St. Jude Global will spend $100 million to improve care for kids with cancer and catastrophic blood disorders in low to middle-income countries, including those in the midst of conflicts, said Carlos Rodriguez-Galindo, executive vice president, chair of the Department of Global Pediatric Medicine, and director of St. Jude Global at St. Jude Children’s Research Hospital.
“We understand that the success in our initiatives and the sustainability of our interventions will require a major focus on educating and growing the workforce,” Rodriguez-Galindo said. “Reducing global disparities has always been the mission of St. Jude. We see St. Jude Global as the second chapter in the history of St. Jude.
“Taking these advances to a global level is the next frontier in pediatric oncology. Can we do it? This is the ultimate challenge; one that will measure the success of our generation. We understand that this is not something that we will do in five or ten years; it will take many decades of work, commitment, and persistence.”
Rodriguez-Galindo spoke with Matthew Ong, a reporter with The Cancer Letter.
Matthew Ong: How long have you been at St. Jude, and how did you become the lead for St. Jude Global?
Carlos Rodriguez-Galindo: I am a pediatric oncologist; I trained here at St. Jude in the late 90s, and I remained on its staff as a clinician and clinical and translational investigator for another ten years. While my work and responsibilities where on those fields, I always helped with what at that time was called the International Outreach Program, which was our first attempt at reducing global disparities through a philanthropic, humanitarian approach.
In 2009 I moved to Boston, where I was the director of the Solid Tumor Program and Medical Director of the Clinical and Translational Investigations Program at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. When Dr. James Downing assumed the leadership of St. Jude, he immediately incorporated a global vision into the new strategic plan, and he recruited me back to St. Jude to help with this initiative two years ago.
When did St. Jude come up with this initiative? And how long has it been in the works before you were ready to launch it?
CRG: St. Jude has been working on international medicine since the 90s with a program that was called International Outreach Program that opened in 1993, and which had a very humanitarian and generous focus. Our model was based on twinning partnerships to build capacity and educate, to facilitate the transfer of technology, and build sustainable programs through advocacy and strengthening local fundraising mechanisms; this is a very standard model of global partnership in many specialties. Over two decades, the IOP helped build 24 programs in 17 countries, mostly in Latin America, but also in the Middle East, China and the Philippines.
Four years ago, St. Jude started a new strategic planning process after Dr. Downing took over as president and CEO. As part of this new process we asked ourselves “What should we be doing globally? What we are doing right now? Is this enough, or should we be trying to take a more comprehensive approach that would allow us to reach out to more children?”
We tried to transform our global health program in a couple of ways. First, by creating an academic department, the Department of Global Pediatric Medicine, to integrate our work within the academic fabric of the institution and build a scientifically rigorous framework to support our global health initiatives.
As a new department, we had to create the entire academic, organizational, and administrative structure, and develop a recruitment strategy to sustain growth. We wanted to transform our global presence to be more effective, more efficient, and broader in scope and reach. We now have 10 faculty members and have lines of work in implementation science, molecular epidemiology, health services and health systems research, burden estimation and simulation analysis, and cost-effectiveness.
We then created St. Jude Global, a program that comes to represent the vision of our institution in its goal to continue to advance in the care of children with cancer and life-threatening blood disorders globally. That’s what St. Jude Global means—it’s St. Jude going global. Overall, completing this process has taken about two-years.
Reducing global disparities has always been the mission of St. Jude. St. Jude was founded under the premise that no child should die in the dawn of life; there was no geographical limitation to that dream. We see St. Jude Global as the second chapter in the history of St. Jude.
Our generation has been part of the one of the most remarkable feats in medicine in the last few decades, the cure of children with cancer. Taking these advances to a global level is the next frontier in pediatric oncology. Can we do it? This is the ultimate challenge; one that will measure the success of our generation. We understand that this is not something that we will do in five or ten years; it will take many decades of work, commitment, and persistence.
What is the budget for St. Jude Global? Is $100 million only the tip of the iceberg, and do you anticipate that amount growing over the years?
CRG: Yes, definitely. I would not like to focus on $100 million; this is just the figure we have estimated to fulfill the objectives set forth by the strategic plan through 2021. We have already invested a significant amount to support programs over the last two decades, and we expect to increase significantly our financial commitment beyond the current strategic plan period.
Our approach has always been to work with the public systems to grow and strengthen the existing structures and processes at the regional, national, and program levels. We are now working on six regional programs: Mexico, Central and South America, Eastern Mediterranean, Southeast Asia and China. And we have set the base for two new regional initiatives in Eurasia and Sub-Saharan Africa. These regional initiatives are integrated within St. Jude Global’s operational structure, the St. Jude Global Alliance.
There is an increasing interest in global oncology, and many academic centers, including NCIdesignated cancer centers are involved in the development of global initiatives. And more importantly, in many cases these initiatives are being incorporated into the programmatic goals of those institutions, which brings more rigorous, long-term, and sustainable interventions.
In our capacity-building programs, we try to encompass the entire continuum of care, from strengthening health systems to training and growing the work force, and improving the quality and reach of the care delivered. Since March this year we are a WHO Collaborating Centre for Childhood Cancer, and we are looking forward to synergizing our efforts with PAHO and WHO.
We understand that the success in our initiatives and the sustainability of our interventions will require a major focus on educating and growing the workforce. Toward that end we have created the St. Jude Global Academy, a comprehensive educational initiative that will include certificate and competency-based training at St. Jude, fellowship training programs in the different regions, a robust distance learning platform, and a Master in Global Child Health degree, the St. Jude Global Scholars Program, in collaboration with the St. Jude Graduate School of Biomedical Sciences.
We are particularly excited with this graduate program; we hope to recruit 10 to 20 promising young health care providers from all over the world to complete the masters degree, which will provide them with the transformative training and leadership skills that are so necessary to implement and sustain change.
Together with capacity-building and education, we will be placing a significant emphasis on research. We understand that it is only through a judicious integration of the research principles that we will able to advance and generate the knowledge for continued and sustained growth.
As we discussed earlier, the Department of Global Pediatric Medicine will host a cadre of research faculty that will focus on global health science. Research will be implemented gradually at all sites, under the leadership and with the mentorship of St. Jude faculty, and local and regional research capacity will be built through the St. Jude Global Scholars program and the St. Jude Global Academy.
The regional networks described above will grow to adopt consortium-like functionality to support research. These regional networks will be provided with a solid clinical research infrastructure, including a global research database, support personnel, and training, for the development of regional clinical research studies and implementation science.
We have prioritized the creation of a global clinical research support unit and we are in the process of defining the operating procedures to regulate and oversee the research operations and the scientific quality of the initiatives proposed by the members of the Department of Global Pediatric Medicine and St. Jude Global Alliance.
As you see, these three main pillars, capacity-building, education, and research, will require major investments in the future and a long term institutional commitment for many more years; the $100M figure is probably the tip of the iceberg, as you say. But we also invest time and resources to train local foundations in resource mobilization and advocacy in collaboration with the American Lebanese Syrian Associated Charities, our foundation; this is a critical component of our model to work towards building sustainable programs.
You might’ve addressed this, but to be sure, St. Jude Global is a strictly philanthropic initiative, right? There’s no business model?
CRG: No, there is no business model associated with that in the sense of generating profit for our institution; this would be against our mission. St. Jude Global is an entirely philanthropic effort integrated within the strategic plan of St. Jude, consistent with our vision, and in fulfillment of our mission.
What are your primary goals for St. Jude Global? Can you briefly describe how you will improve care and access to care for up to 30 percent of children around the world?
CRG: The vision of St. Jude Global is that all children with cancer or catastrophic blood disorders will have access to quality care. And as we discussed, our overarching goals are to train the clinical workforce required to meet the vision, to develop and strengthen health systems- and patient-centered initiatives that encompass the entire continuum of care required for children with cancer and blood disorders, and to advance knowledge in global pediatric oncology and hematology through research. We hope that the operational structure, with initiatives at regional, national, and program-levels will facilitate the fulfillment of those goals and increase our reach exponentially.
Is part of the budget going to a peer-reviewed research grant process or is all of it going straight into policy work, practitioner training, education, direct care and other clinical efforts?
CRG: Most of the funding will be dedicated to the support of the program and the capacity-building and educational initiatives, and the research infrastructure described earlier; however, new programs and initiatives will be constantly developed within the St. Jude Global Alliance. While we are not a granting institution, all these new initiatives will go through a rigorous review process.
You mentioned 17 countries at some point—have the number of countries you’re working with grown since then?
CRG: Yes, our reach has grown significantly. We started with 17 countries two years ago; these are the countries with which we had agreements through our International Outreach Program. With our new structure and model, we have already more than doubled the number of countries with which we are currently working, and we hope to continue to expand our reach.
Would you be able to accommodate more countries if, say, every other nation that isn’t already part of your program reached out tomorrow and said, “I’d love to partner with you”?
CRG: I hope yes, but not immediately. The plan is that the St. Jude Global Alliance will develop the structure and mechanisms to grow and facilitate the incorporation of new programs and new country structures. Also, our work with PAHO and WHO will increase our capacity, and we are hoping to join efforts with other institutions and organizations and maximize the impact.
You talked about agreements and letters of intent—are government health agencies in other countries involved?
CRG: Yes; we work with public entities; all our agreements and relationships are with government hospitals, public administrations, and academic institutions.
Will your international partners and their networks be committing resources to this initiative? Or is it all over the board, depending on who can give what?
CRG: Each case is different. We work in partnership with local institutions and foundations, and we develop the strategies and plans for resource allocation together. The key issue is how to build sustainable programs; it takes time, and we understand that we are in for the long run. We work with local foundations to strengthen their capacity for resource mobilization and advocacy, and try to develop cost-effective analyses of different interventions to help hospital administrators allocate resources more wisely.
Do you know of anyone else with a similar plan?
CRG: There is an increasing interest in global oncology, and many academic centers, including NCI-designated cancer centers are involved in the development of global initiatives. And more importantly, in many cases these initiatives are being incorporated into the programmatic goals of those institutions, which brings more rigorous, long-term, and sustainable interventions. Also, the WHO Cancer Resolution of May 2017 is a call to address the global burden of cancer that initiates the dialogue at many levels in our cancer research community.
It sounds like St. Jude Global is poised to become, if it isn’t already, the most comprehensive program in global pediatric oncology coming from the U.S.; right? What can you do that others cannot?
CRG: We have a 20-year history in global pediatric oncology, and with St. Jude Global we just want to create a more comprehensive and expansive initiative that can reach out to more children. I think that what makes the difference with other programs is that addressing the global burden of pediatric cancer is part of St. Jude’s mission; this makes a big difference.
It starts with Jim Downing, who has prioritized the development of an institution-wide initiative to address the global disparities in childhood cancer; this has expanded St. Jude’s vision and created the basis for building the most comprehensive program to address the global burden of pediatric cancer.
Do you foresee this initiative continuing indefinitely, even after you reach most of your goals?
CRG: Through St. Jude Global, we are taking on the ultimate challenge of tackling childhood cancer and other life-threatening diseases at a new level, and by incorporating this initiative into the institution’s strategic goals we declare a long-term commitment. We know that it may take 20, 30, 40 years, or probably more, to achieve most of our goals, but we are ready to take on this challenge. This may very well define St. Jude’s legacy.
Decades from now, what do you think will be the single most tangible outcome or improvement in health care for children worldwide as a result of your work?
CRG: I hope that through building alliances and joining forces with other institutions and global agencies and organizations, the next generations will see a major reduction in the global disparities in access to quality care for children with cancer, and that at some point, someday, all children with cancer in the world will have the same chances for cure, wherever they are. This is the challenge, and we will not stop until we conquer it.
