30% Survival in the South, 80% in the North: The Inequality of Pediatric Cancers and Initiatives Beginning to Reduce It
A child diagnosed with cancer in France has an 80% chance of survival. The same child, with the same diagnosis, born in Senegal, Bangladesh, or Bolivia, has a 30% chance of survival. This 50-percentage-point gap is not a natural phenomenon. It is the product of decisions — or lack thereof — regarding access to medicines, diagnostic equipment, pediatric oncologists, and treatment protocols.
Each year, approximately 400,000 children worldwide are diagnosed with cancer. Around 300,000 of them live in low- or middle-income countries, where survival rates are dramatically lower than in high-income countries. The International Society of Paediatric Oncology (SIOP) estimates that 80% of preventable pediatric cancer deaths occur in these countries.
What We Know About Pediatric Cancers in Southern Countries
The most common cancers in children in Southern countries are the same as in the North: leukemias (approximately 30% of cases), brain tumors (approximately 20%), lymphomas, neuroblastomas, Wilms tumors, retinoblastomas. The difference lies in diagnosis and treatment.
In high-income countries, acute lymphoblastic leukemia (ALL) has a 5-year survival rate of over 90%. In low-income countries, this rate drops to 20-30%. The reason is not the absence of effective treatment — the drugs exist, are generic, and are relatively inexpensive. The reason is the lack of early diagnosis, trained personnel, functional equipment, and patient follow-up systems.
Late diagnosis is the first obstacle. The lack of pediatric oncologists is the second: sub-Saharan Africa has approximately 1 pediatric oncologist for every 10 million children, compared to 1 for every 100,000 in the United States. Access to medicines is the third obstacle — and the most paradoxical, as many are generics whose patents expired decades ago.
Initiatives Beginning to Close the Gap
St. Jude Global Alliance. St. Jude Hospital in Memphis launched a global program in 2018 with the goal of increasing the survival rate from 20% to 60% by 2030. In Honduras, the ALL survival rate increased from 20% to 65% between 2000 and 2020. In Jordan, the overall survival rate increased from 40% to 70%.
The WHO CureAll Initiative. Launched in 2018, it aims for 60% survival by 2030 in low-income countries. By 2025, 56 countries had joined the initiative.
The GFAOP program in Africa. The Franco-African Pediatric Oncology Group, a network of 23 African countries, has shown that it is possible to achieve survival rates of 50-60% for certain cancers with limited resources.
Persistent Structural Obstacles
Funding is insufficient and unstable. The medical brain drain exacerbates the shortage of oncologists. Drug stockouts interrupt protocols: 60% of pediatric hospitals in low-income countries experienced at least one stockout in the preceding 12 months. Underreporting of cases makes planning difficult.
AI in Diagnosis: An Opportunity
Artificial intelligence applied to medical diagnosis could reduce certain obstacles. The organization Pathology Africa is deploying AI tools for histological analysis in 12 African countries, with an 87% concordance between AI diagnoses and those of expert pathologists for pediatric lymphomas.
What This Implies
The WHO estimates that treating a child with ALL in a low-income country costs between 2,000 and 5,000 dollars with generic drugs. Saving an additional 100,000 children per year would cost between 200 million and 500 million dollars annually — the annual budget of a medium-sized university hospital in France.
For a child born today in a low-income country, the probability of surviving pediatric cancer depends less on the biology of their cancer than on the postal code of their birth. This reality is not an inevitability.
