Refurbished MRI/CT Scanners and the Global Fight Against Cancer
Many of the world’s poorest nations are making great strides in the fight against infectious disease. Between 2010 and 2017, malaria deaths fell by 28%, a cause for celebration particularly in Africa, where 93% of deaths from this disease occur. However, rising life expectancies and the successful fight against infectious disease mean that in even the poorest countries, people are living long enough to develop cancers, a set of diseases often associated with middle and old age.
This makes their public health challenges similar to those faced in economically advanced countries like the United States, where cancer is the second-leading cause of death. But unlike the United States, developing countries in Africa, Asia, and Latin America lack the comprehensive medical infrastructure needed to diagnose, treat and prevent cancer. Traditionally, their limited healthcare systems have focused on acute illness and HIV, but with cancer rates increasing, these systems have not kept up.
This slow adaptation has had a tragic consequence: Many cancer patients face deaths that would have been preventable if the patients had earlier and better access to diagnostic imaging. Research published in The Lancet found that in some low- and middle-income countries, scaling up imaging to fight shortfalls could prevent up to 2.46 million deaths.
That will not be an easy task. New MRI and CT scanners can cost more than $1 million each, a prohibitive barrier to entry even for clinics in wealthy countries. But no imaging center is complete without these machines: Without these tools, doctors struggle to identify cancers, find signs that it has spread in the body, and plan effective treatments.
Despite their importance, countries like Nigeria and Ghana have only 0.30 and 0.48 MRIs per million residents, respectively (in contrast to 51.67 units per million in Japan and 38.96 units per million in the United States). The entire northern region of Ghana lacks a single CT Scanner, with patients having to be referred to the country’s capital of Accra or Kumasi for diagnosis. And few can make the journey due to poverty.
Inequalities in access are just as stark within the developing world. For instance, two-thirds of all MRI machines in West Africa are located in Nigeria, and five countries in the region, including Liberia and Niger, had no units at all.
Equipment shortages are not the only challenge; these healthcare systems must also contend with the persistent problem of ‘brain drain.’ Trained imaging personnel from the poorest regions tend to pursue opportunities in high-income countries with a more developed medical infrastructure, as well as large cities in their own region. This creates a self-perpetuating cycle where imaging specialists in underserved regions leave because there are no clinics, and no new clinics are established, in part because there is a lack of personnel to staff them.
This brain drain will not stop until there is a more robust medical infrastructure in these regions, offering imaging professionals the opportunities they need to build careers there. Developing this infrastructure cannot happen overnight, particularly in countries that are effectively starting from scratch—such as Guinea and Burkina Faso, which only had one MRI unit each as of 2018, and Benin, Mali, and Sierra Leone, which had none. As helpful as they may be in stanching deaths in the short term, one-time donations and pop-up clinics are not enough to fill these countries’ unmet need for high-quality imaging in the long term.
Fortunately, there is a large supply of used MRI and CT scanners emerging from facilities in wealthier countries. These machines are built to be highly durable, and they have many years left in their useful lives, which can be further extended through skilled refurbishment. By selling their fully functional equipment, facilities in wealthier countries subsidize the cost of upgrading their clinics while keeping the machinery out of landfills, and those in developing countries have access to like-new equipment that would otherwise be out of their budgets. Given the large supply of refurbished equipment available, it is clear that these machines will play a critical role in the battle to prevent cancer deaths worldwide.