How Better Cancer Treatment Can Also Mean Better Nuclear Security

recent report in The Washington Post that the self-proclaimed Islamic State almost stumbled upon radioactive material in Mosul—in the form of cobalt-60, a substance used in radiation therapy—raises a profound dilemma about cancer treatment in developing countries and the risk of terrorists obtaining a key ingredient for making “dirty bombs.”

Cobalt-60 radiation machines are one of the many tools doctors have used in the treatment of cancer for the past 50 years. In North America, nearly all of these units have been replaced with more advanced technology called linear accelerators, which do not contain radioactive material and provide medically superior treatment. In developing countries, the cobalt-60 radiation machines remain prevalent. They are cost-effective and appealing in states with limited or intermittent electricity supplies and other physical infrastructure as well as a shortage of medical and technical expertise.

Iraq still has two cobalt-60 machines, according to the International Atomic Energy Agency, having already transitioned to linear accelerators for its 10 other treatment machines. But as Mosul made clear, using even one or two of these radiation machines comes with security risks. If the wrong people, such as members of the Islamic State or another terrorist group, got hold of cobalt-60, they could potentially create a dirty bomb or a radiation exposure device. With more than 70 percent of all cancer deaths now occurring in developing countries, the problem of balancing cancer treatment with security risks will only get worse.

The surest way to prevent terrorists from acquiring these materials, while not limiting people’s access to necessary cancer treatment, is to phase out cobalt-60 radiation machines and replace them with linear accelerators. The U.S. National Nuclear Security Administration, which is in charge of efforts to secure potentially dangerous radioactive material, has been supporting this approach for several years. To do so, developing countries need better technology and treatment environments, not only to support this transition away from cobalt-60 machines but to improve cancer treatment overall.

In 2015, the United Nations approved the Sustainable Development Goals, which called for reducing premature deaths from cancer and other noncommunicable diseases by one-third by 2030. A recent World Health Organization report indicated that with sufficient spending—the vast bulk of which would come from developing countries themselves—more than 4 million cancer deaths could be averted.

Addressing this problem requires the full complement of cancer care: prevention, screening, treatment and sustainable follow-up care. For radiation therapy, there is a shortage of more than 5,000 machines in developing countries around the world, along with the supporting infrastructure and personnel to operate them. Filling this gap won’t be easy, but decades of international efforts against infectious diseases, often led by nongovernmental organizations, demonstrates that, with enough leadership, countries can come together and save millions of lives.

If the wrong people, such as members of the Islamic State or another terrorist group, got hold of cobalt-60, they could potentially create a dirty bomb or a radiation exposure device.

And, thankfully, they are already starting to do so. Two years ago, the U.S. government created an Interagency Working Group on Alternatives to High-Activity Radioactive Sources to replace potentially dangerous radiation sources with alternative technology. Recently, a partnership has emerged linking government agencies—in the United States, the United Kingdom, as well as relevant United Nations and European Union bodies—with technology manufacturers, professional oncology societies and NGOs interested in nuclear nonproliferation and global cancer care.

These partners are working on a two-pronged approach: establishing the human capacity to provide the full spectrum of cancer care, while developing safe and affordable treatment machines specifically designed for challenging environments like Mosul.

Because adequate health care expertise does not exist in developing countries still using cobalt-60 technology, cancer groups, including the International Cancer Expert Corps, are building a cadre of expert mentors who will teach local community members the skills needed to deliver better care. This program builds on local investment in health care infrastructure—reaching beyond cancer, since addressing the causes of cancer also addresses other noncommunicable and infectious diseases. Personnel shortages are by no means limited to doctors, nurses and other health care professionals, but exist in all aspects of health systems.

A global cohort of leading physicists, engineers, physicians and technologists, along with industry partners, are now working to develop innovative cancer treatment technology for developing countries, along with a way to reliably deliver it. Such technology, for example, would be able to operate with less consistent electricity and cooling, and be simpler to operate and repair. Cancer specialists in these countries would also be able to take advantage of advances in telemedicine to get instant second opinions from leading cancer specialists around the world. Ultimately, the long-term goal is to make cancer care available at quality standards, regardless of a person’s location or income, while creating sustainable health care centers with local expertise and first-rate technology for the patients they treat.

To be sure, meeting this challenge will be costly—perhaps between $50 billion and $100 billion in lower-income countries, according to estimates by the Global Task Force on Radiotherapy for Cancer Control using a variety of models. Yet the lives saved and the economic benefits are worth the cost of investment. What’s more, according to the World Health Organization, 85 percent of the funding to strengthen such health care could reasonably come from the countries themselves. Only the very poorest countries, many of which today lack a single cancer treatment machine, are likely to require substantial financial help. Building anti-cancer facilities will also boost capacity to treat other illnesses, including epidemics such as Ebola.

More than money, though, what is needed is a political commitment to improve cancer treatment around the world that would address not just security concerns about radiology machines, but inequality, human suffering and global health overall. This can be done now. There’s no time to waste.

Dr. C. Norman Coleman is the senior scientific adviser to the International Cancer Expert Corps (ICEC).

Dr. Silvia Formenti is the chair of radiation oncology at Weill Cornell Medical College and a founding member of the ICEC board.

Miles Pomper is a senior fellow at the James Martin Center for Nonproliferation Studies and a member of the ICEC board.