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EU Mission on Cancer add real momentum to tackle the entire disease pathway

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Joanna Drake, Deputy Director-General, DG Research and Innovation (RTD)

The implementation of Europe’s Beating Cancer Plan and the EU Mission on Cancer will go far beyond research and innovation to develop new solutions and improve the lives of Europeans, says Joanna Drake, Deputy Director-General, DG Research and Innovation (RTD).

More Europeans are surviving cancer than ever before, and those affected by the disease have a better quality of life. Despite the substantial improvements in reducing the cancer burden, the incidence of cancer is expected to rise due to ageing populations, unhealthy lifestyles, unfavourable health factors, and environmental and working conditions.

The Covid-19 pandemic has worsened the situation by halting or delaying regular check-up screening programmes, treatments and clinical trials. It has also exposed inequalities in access to healthcare due to uneven geographical availability of services and other problems in health systems. These developments will have long-lasting effects on prevention and cancer control.

To fight cancer, it’s crucial to detect and treat as early and precisely as possible. Technology is changing the cancer care landscape, presenting new opportunities – from digital health records to real-world patient data for research purposes.

There is good news on the horizon. The EU’s Mission on Cancer launched in September 2021, together with Europe’s Beating Cancer Plan adopted in February 2021, aims at improving the lives of more than 3 million people by 2030 through prevention and cure, and helping those affected by cancer, including their families, to live longer and better.

Europe’s Beating Cancer Plan is a key pillar of the European Health Union, presented by European Commission President Ursula von der Leyen in November 2020, calling for a more secure, resilient and better-prepared European Union. It reflects the EU’s political commitment to steward the strategy, taking action against cancer and leaving no stone unturned.

In an exclusive interview with Horizon magazine, Joanna Drake, Mission Manager for the EU Mission on Cancer and Deputy Director-General at Directorate-General for Research and Innovation (DG RTD), outlines the European Commission’s commitment to defeating this disease.

Excerpts of the interview follow.

How will the EU Mission on Cancer improve the diagnosis and treatment of cancer for Europe’s citizens and remove the disparity within and among the Member States?

If we look at what’s happening within the Member States, we can see there is currently no real equality in accessing knowledge on cancer or its prevention, diagnosis and treatment, or quality of life for cancer patients and their caregivers. So, what we want is a levelling up through the Cancer Mission actions.

We propose that by 2023, there will be a blueprint for a federated digital platform supported by and for patients and cancer survivors to exchange real-world health data. Once fully operational, they could access hands-on information on guidelines, clinical trials, possible side effects, and personalised care. It will also provide information on cross-border healthcare, psychosocial and legal support, guidance on returning to work, financial issues, and legal rights as a cancer survivor. In addition, scientists will be able to access this aggregated real-world patient data for research purposes.

Secondly, we have started with establishing a blueprint for a database known as the UNCAN.eu platform. This is also a question of putting data together which has not hitherto been combined, but it also includes data on sources outside the health domain. Examples include geographical observation data, climate and environmental exposure, and information concerning the social sciences. By making this data available on a platform, researchers can access it and inform decision-makers about any proposed policy action that needs to be taken.

Our third priority involves working towards a Network of Comprehensive Cancer Infrastructures by 2025. It’s an objective that would level up – at least to a certain minimum level – information provision and efficiency for national cancer infrastructures to make sure that all European regions in the Member States are covered.

We propose that by 2023 there will be a blueprint for a federated digital platform, supported by and for patients and cancer survivors to exchange real-world health data 

Joanna Drake, Deputy Director-General, DG Research and Innovation (RTD)

In terms of overcoming this disparity, what will be the role of the Network of Comprehensive Cancer Infrastructures and the European Reference Networks on cancer?

They will enable scientists to benefit from a state-of-the-art research infrastructure and participate in international clinical studies. Most importantly, creating this network will benefit cancer patients because they will ultimately have better access to prevention, screening, diagnostics and treatments, and improved care pathways.

The European Reference Networks will also be involved in designing clinical studies and care pathways, which we believe will ultimately lead to a levelling up on a European scale for cancer infrastructures, care, prevention, diagnostics, analysis, and quality of life. This obviously demands close cooperation between the Horizon Europe Cancer Mission, Europe’s Beating Cancer Plan, Member States, as well as regions and local communities, and likewise joining up different levels of governance.

How would you describe this to a patient or a doctor?

What we envision is something that produces high quality care and good research results that inform policy and leads to an improvement in access to care. The relevant ministries and governance structures, which are already in place, will manage a comprehensive network of cancer infrastructures across the Member States that share data among themselves.

The network will provide access to researchers, who will gain insights into the policy, care, prevention measures and tools necessary for any Member State or even patients to seek better information about their condition, or where best practices have been established.

But at the end of the day, you need a truly joined up structure that works together much closer than is the case now. There are already a lot of exchanges and conferences taking place, and operational collaboration too, but this will be more visible and organised to enable a patient to be more informed at a European level (for example cross-border healthcare) rather than just at the local, regional or national level.

In time, I believe this can also evolve into a better collaboration over health policy, which is something Covid-19 caused to happen between Member States with a lot of success. Look at the vaccination programme! It wouldn’t have happened so quickly if the health authorities and research communities had not collaborated very closely at European level.

How will the EU Mission on Cancer and Europe’s Beating Cancer Plan enhance EU research efforts and inform future policies?

You can’t inform only with policies. You also need to mobilise support and financial resources. We need greater mixing of existing legal instruments and funding programmes to create better outcomes for cancer patients and those who are at risk or living beyond cancer. So now, we are creating the building blocks with the Mission and Europe’s Beating Cancer Plan, which are designed to complement each other.

This also involves the use of financial incentives and inducements through different legal instruments across the EU institutions to help Member States conduct their own programmes. This is on top of funding from the European budget, and will help mobilise even more financial support for what can be deemed to be a European initiative to deliver European added value.

You can do this both with public money and attracting private investment for innovation and start-ups with ready-for-market solutions and through implementation research. This could be research on primary prevention programmes, which can then attract further investment for other research and innovation programmes that can contribute to diagnosis, care and quality of life. For example, a risk-based screening programme, using cheaper and faster screening technology that could be targeting regions with limited resources, or at the other end of the spectrum, new and tailored palliative end-of-life care solutions for advanced cancer patients.

We need to incentivise even closer, joined-up cooperation between the research ministries, health ministries and stakeholders, researchers, innovators and policymakers. If we can do this, Europe will look like the region where it makes sense to invest money, including private money, to ensure these innovative solutions and in some cases already available technology can be made available and cheaper to those regions with limited resources.

…a risk-based screening programme, using cheaper and faster screening technology that could be targeting regions with limited resources, or at the other end of the spectrum, new and tailored palliative end-of-life care solutions for advanced cancer patients 

Joanna Drake, Deputy Director-General, DG Research and Innovation (RTD)

The Covid-19 pandemic has had a negative impact on cancer control activities, how will the Cancer Mission make up the lost ground?

I agree, Covid-19 has had a negative effect on cancer control in all Member States, whether it is prevention, screening, detection, treatment or care, but it has also exacerbated health inequalities. In fact, cancer diagnoses dropped by 40% in 2020, with far over 1 million undiagnosed cases. Scientists predict that there will be an increase in diagnoses of late-stage tumours, reducing the chances of survival, affecting quality of life, and increasing costs to the healthcare system for the years to come.

So how will the Cancer Mission help? Firstly, it’s now on the map as a truly European objective, and we know President von der Leyen is giving it her personal attention. Secondly, this high profile will ramp up communication and awareness of the risk factors and symptoms of cancer, encouraging people to attend cancer prevention programmes.

The Mission supports home screening solutions like self-testing for cervical cancer and colorectal cancer. It also supports clinical trial designs that require patients to travel less, plus medication and follow-up from home, and different care pathways.

The research in this article was funded by the EU. This article was originally published in Horizon, the EU Research and Innovation Magazine.  

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Why more heatwaves endanger our health and ability to work

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As the Earth warms, heatwaves are expected to occur more often, with sharper intensity and for longer periods. Rising temperatures adversely affect worker productivity and human health, but for policymakers to take substantive action for heat adaptation, and meet what researchers see as a life-saving Paris climate agreement, making an economic case is key.

BY NATALIE GROVER

As the Earth warms, heatwaves are expected to occur more often, with sharper intensity and for longer periods. Rising temperatures adversely affect worker productivity and human health, but for policymakers to take substantive action for heat adaptation, and meet what researchers see as a life-saving Paris climate agreement, making an economic case is key. This article first appeared in Horizon Magazine in August 2020.

It’s actually quite easy for us to point out the problem — we have increasing temperatures, increasing frequency of heatwaves…it affects our physical and cognitive performance,’ said Lars Nybo, a professor of integrative physiology from the University of Copenhagen, Denmark. He worked on a project called HEAT-SHIELD designed to examine the effects of heat exposure on worker productivity in industrial sectors that employ half of Europe’s workforce: manufacturing, construction, transportation, tourism, and agriculture. The project ran from January 2016 until December 2021.

Globally, 2021 was among the seven hottest on record, with Europe experiencing its hottest summer to date. In the Mediterranean region, an intense and prolonged heatwave in July and August lead to new temperature records and devastating wildfires, a poignant reminder that the achievement of the Paris climate agreement to keep global mean temperature increases well below 2°C is as important as ever.

Data from HEAT-SHIELD project suggest that exposure to external heat in combination with physical activity, which elevates the body’s production of heat, can result in physiological changes that can diminish occupational performance, via reduced working endurance, vision, motor coordination and concentration. This can lead to more mistakes as well as injuries.

‘Roughly 70% of all European workers, at some time during the working day, are not optimally hydrated,’ Prof. Nybo said. The solution to the problem, he added, is intuitive: drink water, replace electrolytes and reduce physical activity, but implementing these measures whilst maintaining productivity is where things get tricky. 

‘You could just say to the worker stay at home and drink cold margaritas in the shadow to prevent heat stress,’ he joked. ‘But that will not help productivity.’

Productivity

As coordinator of HEAT-SHIELD, Prof. Nybo and his team were tasked with not just assessing the extent of the problem — modelling the expected rise in temperature in Europe in the coming years and its impact on worker productivity ­— but also devising and implementing solutions that are location and vocation specific to adjust to the inevitable increases in temperature.

A construction worker wears a safety helmet, which impairs the body’s ability to purge heat, but the worker thinks this problem cannot be solved because it is intrinsic to their work, Prof. Nybo noted.

Surmounting challenges like this was one of the key objectives of the project — conceiving ways to weave in heat mitigation strategies alongside the practicalities of the job.

For instance, outdoor workers should be vigilant of weather patterns and plan work earlier in the day during periods of extreme heat, take a short break every hour and secure easy access to water. Similar remedies for workers in enclosed settings could mean a combination of air conditioning, working in shade and improving ventilation — keeping in mind the ecological footprint of such measures.

But on a macro level, for climate change policymakers to take concrete action here and now ­— the numbers are key, Prof. Nybo said.

In Europe, agricultural and construction workers for instance, lose some 15% of effective working time when the temperature goes beyond 30°C, which works out to almost one working day per week, he noted, citing HEAT-SHIELD analyses.

If you are a policymaker, he says, the numbers show that there’s an incentive to act now: if you mitigate the problem the cost will stabilise at a lower level in the long run than if you don’t.

Excessive heat

Diminished worker productivity and the downstream economic damage are prominent impacts of rising temperatures caused by climate change. But to get a full picture of the consequences, it’s necessary to understand what excessive heat does to the human body.

It can damage organs such as the heart and the lungs, exacerbate a range of diseases, and increase the risk of death.

Extreme heat can increase the occurrence of heart attacks and strokes in susceptible patients due to increased blood viscosity, and raise the risk of cardiovascular death in vulnerable patients. Hot, humid days can also trigger asthma symptoms and have been shown to increase airway resistance, while warmer climates tend to extend the pollen season.

Another side effect of rising temperatures is the association with air pollution — the largest environmental killer in Europe, causing roughly 500,000 premature deaths annually.

Observational data and modelling suggest that as it gets warmer, air pollution levels — particularly surface ozone gas (O3) and fine particulate matter (PM2.5) — increase in some populated regions, even when emissions of air pollutants have not risen, as well as create conditions favourable for forest fires.

Both extreme heat and air pollution raise the risk of cardiovascular and respiratory disease, which currently costs the European Union an estimated €600bn a year. If these environmental stressors continue to accumulate unabated, these costs could jump.

Projections

But the synergistic relationship between air pollutants and rising temperatures is not well understood and existing health-risk projections in Europe do not properly account for adaptive measures that can be taken to ameliorate associated health risks, according to Dr Kristin Aunan, a senior researcher at the Norway-based Center for International Climate Research.  

‘There’s quite a lot of literature on short-term impact — in terms of the day-to-day variation on the impact of heat stress on mortality — but when it comes to long-term impact, there is not a lot of information,’ she said.

As part of a project called EXHAUSTION that kicked off in 2019 and is due to run until May 2023, researchers including project coordinator Dr Aunan, are focused on quantifying the risks of cardiopulmonary disease in different temperatures.

The project is also working on identifying interventions to minimise the risks to health sparked by environmental stressors and demystifying the link between air pollution and temperature hikes.

Quantifying the cascading effect of cardiopulmonary diseases on the economy is key to affecting action on climate change, she suggests.

EXHAUSTION researchers, for instance, are devising a macro-economic model that tracks increased hospitalisation and mortality in different age groups to measure the impact on the broader economy in different European countries. ‘We also have a bottom-up model — where you put a price on every premature death or hospital admission and add up to estimate the economic cost.’

One of the main questions the researchers hope to answer is the magnitude of impact limiting temperature spikes to 1.5°C — the aim of the Paris climate agreement — will have on health. 

‘I have no answer to that today — but the reason why we’re doing this project…is that we think there are reasons to believe that being able to comply with a Paris agreement will save very many lives and reduce human suffering,’ Dr Aunan said.

‘When you discuss climate policy and discuss the costs of it — it’s very expensive to reduce emissions of greenhouse gases, etc. But you also need to consider the benefits and that’s what we are doing with this project — hoping that we can contribute to the other side of the coin.’

This article first appeared in Horizon Magazine in August 2020.

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Children at risk of new ‘unexplained acute hepatitis’ outbreak

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The world is currently facing a new outbreak of “unexplained acute hepatitis infections” affecting children, the World Health Organization (WHO) warned on Thursday, World Hepatitis Day.

The current uptick focuses attention on the thousands of acute viral hepatitis infections that occur every year among children, adolescents, and adults.

Treat hepatitis

WHO, together with scientists and policymakers in affected countries, are working to understand the cause of this infection that does not appear to belong to any of the known five types of hepatitis viruses: A, B, C, D, and E.

While the world has the guidance and tools to diagnose, treat, and prevent chronic viral hepatitis, these services are often out of reach for communities and are sometimes only available at centralized or specialized hospitals.

“To be most effective, hepatitis care must be delivered in communities through strong primary healthcare and integrated with other health services that address the full range of health needs,” WHO chief Tedros Adhanom Gebreyesus said in his message for World Hepatitis Day.

At risk

Although most acute infections cause mild disease and even go undetected, some can lead to complications and turn fatal.

In 2019 alone, complications of acute hepatitis A to E infections caused an estimated 78,000 deaths worldwide.

Global efforts prioritize the elimination of hepatitis B, C and D infections.

Unlike acute viral hepatitis, B, C and D cause chronic disease, which lasts for several decades, culminating in over one million deaths per year from cirrhosis and liver cancer. And they are responsible for over 95 per cent of hepatitis deaths.

Death every 30 seconds

“Every 30 seconds, someone dies from hepatitis-related diseases, including liver failure, cirrhosis and cancer,” said the WHO chief.

Moreover, some 80 per cent of people living with the disease are unable to access or afford care.

With the goal of eliminating hepatitis by 2030, the UN health agency has called on countries to reach four specific targets.

It aims to reduce new infections of hepatitis B and C by 90 per cent; reduce hepatitis-related deaths from liver cirrhosis and cancer by 65 per cent; ensure that at least 90 per cent of people with hepatitis B and C virus are diagnosed; and at least 80 per cent of those eligible, receive appropriate treatment.

Low coverage of testing and treatment is the most important gap to be addressed, in order to achieve the global elimination goals by 2030,” according to WHO.

Call to action

WHO is calling on all governments and partners to “scale up the use of effective tools” against the potentially deadly disease.

Tedros drew attention to a new WHO report that shows how Brazil, Egypt, Georgia, Mongolia, Rwanda, Thailand and the United Kingdom, are making progress towards the elimination of hepatitis B and C by applying the UN health agency’s tools and guidelines.

“With political commitment and investment, the elimination of viral hepatitis is within our reach,” he stated.

July spotlight

The day aims to raise awareness of viral hepatitis, which causes inflammation of the liver that leads to severe disease and liver cancer.

It also offers an opportunity to step up national and international efforts on the infection, encourage individuals, partners and the public to act, and highlights the need for a greater global response, as outlined in the WHO’s Global hepatitis report of 2017.

This year, WHO is highlighting the importance of bringing hepatitis care closer to primary health facilities and communities for better access treatment, no matter the type of hepatitis.

The 28 July date was chosen because it is the birthday of Nobel-prize winning scientist Baruch Blumberg, who discovered hepatitis B virus (HBV) and developed a diagnostic test and vaccine for the virus. 

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Tone as important as truth to counter vaccine fake news

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By ALEX WHITING

Lack of trust in health authorities, combined with the fear and uncertainty about the disease, created fertile ground for false rumours to spread about Covid-19 vaccines. Countering the rumours may be about attitude as well as facts.

False assertions about Covid-19 vaccines have had a deadly impact – they are one reason why some people delayed being inoculated until it was too late. Some still refuse to be vaccinated.

More than two years after the start of the pandemic, false rumours continue to circulate that the vaccines do not work, cause illness and death, have not been properly tested and even contain microchips or toxic metals.

Now a study raises hopes of deflecting such falsehoods in future by changing the tone of official health messaging and building people’s trust.

In many countries, public confidence in government, media, the pharmaceutical industry and health experts was already on the wane before the pandemic. And in some cases, it deteriorated further during the rollout of Covid vaccines.

This was partly because some national campaigns said the jabs would protect people from falling ill.

Friends over facts

‘There was a lot of overpromising around the vaccine without really knowing what would happen,’ said Prof Dimitra Dimitrakopoulou, research scientist and Marie Curie Global Fellow at the Massachusetts Institute of Technology and the University of Zurich.

‘Then people started getting sick, even though they were vaccinated. That created a lack of trust in the government issuing these policies, and in the scientific community.’

Prof Dimitrakopoulou studied public perceptions of Covid vaccines and obstacles to acceptance of reliable information as part of a project called FAKEOLOGY.

She found that, when people lose faith in institutional sources, they end up relying only on themselves, close friends and family.

‘They trust their instincts, they trust what resonates with them,’ Prof Dimitrakopoulou said. That means they will search the internet, social media and other sources until they find information that reinforces the beliefs they already hold.

‘We have lived with fake news and misinformation long enough to understand that it cannot be debunked with facts,’ she said. ‘People just raise these emotional blocks.’

For example, a story about a mother whose child fell sick after getting a Covid vaccination would likely be more influential than a message containing scientific facts.

Building trust

Prof Dimitrakopoulou surveyed 3 200 parents of children under 11 years old in the United States, and conducted focus groups with 54 of them, to discuss their views about Covid vaccines for kids.

Many parents felt confused by conflicting information about the shots and had a lot of questions about their effectiveness.

She gave the parents a selection of messages to assess. They were put off by the ones that were largely factual, rigid and prescriptive – the tone of many public health campaigns.

They were more persuaded by messages that addressed their concerns about the vaccines with empathy and compassion while acknowledging that they face a difficult decision.

‘We need to be ready to answer any questions they may have and be ready to have a conversation – without expecting the conversation to end with someone getting vaccinated,’ said Prof Dimitrakopoulou.

Those exchanges will ultimately help bolster public faith in health bodies and government institutions. ‘Covid is a great opportunity for us to start building this trust,’ she said.

While a lengthy process, building these bridges could enlighten people’s perceptions for the rest of their lives, she said.

Fake news filter

It is also important for journalists, researchers and the general public to be able to spot and filter out fake news.

Researchers on a project called SocialTruth have developed a tool to flag fake news content on the internet and social media.
 
The software, called a Digital Companion, can check the reliability of a piece of information. It analyses the text, images, source and author and, within two minutes, produces a credibility score – a rating of between one and five stars.

‘This is a computer-generated score that can give a red-flag warning if the content is very similar to other types of content that have been found to be false,’ said Dr Konstantinos Demestichas, researcher at the Institute of Communication and Computer Systems in Athens and coordinator of SocialTruth.

The Digital Companion uses computer algorithms that draw on a wide variety of verification services. These include non-governmental organisations, businesses and academic institutions – all with different interests, opinions and intentions.

Because of the diversity of verification-service providers, ‘We need to establish their trustworthiness by continuously evaluating their results,’ said Dr Demestichas.

To do this, the project uses blockchain to record all the scores and results produced by the verifiers. If the verifiers perform poorly, they lose their status – ensuring the Digital Companion can offer a quality assurance, he said.

Digital and human fact checkers

For now, the technology has been developed to scan health science and political content. In future, it could be developed for almost all areas.

Initially it will be for institutions that monitor fake news and disinformation, but the aim is to enable journalists and the general public to take advantage of the resource too.

The technology ‘could really make a difference in the daily use of the internet and social media,’ said Dr Demestichas.

Still, because it will never be able to spot all fake news, ‘We need journalists, fact checkers, and citizens to be well-trained to exercise their critical thinking,’ he said.

Manipulated feelings

The fight against misinformation is about more than protecting people’s health, important as that is. The well-being of democratic societies themselves is also at stake, said Dr Demestichas.

‘Fake news tries to manipulate our feelings and fears to get our “clicks” to read their content,’ he said.

Curbing it is critical ‘to defend our democracies and allow our societies to function better.’

The research in this article was funded by the EU. This article was originally published in Horizon, the EU Research and Innovation Magazine

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