VZCZCXYZ0008
PP RUEHWEB

DE RUEHUNV #0150/01 0971123
ZNR UUUUU ZZH
P 071123Z APR 09
FM USMISSION UNVIE VIENNA
TO RUEHC/SECSTATE WASHDC PRIORITY 9267
RHMCSUU/DEPT OF ENERGY WASHINGTON DC PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY
INFO RUEHII/VIENNA IAEA POSTS COLLECTIVE
RUEHLM/AMEMBASSY COLOMBO 0047
RUEHDR/AMEMBASSY DAR ES SALAAM 0029
RUEHHI/AMEMBASSY HANOI 0049
RUEHMU/AMEMBASSY MANAGUA 0001
RUEHYN/AMEMBASSY SANAA 0052
RUEHGV/USMISSION GENEVA 0873

UNCLAS UNVIE VIENNA 000150 
 
SIPDIS 
 
STATE FOR IO/T, ISN/MNSA, ISN/RA AND G 
 
E.O. 12958: N/A 
TAGS: ETTC KNNP MNUC PREL SOCI TRGY EAIO
SUBJECT: IAEA BUDGET: PROGRAM OF ACTION FOR CANCER THERAPY (PACT) 
HIGH PRIORITY FUNDING NEEDS 2009-2011 
 
REF: A) 08 UNVIE 539; B) 08 UNVIE 541; C) UNVIE 65 
 
-------------------------- 
Summary and Action Request 
-------------------------- 
 
¶1.  (U)  The IAEA's Program of Action for Cancer Therapy (PACT) 
expertise in radiotherapy to assist developing Member States to 
design comprehensive National Cancer Control Plans (NCCP).  PACT 
looks to the U.S. as one of its main supporters and would welcome 
USG funding or cost-free expertise during its three year planning 
cycle for 2009-2011.  To date, PACT has mobilized more than USD 22 
million applied to cancer control efforts in developing countries 
and more than 40 IAEA Member States have requested imPACT reviews, 
the first stage in PACT's assessment of cancer incidence in a 
particular country.  PACT has seven program/funding priorities 
ranging from conducting cancer-policy workshops, to providing 
equipment and creating regional cancer therapy networks.  The U.S. 
is the leading state supporter of PACT, contributing USD 300,000 in 
seed money, USD 500,000 in 2006, and over USD 365,000 in cost-free 
experts from 2004-2006. 
 
¶2.  (U) In parallel with deliberations over the IAEA 2010-2011 
regular budget, in which PACT would command enhanced but still 
modest funding,  Mission requests guidance to respond to PACT 
2009-2011 extrabudgetary funding priorities and staffing requests. 
 
----------------------- 
What has PACT achieved? 
----------------------- 
 
¶3.  (U)  For more than 30 years, the IAEA has worked with Member 
States to build diagnostic and therapeutic radiotherapy capacity. 
In 2004, responding to the World Health Organization's (WHO) call 
for action to address this issue, the IAEA established PACT with a 
mission to use the IAEA's expertise in radiotherapy to assist 
developing Member States to design comprehensive National Cancer 
Control Plans (NCCP).  NCCPs address the entire cancer spectrum, 
from prevention to palliation, maximizing public health return from 
investments in radiotherapy and technology.  PACT executes its 
mission through partnerships with the WHO, the International Agency 
for Cancer Research (IARC), International Union Against Cancer 
(UICC), International Network for Cancer Treatment and Research 
(INTCR), American Cancer Society (ACS), the American National Cancer 
Institute (NCI) and national cancer institutes in Argentina, 
Algeria, Brazil, Egypt, France, Morocco, Philippines, South Africa, 
Thailand, and the United States. 
 
¶4.  (U)  Six PACT Model Demonstration Sites (PMDS) in Albania, 
Nicaragua, Tanzania, Sri Lanka, Vietnam, Yemen, and Ghana have 
received long-term development loans from international 
organizations for cancer control after obtaining initial seed money 
from PACT.  Donor states and organizations have endorsed PACT's 
partnership approach, which seeks to maximize public-private funding 
and expertise.  To date, more than USD 22 million has been mobilized 
and applied to cancer control efforts in developing countries and 
more than 40 IAEA Member States have requested imPACT reviews, the 
first stage in PACT's assessment of cancer incidence in a country. 
(NOTE: The U.S. was the leading member state in recognizing and 
supporting PACT, contributing USD 300,000 in seed money, USD 500,000 
in 2006, and over USD 365,000 in cost-free experts from 2004-2006. 
END NOTE) 
 
------------------------------ 
Programming/Funding Priorities 
------------------------------ 
 
¶5.  (U) PACT Director Massoud Samiei recently outlined to potential 
donors countries seven projects that PACT will focus on from 
2009-2011: 
 
-- The first project, to conduct two Policy-Level Cancer Awareness 
Seminars per year, is designed to raise awareness and broaden 
understanding among policy and decision-makers of the importance of 
national cancer control strategies, the fundamental role of 
radiotherapy, and its implications for developing national policies 
and strategies. The seminars are intended to produce plans of action 
for selected countries in the regions where the seminars are held 
and to improve their capacity for cancer treatment.  The required 
funding for this project is $240,000 per annum.  For 2009 the 
seminars will be help in Africa and Asia. 
 
 
-- The second project develops Baseline Data Collection Criteria, 
Outcome Indicators and Monitoring and Evaluation Methodology for 
PACT Model Demonstration Sites (PMDS).  PMDS is ongoing in Albania, 
Nicaragua, Sri Lanka, Tanzania, Vietnam, and Yemen; under this 
project PACT would add another six countries.  PMDS projects ensure 
that countries sustainably implement appropriate cancer therapy 
programs by anchoring such programs to comprehensive national cancer 
control plans and strategies.  The main objective is to develop 
methodology, allowing PMDS initiatives to be objectively evaluated; 
a necessary first step in demonstrating success, especially to 
donors and host governments.  Because such complex interagency 
cancer control efforts have never before been measured, new and 
adequate methodologies are required.  PACT would work with the WHO 
under its joint cooperation agreement to ensure that evaluations of 
projects are conducted appropriately by medical experts.  The 
required funding for this project is $160,000 per annum.  PACT wants 
to start immediately on the field research, country visits, 
analytical work, development of materials and reporting, and 
implementation of evaluations in up to 12 countries. 
 
--  The third project for PACT's Regional Cancer Training Networks 
and establishment of a Virtual University for Cancer Control (VUCC), 
focuses on education and training of staff locally and regionally to 
advance cancer care capacity in countries.  Through its 
public-private partnerships and close collaboration with the IAEA 
Program Office for Human Health (NAHU), PACT would like to create 
regional centers of excellence (the first one would be in Africa) 
and online learning tools. Required funding is USD 700,000 over 
three years, which includes field visits by external cancer training 
and educators, reporting, development of terms of reference for the 
establishment of Regional Cancer Training Networks, definition of 
VUCC content and IT requirements, development or adaptation of 
training material for distance learning for specialists involved in 
cancer diagnosis and treatment, support for the establishment of 
national radiation oncology and nuclear medicine graduate courses in 
up to 25 locations in Africa, Asia, and Latin America, and various 
consultancies and expert assignment during implementation of the 
project. 
 
-- The fourth programming priority is to recruit a full-time Health 
Economist at the P-5 level.  This expert would provide cancer 
economic studies and cost-effective analysis for cancer treatment 
including radio therapy programs.  The PACT Program Office has 
developed a concrete plan to conduct such studies in support of PMDS 
projects currently underway in Albania, Nicaragua, Sri Lanka, 
Tanzania, and Yemen.  The required funding is USD 220,000 per annum. 
 The appointment would be for 2-3 years starting in 2009. 
 
-- The fifth programming priority is the recruitment of a Public 
Health Specialist with experience in non-communicable diseases, at 
the P-5 level.  This expert would coordinate the recently signed 
WHO-IAEA Joint Program and assist with imPACT Reviews (see para 6, 
below).  The overall objective of the WHO-IAEA Joint Program is to 
strengthen the development and implementation of comprehensive 
national cancer control programs, including development of cancer 
therapy capacity, with special emphasis on low- and middle income 
countries. The required funding is USD 220,000 per annum.  The 
appointment would be for two years starting in 2009. 
 
-- The sixth project entails the purchase of a High Dose Rate (HDR) 
brachytherapy for PMDS Sri Lanka at the General Teaching Hospital 
(Cancer Unit) in Karapitiya, Galle (southwestern province).  A 
critical short-term need for Sri Lanka is the installation of a new 
HDR machine and training of a radiotherapy technologist (RTT).  Sri 
Lanka is one of the six PACT Model Demonstration Sites and this 
effort complements past and on-going IAEA radiotherapy investments 
with critically-needed development of capacity in cancer prevention, 
early detection, registration, palliation, and civic society 
activities.  This project seeks to achieve the advancement of each 
component area of cancer control through better alignment of 
existing resource expenditure and augmentation of resources beyond 
those currently available. According to PACT, these efforts are 
especially important to Sri Lanka where cervical cancer accounts for 
20 percent of female cancers, most with advanced cases at stage III 
and above. The required funding for purchase of the machine, 
installation and safety checks, and training of one radiotherapy 
technologist and one medical physicist for three months at the Tate 
Memorial Center in India is USD 450,000. 
 
--  The seventh project is the establishment of a National Degree 
 
Program in Radiation Therapy at the PMDS in Vietnam. This project 
aims to kick-start the development of curriculum and training of 
domestic radiation oncologists and medical physicists. According to 
PACT, such an effort is critical in order to ensure that there is 
sufficient human resource capacity to effectively utilize the new 
technical equipment that will arrive in the country in the coming 
years, and is considered a high priority high-impact short term 
action. (NOTE: Australia is considering funding the training of 30 
radiation therapy professionals and Austria is considering providing 
six radiotherapy machines through bilateral programs.  END NOTE) 
The required funding is USD 200,000 per annum, with approximately 
USD 100,000 supporting the training of 15 medical professionals and 
the remainder used for degrees program development. 
 
---------------------------- 
New Partnership on the Block 
---------------------------- 
 
¶6.  (U)  The WHO-IAEA Joint Program on Cancer Control, recently 
signed by both agencies, is designed to strengthen the development 
and implementation of comprehensive national cancer control program 
(NCCPs), including the development of cancer therapy capacity, with 
special emphasis on low to middle income countries.  The Joint 
Program's main areas of partnership are: 1) developing and enhancing 
cancer registration and planning capacity; 2) strengthening support 
to countries implementing measures to prevent cancer; 3) supporting 
establishment and evaluation of early detection programs to ensure 
timely diagnosis for curable cancers; 4) increasing access to 
treatment; 5) increasing effective pain management and palliative 
care; 6) promoting research and development; 7) building national 
capacity for managing and evaluation national cancer control 
programs; and 8) mobilizing resources.  Initially, the Joint Program 
will focus on full implementation of the PMDS in Albania, Nicaragua, 
Sri Lanka, Tanzania, Yemen, and Vietnam.  Depending on resource 
availability, further demonstration sites may be developed. 
 
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COMMENT 
------- 
 
¶7.  (U) PACT continues to be one of the strongest IAEA programs that 
delivers results in an area of global human health importance.  The 
model of public-private partnerships and proactive fundraising has 
been successful, and major donors, including the U.S., continue to 
call on the Agency to embrace the approach as a model for other 
parts of its operation.  Mission recommends USG consideration of the 
PACT funding and staffing priorities for 2009-2011, specifically the 
staffing requests either on the basis of establishing a new position 
as PACT wants or as a CFE. On the project side, Mission recommends 
working with PACT to identify a new PMDS country, with possible 
on-going bilateral USG programs, which would dovetail nicely with a 
USG/PACT initiative.  We would welcome advice from USAID regarding 
countries where such complementarities with U.S. programs might be 
achieved. 
 
SCHULTE