organization found that cancer services were disrupted in at least 122 countries.

In Europe, clinicians saw 1.5 million fewer cancer patients in the first year of the pandemic compared to pre-pandemic levels. Half of patients did not receive timely surgical or chemotherapy treatment. European clinicians are now working through a backlog in diagnosis.  The continent has fallen behind by 100 hundred million routine cancer screenings, and as many as nine million people may be undiagnosed due to the diagnosis backlog.

Another study underscores disruptions in Africa. Three-quarters of oncology providers reported that their facilities experienced a drop in patient volumes. Researchers also found a sizable percentage of new-therapy initiation delays and existing-treatment plan modifications, issues that were significantly more prevalent in low-income countries.

Today, we are increasingly seeing the fallout of these disruptions—most notably, a reduction in five-year survival rates.

Research shows that a treatment delay of just four weeks is associated with a 6–13% increase in risk of death, depending on the type of cancer. Moreover, detecting cancer at a later stage results in excess death. A United Kingdom-focused study predicted 3,600 excess deaths resulting from three months of cancer care disruption, and 7,200 excess deaths from six months of disruption.

These projections are likely even worse for low- and middle-income countries, which are disproportionately impacted by the pandemic. Policy-makers must recognise the long-term, far-reaching implications of this slow-burning crisis and consider what can be done to mitigate them—and prevent such disruption in the future.

Find more on the Forum Network: Americans have continued to experience mental health distress over the course of the pandemic, by Moira Fagan, Research Analyst, Pew Research Center

Tackling delays and gaps in cancer care

As vaccines and treatments bring hope to ending the COVID-19 crisis, leaders and decision-makers shouldn’t lose sight of other urgent health issues. This call to action is not only from healthcare professionals and patient organisations who saw the drama unfold before them—it is from all of us in the global health community.

The biopharma industry is keenly aware of the critical situation COVID-19 has caused for cancer patients and has been doing its part to maintain continuity of care. At Bristol Myers Squibb, we have put a number of initiatives in place since the outset of the pandemic to help patients, including those with cancer, access necessary care.

While we recognise that delayed cancer care is not unique to any one country, community or cancer type, it is undoubtedly worse for those that were already experiencing health disparities prior to the pandemic. To address this, we have put a programme in place to support our colleagues who are volunteering with local clinics and hospitals to expand access to care. These efforts represent just a fraction of what’s being done by our company and across our industry, but collectively we must do more.

Recovering and reshaping future healthcare

As we gradually emerge from the pandemic, the top priority of our health systems must be to tackle the backlog of patients who have faced screening, diagnosis or treatment delays. But health professionals cannot manage this alone. Policy makers need to balance principles of resilience and the value interventions bring to patients and society. They have a responsibility to ensure that well-resourced and equitable plans to address the backlog of cancer care are included in broader recovery agendas.

Recovery is only half the battle. How can we lay the groundwork for stronger, more reliable systems that work better for all cancer patients, even amid a pandemic?

  • Continue to support flexible, agile health care delivery practices that emerged during the pandemic, such as cancer care clinics strategically separated from clinics triaging COVID-19 patients or increased use of telemedicine;
  • Protect access to innovative cancer treatments;
  • Safeguard and bolster cancer care budgets to improve equitable access to innovations, continuity, efficiency and sustainability for all patients
  • Ensure all future policies approach systematic health care changes through an equity lens to reduce health disparities and narrow the gaps in access to high-quality cancer care;
  • Address shortages in the oncology workforce to ensure more comprehensive and high-quality care and avoid straining the health care system, particularly in low-resource settings;
  • Fast-track the uptake of digital innovation to strengthen cancer care and provide efficient care to patients; and
  • Enhance data collection to promote care co-ordination and inform future policymaking.

While we work to navigate the COVID-19 crisis, it’s critical that we, the global health community, also do our part to consider how this transformed environment will impact future cancer care. We have the opportunity to learn lessons from the unprecedented challenges of the last 18+ months and channel them into positive change. We must seize the opportunity to evolve, innovate and improve cancer care for all patients by building health systems that can withstand future shocks and achieve flawless pandemic preparedness.

Find more information on the state of health system performance in the Health at Glance: OECD Indicators

Find more data on health and health systems at the OECD Health Statistics database:

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Amadou Diarra, Ph.D.

Senior Vice President, Global Policy & Government Affairs, Bristol Myers Squibb

Amadou leads an integrated organization focused on external policy environment dynamics, innovation and patient access, working with key stakeholders including policymakers, patient support organizations, health care professionals and industry associations.

Amadou joined BMS in 1991 holding positions of increasing responsibility. From 1999 to 2002 he led Secure the Future (landmark philanthropic program) before becoming General Manager in Indonesia (2002), Turkey (2005), Ireland & Nordics (2008), VP-Access Europe and then VP-General Manager-UK & Ireland (2010) with responsibilities including European Works Council Chair, Association of the British Pharmaceutical Industry Board Member, also being Health Technology Assessment Task Force and Reputation Strategy Group Chair.

Amadou holds a Doctorate in Pharmacy, University of Tours (France), a MBA from École Supérieure de Commerce de Tours and completed the General Management Program (INSEAD).

Amadou represents Bristol Myers Squibb as an American Associate of the Science & Technology in Society Forum (STSF), Member and former 4 years-term Chair of the Pharmaceutical Research and Manufacturers of America (PhRMA) International Section Executive Committee (ISEC), Council Chair of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) where he also chaired the Value & Access Committee. At Bristol Myers Squibb Amadou is a member of the Global Leadership Team as well as the Global Diversity & Inclusion Council and Sustainability Council. He is also Executive Sponsor for the Corporate Affairs Diversity & Inclusion Working Group.