ECO’s Mike Morrissey: Ukraine is a priority of our lifetime in oncology

On March 7, or 11 days into Russia  invasion, Mike Morrissey, chief executive of the European Cancer Organisation, approached the society’s board to inquire as to whether they should convene a special network for Ukraine. 

“I said, ‘Look, you need to decide how you see this as a priority. Because if we go for this, we won’t be able to do some other things, but you need to tell me where you see the priority,’” Morrissey said to The Cancer Letter. “And [they] unanimously said it was the priority of their lifetimes in oncology. So, for the board, it was a no-brainer.”

In the early days of the invasion, ECO moved quickly, partnering with the American Society of Clinical Oncology, the World Health Organization, and the European Commission to share intelligence, experience, and contacts—and to dedicate time and resources into building an international coalition to help Ukrainian cancer patients.

“The last week has been really tough in seeing the pictures from Bucha, amongst other places,” he said. “I think in the conversations that I’m having, this has changed the tone of the conversation completely.”

Within two weeks into the crisis, cancer groups across Europe and the United States have joined the ECO-ASCO Special Network and pledged their services and expertise to the cause (The Cancer Letter, March 11, 2022).

To date, the network includes representatives from more than 300 organizations around the world.

“We know that, in a way, cancer is a secondary issue, right? Survival in that moment from those attacks and the injury sustained by many people in Ukraine from those attacks, if they were not fatal—that’s a massive priority to deal with those issues,” Morrissey said. “But the reality is that those of us working in the cancer community know that cancer doesn’t wait for anything.

“We went through all of this with COVID. And so, we almost have a responsibility, not to say cancer’s more important than anything else, but to say, we’ve got the knowledge, we’ve got the contacts. We, as a family, have the connections to help people who are on the move from Ukraine. And we want to, in as coordinated a fashion as we can, respond to the response to the crisis.”

The network has helped make connections for hospitals in need of supplies or equipment, provide resources to patients, and serve as an intelligence lifeline for WHO and the European Union.

“I think the WHO and the EU are better off because of the intel that we’ve been able to gather from our community and share with them, so that if there are any gaps in their knowledge—and surely there are, because they’ve been reliant on working with national health ministries—that the information we’ve gleaned from cancer centers, patient organizations, etc., [helps] them,” Morrissey said. “So, being able to share that with governmental organizations, I think has been, for the governmental organizations, meant that things have happened maybe slower than we would like, but faster than they would’ve done.”

During a crisis, cancer groups and other healthcare organizations play a significant—and speedy—role in saving lives while governments mobilize to scale up military or humanitarian interventions, Morrissey said.

“Governments are big tankers, they don’t move so fast,” he said. “On the other hand, patient organizations, individual doctors, nurses, pharmacists, individual hospitals, can move fast with individual patients. That’s where you saw the amazing work done by St. Jude’s and SIOP and Childhood Cancer International, getting kids out as early as possible—amazing work, moving fast, faster than any government machine could do, right?

“At some point in this war, those two things need to get closer together, because the governmental side needs to recognize the amazing capacity of individual doctors, hospitals, patient groups, but also it’s natural that the system needs to improve. Because we’re in this for the long haul.”

The cancer community must now start thinking about how public and private healthcare systems can ensure that Ukrainian refugees are being treated equitably, Morrissey said.

“What are the reactions going to be, longer term, when this comes down the pecking order of headlines? And how will those cancer or healthcare systems cope? And how will a level of equity between national citizens in those countries and Ukrainian refugees be managed?” he said.

“I think we have a responsibility to start thinking about how that’s going to be addressed, in parallel to dealing with the emergency.”

American oncologists, cancer groups, and cancer centers have much to offer in the Ukraine crisis, Morrissey said.

“The U.S. is a powerhouse of ideas and thought leadership and investment and innovation in cancer,” he said. “I always think that the U.S. is at its best when it’s inclusive and global and sharing the fantastic experience of your country with the rest of the world, and learning as well from experience from other parts of the world.

“We all have the same mission. We’re all about improving and saving lives. And what’s going on in Ukraine is horrific.”

A video of this conversation appears here.

Morrissey spoke with Matthew Ong, associate editor of The Cancer Letter.

Matthew Ong: Mike, thank you for speaking with me. What are you hearing from your networks in Ukraine and in Eastern Europe at the moment, and also from WHO and the Europe commission?

Michael Morrissey: I wanted to say, from the outset, Matt, what a huge learning experience this has been for the European Cancer Organization. 

And for me personally, to be trying in some small way to be helping the impact of the war in Ukraine on cancer, particularly patients from Ukraine who’ve been forced to move either to another part of Ukraine or across the border.

I think some of my reflections are—and I guess we’re a month in now— it feels like every day is different. You learn something new every day, mostly from people who are in the Ukraine and who are very generous with their time and their insights.

I think I’ve been overwhelmed by the massive response within the cancer community. We all know that the cancer community can be fragmented at times because of different passions, different experiences.

There are so many different kinds of cancer. They affect people in different ways, at different stages of their lives—and cancer touches all of us, either personally or through someone we love. That gives people working in the cancer community a certain passion for their bit of the cancer problem. Sometimes that means, sadly, that we don’t all speak with one voice.

I think that this is the first time I’ve seen the cancer community speaking with one voice in relation to the international solidarity with Ukraine and the real concern of the community to help, in any way possible, Ukraine and cancer patient refugees. I suppose that’s the first thing.

Second thing, I sense that, for oncologists in Ukraine and patient organizations in Ukraine trying to help cancer patients, the last week has been really tough in seeing the pictures from Bucha, amongst other places.

I think in the conversations that I’m having, this has changed the tone of the conversation completely, in that of course there was a real positive national spirit within Ukraine, healthcare professionals and patient groups, a real passionate defense of the country, right?

But I think people have found it unbearable to see the things in the cities around and towns around Kyiv. For people, especially [those] who work in health care, to see that done deliberately to their brothers and sisters of their own nationalities—oftentimes just minutes from where they live—is changing the level of horror in all of this.

And of course, what’s tricky about the work of the Special Network, Matt, is that, on one hand, we know that people are fleeing Ukraine, people fleeing danger in Ukraine. 

We know that in a way, cancer is a secondary issue, right? Survival in that moment from those attacks and the injury sustained by many people in Ukraine from those attacks, if they were not fatal—that’s a massive priority to deal with those issues.

And you could say, as a cancer community, “Well, people will get to cancer when we get to it, and those headline issues that we see on the news at night should be the priority.”

But the reality is that those of us working in the cancer community know that cancer doesn’t wait for anything.

We went through all of this with COVID. And so, we almost have a responsibility, not to say cancer’s more important than anything else, but to say, we’ve got the knowledge, we’ve got the contacts. We, as a family, have the connections to help people who are on the move from Ukraine. And we want to, in as coordinated a fashion as we can, respond to the response to the crisis.

So, I think on one hand, it feels like we’re doing a very small bit, right? And on the other hand, it feels like we’ve got a real responsibility to our bit.

I think the Special Network, particularly with the support of ASCO, has been fundamental in demonstrating the unity of the cancer community to try and help in small ways, whether that’s providing information in Ukrainian or other languages, for people on the move to other countries, whether it’s trying to match an offer to help with a request for help, which we’re doing a little bit of—we’re seeing communications from individuals in Ukraine trying to get help and connecting those people with people who can help. These are small things, but they’re important ones.

And I think that the other big thing—and I’m going to let you talk in a second, Matt—the other big thing, while I get this off my chest, is that in the initial response to the Ukraine war, it’s natural, the governments take time to sort themselves out, right? Governments are big tankers, they don’t move so fast.

On the other hand, patient organizations, individual doctors, nurses, pharmacists, individual hospitals, can move fast with individual patients. That’s where you saw the amazing work done by St. Jude’s and SIOP and Childhood Cancer International, getting kids out as early as possible—amazing work, moving fast, faster than any government machine could do, right?

Because of that, in the early weeks of the response, there’s sometimes a bit of a disconnect between the protocols and the processes that governments by nature have to set in place when you’re talking about moving people from one country to another. 

And you’ve got the reality on the ground that is that people talk to each other, help each other drive across borders to get people out of there, right?

That’s a very brave humankind action. At some point in this war, those two things need to get closer together, because the governmental side needs to recognize the amazing capacity of individual doctors, hospitals, patient groups, but also it’s natural that the system needs to improve. 

Because we’re in this for the long haul. This is not going to be over in a short time and we need a system to be able to cope as much as possible. So, yes, a lot of learning, I guess, is my headline of that.

MM: Well, I think that people involved in cancer care, cancer prevention and care, have a natural instinct towards equity and equality of access to treatment, access to information. I think everybody working in the cancer community has that instinct for equity.

And we know that Europe, with all of its different governments and languages and institutions, already had an equity problem, an equality problem in terms of access—and without over generalizing, somewhat of an east-west divide in access to cancer care, which was already identified by the European Union as being unacceptable.

So, the Beating Cancer Plan and the EU cancer mission are governmental pan-European devices to inject €4 billion into leveling up cancer care to ensure that somebody who suffers from cancer in Romania doesn’t have a completely different experience or life expectancy to somebody in France, right? That was there already, that problem.

Now, you’ve seen in those same countries an influx of, I don’t know how many it is, 4.5 million refugees. And some of those people know that they’ve got cancer. Some of the people don’t know they’ve got cancer. Some of those people will get cancer and that’s going to put an enormous strain on already stressed cancer systems.

And I think for your readers—the quality of your publication being what it is and the audience that I imagine reads The Cancer Letter—I think we’ve got to be responding in the short term as best we can, but we’ve got to start thinking about the medium- to long-term of this, because not all those four billion people are going to go back whenever this ends.

What are the reactions going to be, longer term, when this comes down the pecking order of headlines? And how will those cancer or healthcare systems cope? And how will a level of equity between national citizens in those countries and Ukrainian refugees be managed?

So, it’s about the scale, but also about the tone of equity around the whole thing. 

We’ve never seen anything like that scale. And I think we have a responsibility to start thinking about how that’s going to be addressed, in parallel to dealing with the emergency.

Off the top of your head, what are some of the other emerging challenges in the network’s response to the crisis? Are you seeing that existing issues are amplified by the situation as more Ukrainians are displaced?

MM: I think that in this sort of situation, you see the best of people and the worst of people. 

And the best of people, we are seeing incredible numbers of attempts to get medicines, other supplies, medical supplies into Ukraine. And that effort is really amazing, but it’s all uncoordinated in many respects and it’s the personal networks and contacts of different people trying to help.

And of course, many of the supplies that are needed in Ukraine, cancer doesn’t start at the top of the list. You’re talking about people with war injuries needing to survive. So, I think all of the acts of generosity and kindness and energy, positive energy to do something, has been amazing.

Sometimes the lack of coordination creates challenges. The worst thing would be if those challenges were pulling Ukrainian healthcare professionals away from caring for patients—I don’t think we’re at that point, but you can imagine that there’s that risk.

There’s also an increasing desire, I think, an increasing atmosphere within Ukraine, that they want their citizens to stay and where possible to be treated in the eight cancer centers that we think are still functioning pretty much the same as they were.

Increasingly from neighboring countries, you hear, ‘We don’t need extra supplies, get them to Ukraine.’ Where possible, Ukrainians treating Ukrainians in Ukraine is becoming more of a priority.

Now, that puts a huge demand on the people. In Lviv, for example, that puts huge stress on those hospitals and on the healthcare professionals working in those hospitals. 

On the other hand, there are new teams of healthcare professionals arriving from the east, Ukrainians in hospitals in the west that are now joining the team to be able to help.

So, I think all of that effort, and I think increasingly from neighboring countries, you hear, “We don’t need extra supplies, get them to Ukraine.” Where possible, Ukrainians treating Ukrainians in Ukraine is becoming more of a priority, I think, based on the conversations I have.

But also, the worst of people. We’ve seen people trying to take advantage of that situation on lists of medicines that don’t look right at all. And you would hope that nobody would do anything during a time like this for the wrong reasons, but sometimes, we have to sense-check some of the information we get, and not everybody’s an angel. 

So, that in itself, creating that extra work for people to be checking whether something’s legit, a legit request or not—that’s a distraction that people could do without.

So yes, I think that these are some of the challenges—dealing with the sheer volume of kind offers and opportunities to help, but also trying to make sure that the stuff that’s clearly wrong gets filtered out of the discussion.

The response that we’ve been getting here in the United States is that your call to action has been one that is very much needed, I would say. How you describe the response that you received, not only in Europe, but also in the U.S. over the past month?

MM: Well, I mean, we were very impacted by the initial number of requests for ECO to do something to help. 

And we were very energized and felt supported when ASCO, which of course is a much bigger organization than the ECO, wanted to help too. We quickly came up with this idea of a special network.

The special network idea came because we did something similar with COVID at ECO. We had a campaign called Time To Act, which you can see on timetoactcancer.com. We did that in 30 languages, basically getting the word out, Matt: don’t let COVID stop you from tackling cancer, because of all the stay-at-home messages, and people ignoring warning signs, missing appointments.

We did some research, a data study, which showed that a million people were walking around Europe, not knowing they had cancer because a hundred million screening tests had been delayed or canceled because of COVID.

So, we had a little bit of experience in mobilizing in multiple languages, and that experience last year taught us that if you are going to be a relevant organization in Europe, and you’re going to be passing on messages to cancer patients and their loved ones, you need to speak in their language. It’s not enough to expect people to Google translate stuff on your website, right?

So, that led both us and ASCO to invest in getting those resources up there. And the idea of Oncohelp—the website is onco-help.org, you can spell it with a K as well, because the Eastern European countries spell onco with a K. 

We did a very big, quick bit of research with Ukrainians and Eastern Europeans with onco, and help seemed to be the buzzwords that worked best rather than the word cancer, for example.

Then we are signposting to work that other people have done, but we’re trying to do it in one place, and all the work that ASCO does, we put there. We’ve done a big section on psychosocial support, because that very early on became a priority—that Ukrainian cancer patients who’ve been fleeing the war not only had to deal with cancer and the fact they were leaving their homes, they also saw some horrible stuff along the way. 

That psychosocial support, dealing with the whole thing of being in another country with cancer and witnessing all that—we are working together with ASCO on that.

And we are evolving as we go to try and address needs that are presented to us. I mean, I think you could take the view that working on a humanitarian crisis isn’t our particular USP as an organization.

But when I went to my board and talked about it—on the 7th of March, I think it was—I said, “Look, you need to decide how you see this as a priority. Because if we go for this, we won’t be able to do some other things, but you need to tell me where you see the priority.” And [they] unanimously said it was the priority of their lifetimes in oncology. So, for the board, it was a no-brainer.

What are some of the tangible examples of the impact that the special network has had in Eastern Europe and Ukraine that you can tell so far?

MM: Well, we know that individuals have been helped in different situations. We know that we’ve made connections between, for example, in Moldova, a hospital that needs a CT facilities, with somebody offering to give mobile CT facilities to that hospital. We know we’ve done some connectivity like that.

We know that visits to our website from Ukraine have shot up to a huge number. So, we know that there are people in Ukraine visiting Oncohelp. We know that people are accessing that info, which, considering it’s a new website, is quite powerful.

Oh, and I think the other thing that is important, is our advocacy work. I think the WHO and the EU are better off because of the intel that we’ve been able to gather from our community and share with them, so that if there are any gaps in their knowledge—and surely there are, because they’ve been reliant on working with national health ministries—that the information we’ve gleaned from cancer centers, patient organizations, etc., [helps] them. Our job is to make sure that they have reality checks when needed.

We’ve been doing that in as fair and transparent way as we can to make sure that—because doctors and nurses and pharmacists and patient organizations on the ground, they really know what’s going on. 

So, being able to share that with governmental organizations, has, I think, for the governmental organizations, meant that things have happened maybe slower than we would like, but faster than they would’ve done.

In closing, what do you have to say to cancer organizations and oncologists in the U.S., whether it’s about participation in ECO’s efforts in Ukraine, or whether it’s about building closer relationships, as you mentioned in the long-term, with cancer networks in Europe?

MM: It’s always been the case with cancer, but I think what’s been highlighted by COVID is that we are one global population, that there’s nothing about the Atlantic that’s so special that it stops disease from spreading; right?

And the U.S. has a huge amount to offer. The U.S. is a powerhouse of ideas and thought leadership and investment and innovation in cancer. I’ve been working in the U.S. since I was 19 years old.

And I always think that the U.S. is at its best when it’s inclusive and global and sharing the fantastic experience of our country with the rest of the world, and learning as well from experience from other parts of the world. 

That’s when I think the U.S. is at its best, particularly in the world of medicine. I used to work in cardiology—and it’s not just oncology, which is a little bit North American and European in its institutions, right?

But I think this is an example, and I think COVID was an example as well, about how shared learning and shared experience and shared intelligence data anecdotes—all of that is a vehicle to demonstrating that we are all in the same business.

We all have the same mission. We’re all about improving and saving lives. And what’s going on in Ukraine is horrific.

I think that’s most of the questions I have on the record. Did we miss anything?

MM: No, I don’t think so. Well done, Matt.

Thank you.