Photo by Kelly Sikkema on Unsplash

The HIV Transformation

In the mid-1990s, as a young resident new to the U.S., I was still learning about HIV/AIDS when a patient arrived in our Connecticut ER one night – a young man, close to my age, muscular and healthy-looking but desperately short of breath. I remember him vividly. His chest glistening with sweat, he heaved with each breath. He had pneumocystis pneumonia and, despite our efforts, died shortly after.

At that time, HIV was still largely a death sentence, and the treatments that existed were prohibitively expensive and available only to a fortunate few.

Today, that same patient would likely be living a full life on a single daily pill that costs pennies in many parts of the world.

Cancer Innovation by the Numbers

I’ve been thinking about this transformation while reading the recent Global Oncology Trends report. These numbers caught me by surprise: 132 new cancer drugs launched globally in the past five years. $252 billion invested in oncology in 2024 alone.

Even though I work at a tertiary cancer center and see the changes around me every day – new therapies, novel approaches, breakthrough treatments moving from trial to standard care – seeing it quantified like this made me pause.

We’re living through what might be the most intensive scientific effort humanity has ever mounted against a single category of disease. Thirty-five percent of current oncology trials now involve modalities that didn’t exist a decade ago: CAR-T therapies that reprogram immune systems, antibody-drug conjugates that deliver chemotherapy with surgical precision, bispecific antibodies that bridge our natural defenses to cancer cells.

The Access Gap

But here’s what keeps me up at night: innovation and implementation are not the same thing. While we celebrate these breakthroughs, a patient’s zip code or country still determines their access to cutting-edge care. The same genetic mutation that receives personalized therapy in Boston might go untreated in Bangladesh. Even within the United States, the quality of cancer care varies dramatically by geography, insurance status, and socioeconomic factors.

Global Models That Work

Maybe the question isn’t whether we can continue to innovate in cancer care – we’ve proven that beyond doubt. Maybe the question is whether we can apply that same innovative spirit that transformed HIV care to ensuring our cancer breakthroughs reach everyone who could benefit.

We don’t have to look far for proof that this is possible. Rwanda’s Butaro Cancer Center has treated over 18,000 patients since 2012, providing free comprehensive cancer care in rural East Africa where none existed before. Brazil has taken a different approach at a massive scale – their Unified Health System guarantees universal cancer care for 220 million people, with major public investments like 90 new radiotherapy machines delivered to underserved regions, dramatically reducing wait times.

But transformation isn’t just happening at the country level. The ChemoSafe program represents a continental effort to establish systematic safety protocols for chemotherapy handling across Sub-Saharan Africa, where healthcare workers often lacked proper protective equipment and training. Through coordination between the American Cancer Society, Oncology Nursing Society, and Clinton Health Access Initiative, the program has trained over 100 healthcare workers in Kenya alone and helped Nigeria become the first African country to adopt national chemotherapy safety policies.

These examples show what’s possible with political will and coordinated investment. Rwanda built from nothing. Brazil transformed an existing system. ChemoSafe tackled infrastructure and safety across an entire continent. Different scales, different approaches, same principle: when we decide cancer care is a priority, not a privilege, dramatic change follows. (And there are plenty of examples to the contrary—for the best one, see “Everything is Tuberculosis“.)

A Call for Coordinated Action

The same coordinated action, innovative financing, and political will that transformed HIV from a death sentence to a manageable condition could do the same for cancer care. We have the medical breakthroughs. We have proven delivery models at every scale.

What we need now is the commitment to bridge that gap between what’s possible in Boston and what’s available everywhere else.

Because the most elegant therapy is only as good as our ability to get it to every person it could save.