Statement by Dr Hans Henri P. Kluge, WHO Regional Director for Europe

4 February 2021, Copenhagen, Denmark

COVID-19 poses multiple threats. One we cannot afford to ignore is an epidemic of cancer. Ensuring continuity of cancer care while fighting COVID-19 has been hugely challenging for countries across the WHO European Region, a continent that accounts for approximately one third of all reported COVID-19 cases and deaths to date – that is more than 750 000 lost lives.

In a normal year, cancer kills close to 2.2 million people in the Region: a far-too-heavy toll when we know that these deaths could have been prevented.

Compromised cancer services

Early on in the pandemic, WHO found that globally, in 122 out of 163 countries, noncommunicable disease services had been disrupted, and that 1 in 3 countries in the European Region had partially or completely disrupted cancer services.

At the Kyrgyzstan National Center of Oncology, the number of cancers diagnosed in April last year dropped by 90%, while in the Netherlands and Belgium in the first lockdown of 2020, it dropped by 30–40%. Delayed diagnosis and treatment in the United Kingdom are expected to result in an increase in the number of deaths from colorectal cancer by 15%, and 9% for breast cancer over the next 5 years.

A crisis of noncommunicable diseases, including cancer, is brewing, brought on by the pandemic.

Cancer in a pre-COVID-19 era

Let me set the scene. Even in a normal year, noncommunicable diseases such as cancer, chronic respiratory diseases and diabetes are the leading cause of death and disability in the WHO European Region, accounting for more than 80% of deaths.

Funds for palliative care and cancer prevention and control are insufficient, and too often, the majority of national health resources are put towards treatment at the cost of investing in prevention and early detection.

Across and within countries in the Region, differences in cancer outcomes are pronounced, and the fact that inequalities in care have increased in the past year calls for more solidarity and far stronger commitment.

The numbers speak for themselves. In 2020, 4.8 million Europeans were diagnosed with cancer. That’s more than 13 000 people every day, 546 every hour, 9 every minute. All of us know someone who has experienced cancer. One in 3 of us in western European countries and 1 in 4 of us in eastern European countries will develop cancer in our lifetimes.

A deadly interplay

The impact of COVID-19 on cancer in Europe is complex, and has been referred to by some as a “deadly interplay”. Due to travel restrictions and the enormous strain on health systems of fighting COVID-19, cancer services have been disrupted across the entire WHO European Region, significantly delaying diagnosis and treatment, directly impacting the chances of a cure or survival for hundreds of thousands of cancer patients.

Some countries have experienced shortages of cancer drugs, and many have seen a significant drop in new cancer diagnoses – even the most resource-rich countries. Oncology health personnel were in demand even before the pandemic. The high cost of cancer medicines and treatments is a challenge for all countries, including high-income ones.

Pre-existing inequalities are also growing because of the economic crisis, making it harder for many to adopt healthy behaviours or have access to prevention or care services.

The impact of the pandemic on cancer in the Region is nothing short of catastrophic. It has made us realize the actual human cost of neglecting a noncommunicable disease such as cancer.

This is our wake-up call, from grassroots to governments, to tackle cancer together.

Fast-track solutions

Today we are launching a Pan-European Cancer Initiative to unite all towards better cancer control and prevention and to enable policy-makers to make the right decisions to address cancer effectively.

It is a critical strand of the WHO European Programme of Work, which seeks to promote effective solutions to the health issues our citizens face through united action for better health.

The Initiative encompasses 5 elements: prevention (ultimately a political choice), early detection, access for all to diagnosis and treatment, palliative care, and a focus on data.

We need change along the cancer continuum. Our vision is bold, but realistic. We strive to create a Region where cancer is no longer a life-threatening disease, where dying from cancer is no longer accepted or the norm.

Our initial focus is on childhood, cervical and breast cancers. We seek to strengthen collaboration and partnerships, reinforce political leadership, engage youth and civil society and – last but not least – fast-track the implementation of WHO’s signature solutions. These are cost-effective, evidence-based policies and measures accompanied by technical guidance and tools, aligned with WHO expertise and resources to achieve real impact at country level.

Today, I welcome Aron Anderson, a Swedish adventurer with first-hand experience of cancer, as a Cancer Ambassador for WHO/Europe. Aron’s voice and personal experience will be invaluable in the work ahead, uniting forces against cancer.

Today, we have an opportunity to map a new path, to put the lessons of the pandemic to good use, and to step up cancer control and prevention. We can’t eliminate cancer – but we can aim to eliminate cancer deaths. Join us in United Action Against Cancer.

Thank you.

Each day, approximately 13 100 people in the WHO European Region receive the life-changing news that they have cancer. This statistic is compounded by a further 6000 people who lose their lives to the disease every day.

Today, on World Cancer Day, WHO/Europe launches United Action Against Cancer to galvanize support and cooperation from grassroots to governments using a wide variety of underutilized tools with the long-term vision of eliminating cancer as a life-threatening disease in Europe.

While the movement encompasses all of society, the responsibility for tackling cancer lies with policy-makers, who must close gaps in access to care and ensure healthier environments for citizens.

Communicating to the grassroots

Aron Anderson is a cancer survivor who tells his story to inspire countless individuals. He became the first person in a wheelchair to climb Kebnekaise in Sweden and Kilimanjaro in Tanzania. He has also arm-biked from Malmö, Sweden, to Paris, France, and skied across Antarctica to reach the South Pole.

Recently announced as WHO/Europe’s Cancer Ambassador, Aron explained that he is grateful to the health-care system in his home country of Sweden, without which he might not be here today: “Unlike many other children with cancer, I was given a second chance at life – many who go through what I did are not as lucky as I was.”

Introducing Aron, WHO Regional Director for Europe Dr Hans Henri P. Kluge said: “We have a collective dream of living in a Region where cancer deaths are a rare exception, instead of the norm. Aron reminds us that this dream is not impossible, but it does demand that we unite our forces at all levels, from grassroots to governments, and put our knowledge to use, doing what we know works.”

We know what works: signature solutions

WHO has developed a set of signature solutions – evidence-based, cost-effective policies and measures designed to achieve impact at the country level by offering guidance to policy-makers.

These solutions cover the whole cancer continuum, from prevention and early detection through to diagnosis, treatment and palliative care. WHO is also currently developing more advanced and specific solutions for cervical, breast and childhood cancers. These solutions will be rolled out in the coming year with clear, actionable packages.

Prevention is key

Evidence suggests that up to 30% of cancers are caused by the consumption of alcohol and tobacco. Much more can be done to limit the risk factors that lead to cancer. While individuals can take steps to reduce their risks, it is clear that policy-makers need to implement the evidence-based policies which make healthy choices possible. This includes creating urban environments where people can exercise, for example, with more bike lanes, and reducing access to tobacco, alcohol, and foods high in fats, salt and sugar.

“We have to remind policy-makers that we need to think in a 25–30 year cycle,” says Aron. While policy-makers often have shorter-term goals, Aron is clear that this long-term vision reflects that the battle against cancer is “a marathon, not a sprint”, and should be passed down through generations of politicians.

Tackling inequities

Prevention, early detection, diagnosis and treatment are just some of the areas where cancer survival rates are impacted by inequities. Currently, the risk of developing cancer is 3 times higher in northern Europe than central Asia, yet chances of a cure are 2.5 times higher by comparison. This is often a result of differing access to quality diagnosis and treatment.

Furthermore, uptake of vaccines that can reduce the chances of developing cancer, such as those against human papilloma virus (HPV) and hepatitis B, remain too low across the Region, and healthy choices are often considered solely an individual responsibility.

Finally, the majority of national resources are dedicated to cancer treatment, while prevention, early detection and palliative care remain underdeveloped. These are all areas where governments and policy-makers must act to improve cancer control.